Reverse Knot Technique for Face Lifting With Polydioxanone Thread

BACKGROUND: The use of polydioxanone thread has grown substantially for facial soft-tissue repositioning and collagen biostimulation, with a well-established safety profile and favorable tissue integration. AIMS: To describe the reverse knot technique, a novel method for the implantation of polydioxanone suspension threads. PATIENTS/METHODS: