A Gentler Thread Lift, Built on Cogs Instead of Barbs

Facial thread lifting with FDA-cleared absorbable PDO sutures, placed by Dr. Ellen Turner using Dr. Mariano Busso’s technique at our Dallas and Irving dermatology offices.

INTRODUCTION

Not Every Thread Lift Is the Same Procedure

PDO threads are ultra-fine dissolvable sutures made of polydioxanone, a biocompatible material used in surgery for decades. Placed beneath the skin, they provide a mechanical lift while stimulating your body’s own collagen as the thread gradually absorbs. That much is true of every PDO thread on the market.

What separates one thread lift from another is how the thread grips the tissue. Most traditional PDO threads use barbs that are cut into the suture. Cutting removes material, which weakens the thread and allows it to drag against the tissue it is meant to hold. The threads Dr. Ellen Turner uses are different: their cogs are molded into the thread rather than cut from it, so tensile strength is preserved and the tissue is engaged without being torn.

Dr. Turner places them using the specific technique developed by Dr. Mariano Busso, a board-certified dermatologist in Miami widely recognized as a pioneer of thread lifting in the United States. Rather than a needle, the thread is delivered through a blunt 18-gauge cannula, which is gentler on vessels and nerves. She performs this on the face only, where the technique is most precise and where the results have been most consistent in her hands.

Key Facts

  • ✓Polydioxanone (PDO), FDA-cleared as an absorbable surgical suture
  • ✓Molded cogs, not cut barbs, so the thread holds without tearing tissue
  • ✓Delivered through a blunt 18-gauge cannula rather than a sharp needle
  • ✓Performed on the face only, where the technique is most precise

12-18 mo

Commonly reported duration of result

18G

Blunt cannula, no sharp needle

FROM DR. TURNER

Why I Waited Years to Offer Thread Lifting

My work with thread lifting began with Silhouette InstaLift®. I watched a couple of cases, and when my own first two patients were scheduled, the physician who was meant to teach me backed out at the last minute. I went ahead on my own. That first patient was such a success that the manufacturer still uses those images nationwide as an example of what an InstaLift result should look like. In 2020 I was named a Silhouette InstaLift® Center of Excellence and trainer, and I served as a trainer for Allergan as well, where I now hold the title of trainer emeritus.

For years I deliberately did not offer PDO threads. I had three reasons. The barbs concerned me, because cutting barbs into a suture weakens it and drags on the tissue it is supposed to support. The longevity was not competitive, typically around six months. And the learning curve was steep. I once heard a physician lecturing on PDO threads say it usually takes about ten patients before you become good at the procedure.

“What happens to the first nine?”

Dr. Ellen Turner

That question is why I stayed away. I am not willing to learn a procedure on the people who trust me with their faces.

What changed my mind was Dr. Busso’s technique and the specific threads it uses. These do not have barbs. They have cogs, molded into the thread, gentle on the tissue and far less likely to tear it. The placement method he teaches produces a result that lasts closer to a year to eighteen months rather than the six months I had come to expect. I am doing more and more of these, with results I am genuinely proud of.

PATIENT RESULTS

Real Results from Dr. Turner’s Dallas and Irving Patients

Every case shown here was treated by Dr. Ellen Turner at our Dallas and Irving dermatology offices. Individual results may vary.

BussoLyft cog thread facial lift before, Dr. Ellen Turner Dallas patientBefore
BussoLyft cog thread facial lift after, Dr. Ellen Turner Dallas patientAfter

BussoLyft® Cog Thread Lift

BussoLyft cog thread lift before, male patient of Dr. Ellen Turner in DallasBefore
BussoLyft cog thread lift after, male patient of Dr. Ellen Turner in DallasAfter

BussoLyft® Cog Thread Lift

BussoLyft cog thread facial lift before, Dr. Ellen Turner Irving patientBefore
BussoLyft cog thread facial lift after, Dr. Ellen Turner Irving patientAfter

BussoLyft® Cog Thread Lift

BussoLyft cog thread lift before, male patient of Dr. Ellen Turner in DallasBefore
BussoLyft cog thread lift after, male patient of Dr. Ellen Turner in DallasAfter

BussoLyft® Cog Thread Lift

THE DIFFERENCE THAT MATTERS

Cut Barbs vs. Molded Cogs

Both designs anchor a thread in tissue. How they are manufactured changes how the thread performs, how gently it behaves, and how long the lift holds.

Cut barb versus molded cog thread diagram showing reduced core diameter and tissue tearing compared with intact core and gentle tissue engagement
Traditional ApproachCut BarbsBarbs are cut into the body of the suture. Removing material reduces the thread’s tensile strength at exactly the points under load, and the cut edges drag against tissue during placement and with normal facial movement. This is the design Dr. Turner chose not to offer, and it is associated with the shorter durations, typically around six months, that gave thread lifting a mixed reputation.
Dr. Turner’s ApproachMolded CogsCogs are formed into the thread during manufacture rather than cut away from it, so the suture keeps its strength where it grips. The result is a broader, gentler engagement with the tissue that holds without tearing. Combined with Dr. Busso’s placement method and a blunt cannula, this is what allows the lift to hold closer to twelve to eighteen months.

TREATMENT AREAS

Focused on the Face

Dr. Turner performs cog thread lifting on the face, where the technique is most precise. She maps your entry points and vectors of lift during a consultation at our Dallas or Irving office.

Midface & CheeksThe central focus of the BussoLyft® technique. Cogs engage and reposition the superficial fat pads of the cheek that descend with age, restoring the contour rather than simply tightening the surface.
Jawline & JowlsSoftening of early jowling and definition along the jaw, achieved by lifting tissue upward and back rather than pulling skin taut.
Nasolabial FoldsBecause the fold deepens largely as cheek tissue descends, repositioning the midface often softens it at the source instead of filling it from below.
Marionette LinesLines running from the corners of the mouth downward respond to the same upward repositioning that addresses the jowl, treated together as one vector.
Brow & TempleA gentle lift and support of the brow for a more open, rested appearance, without the incisions of a surgical brow lift.
Combination with FillerThreads restore position, fillers restore volume. Dr. Turner frequently combines the two, and published studies document mid-face improvement from combination treatment assessed out to 24 months.

THE TECHNIQUE

What Is the BussoLyft®?

The BussoLyft® is a trademarked cog thread technique developed by Dr. Mariano Busso, a board-certified dermatologist in Miami recognized as a pioneer of thread lifting in the United States. Rather than tightening skin, it uses a specific placement pattern to lift and reposition the superficial fat pads of the face that descend with age and gravity, helping restore natural contour through the cheeks and jawline.

The threads are delivered through blunt 18-gauge cannulas, which pass between vessels and nerves rather than through them. As with all PDO threads, the material stimulates your own collagen as it absorbs, and the technique combines readily with dermal filler for a more complete result.

01Fat Pad RepositioningLifts the superficial facial fat pads that descend with age, addressing the cause of the change rather than tightening skin over it.
02Cogs, Not BarbsMolded cogs engage tissue broadly and gently, preserving thread strength and avoiding the tearing associated with cut barbs.
03Blunt Cannula DeliveryAn 18-gauge cannula navigates around vessels and nerves instead of piercing them, which supports a gentler placement and recovery.

TREATMENT JOURNEY

What to Expect at Your Appointment in Dallas or Irving

Dr. Turner performs cog thread lifting as an in-office procedure at our Dallas and Irving locations. Most appointments take about 30 to 60 minutes.

Step 1 – Consultation at Our Dallas or Irving Office▾
  • ✓Dr. Turner reviews your goals, facial anatomy, and where tissue has descended
  • ✓She determines whether cog threads, filler, or a combination best fits your goals
  • ✓The number of threads, the vectors of lift, and realistic outcomes are fully discussed
  • ✓Candidacy is confirmed and photographs are taken for your records
Step 2 – Mapping & Comfort▾
  • ✓The face is cleansed and marked with the entry points and lift vectors for your plan
  • ✓A local anesthetic numbs each entry point for comfort
  • ✓Placement follows Dr. Busso’s mapped pattern rather than a freehand approach
Step 3 – Cannula Placement▾
  • ✓Each thread is introduced through a blunt 18-gauge cannula in the subcutaneous plane
  • ✓The blunt tip navigates around vessels and nerves rather than piercing through them
  • ✓Cogs engage the tissue and the thread is drawn to create the planned lift
  • ✓Excess thread is trimmed at the entry point, leaving no visible suture
Step 4 – Aftercare & What Happens Next▾
  • ✓Mild swelling, bruising, or tenderness at entry points is common and typically resolves within one to two weeks
  • ✓Avoid strenuous exercise and exaggerated facial movement for the first one to two weeks, as advised
  • ✓Sleep with your head elevated for the first few nights
  • ✓Follow all aftercare instructions and schedule your follow-up as recommended

In a 2026 meta-analysis of 26 studies and more than 2,800 thread lift patients, the most commonly reported effects were swelling and bruising, both temporary. Less common issues included a visible or palpable thread and skin dimpling. Dr. Turner reviews all risks with you before treatment.

THE SCIENCE

How a Dissolvable Suture Delivers Lift Today and Collagen Tomorrow

Cog threads work through two complementary mechanisms, an immediate mechanical effect and a longer-term biological response.

How a PDO cog thread works, from immediate tissue engagement to collagen renewal

01

Immediate Repositioning

The molded cogs engage the surrounding tissue the moment the thread is drawn, lifting descended fat pads back toward their original position. Most patients notice the change right away.

02

Healing Response

As a biocompatible material, PDO triggers a mild, controlled healing response in the tissue surrounding each thread.

03

Collagen Renewal

This response activates fibroblasts, the cells that produce collagen. The thread itself absorbs by hydrolysis over roughly 4 to 6 months, leaving behind a framework of your own newly built collagen.

The Evidence

✓PDO threads are FDA-cleared as an absorbable surgical suture, Class II, under 21 CFR 878.4840

✓Thread material absorbs by hydrolysis over approximately 4 to 6 months, while the lift is reported to persist substantially longer

✓Peer-reviewed studies document collagen production and tissue contraction following PDO thread placement

✓Molded anchor designs are reported to preserve suture tensile strength compared with cut barb designs

✓A 2026 meta-analysis of 2,827 patients found thread lifting generally safe, with swelling and bruising most common

✓Combination studies of threads with dermal filler report mid-face improvement assessed out to 24 months

PLACEMENT TECHNIQUE

How Dr. Turner Places Cog Threads with Precision

Entry points and thread paths are mapped to your anatomy before anything is placed. A blunt 18-gauge cannula then carries each thread through the subcutaneous plane, engaging the fat pads that have descended.

Cog thread placement technique diagram showing entry point, thread path, and trim point

HOW IT COMPARES

Three Approaches to Non-Surgical Lifting

Dr. Turner offers both cog thread lifting and Silhouette InstaLift®. Traditional barbed PDO threads are shown for context, since they are what most patients have read about.

Traditional Barbed PDO BussoLyft® Cog Technique Silhouette InstaLift®
Material Polydioxanone (PDO) Polydioxanone (PDO) Poly(glycolide/L-lactide)
Tissue Anchor Barbs cut into the suture Cogs molded into the suture Bidirectional cones
Placement Instrument Sharp needle or cannula Blunt 18-gauge cannula Needle
FDA Status Cleared as an absorbable suture Cleared as an absorbable suture Cleared for mid-face suspension
Reported Duration Approximately 6 months Approximately 12 to 18 months 18 to 36 months in clinical studies
Offered by Dr. Turner No, by choice Yes, face only Yes

Dr. Turner does not offer traditional barbed PDO threads, a decision she made deliberately and explains above. Between the cog technique and Silhouette InstaLift®, both remain available, and she reaches for cog threads increasingly often for facial lifting. Your consultation determines which is the better fit, and for many patients the answer includes dermal filler alongside either one.

WHY THIS TECHNIQUE

A Gentler Lift That Holds Longer

Cogs

Molded into the thread rather than cut from it, engaging tissue without tearing it.

12-18 mo

Commonly reported duration, roughly double what traditional barbed PDO delivers.

Face

Deliberately focused where the technique is most precise, rather than offered everywhere.

Cog thread lifting is one of several options Dr. Turner offers, alongside Silhouette InstaLift®, Sculptra®, and Radiesse®. During your consultation she will recommend the most appropriate option, or combination, for your goals.

PATIENT QUESTIONS

Frequently Asked Questions

What is the BussoLyft® technique?▾
It is a trademarked cog thread technique developed by Dr. Mariano Busso, a board-certified dermatologist in Miami. It uses PDO threads with molded cogs, delivered through blunt 18-gauge cannulas in a specific mapped pattern designed to lift the superficial facial fat pads that descend with age, rather than tightening skin alone.
What is the difference between cogs and barbs?▾
Barbs are cut into the suture, which removes material and weakens the thread at the points bearing the most load. The cut edges also drag against the tissue they are meant to hold. Cogs are molded into the thread during manufacture, so the suture keeps its strength and engages tissue more broadly and gently. This distinction is the reason Dr. Turner declined to offer thread lifting for years and the reason she offers it now.
Are PDO threads FDA-approved?▾
PDO thread material is FDA-cleared as an absorbable surgical suture, the same broad category used in many types of surgery for decades. That clearance covers the suture material itself, not a specific approval for cosmetic facial lifting. Thread lifting with PDO is a well-established technique documented in peer-reviewed aesthetic literature, and Dr. Turner believes in being precise about what regulatory clearance does and does not cover.
How is this different from Silhouette InstaLift®?▾
They use different materials and different anchoring designs. Silhouette InstaLift® uses a poly(glycolide/L-lactide) thread with bidirectional cones and is FDA-cleared specifically for mid-face suspension, with clinical studies reporting 18 to 36 months. The BussoLyft® uses PDO with molded cogs placed through a blunt cannula, with results commonly reported at 12 to 18 months. Dr. Turner offers both and increasingly reaches for the cog technique for facial lifting. Your consultation determines which suits your anatomy and goals.
How long do results last?▾
Results are commonly reported to last about 12 to 18 months, considerably longer than the roughly six months associated with traditional barbed PDO threads. The thread itself absorbs over about 4 to 6 months, but the collagen your body builds around it remains after the thread is gone.
Does the procedure hurt?▾
Discomfort is generally mild. Each entry point is numbed with a local anesthetic, and because the threads are delivered through a blunt cannula rather than a sharp needle, most patients describe the sensation as pressure or gentle pulling.
What is the downtime?▾
Minimal, but not none. Mild swelling, bruising, or tenderness at entry points is common and typically resolves within one to two weeks. Dr. Turner will ask you to avoid strenuous exercise and exaggerated facial movement during that period, and to sleep with your head elevated for the first few nights.
What are the risks?▾
The most common effects are temporary swelling, bruising, and tenderness. A 2026 meta-analysis of more than 2,800 thread lift patients confirmed these as the most frequent. Less common risks include infection, a visible or palpable thread, skin dimpling, and asymmetry, which is precisely why the experience of the physician placing them matters. Dr. Turner reviews your full medical history and all risks before treatment.
Can this be combined with filler?▾
Frequently, yes. Threads restore position and fillers restore volume, and the two address different aspects of facial aging. Combination treatment of threads with dermal filler for mid-face rejuvenation is documented in the clinical literature with improvement assessed out to 24 months.
How much does it cost in Dallas?▾
Cost depends on the number of threads and the areas treated. Because every plan is mapped to your individual anatomy, pricing is best discussed at your consultation, when Dr. Turner can assess your goals and provide a precise quote. Call our Dallas or Irving office at (214) 373-7546 to arrange one.

COSMETIC DERMATOLOGY | DALLAS & IRVING

See What a Gentler Thread Lift Can Do

Lift, reposition, and rebuild collagen without surgery, with expert care from Dr. Ellen Turner, serving Dallas, Irving, and the surrounding communities.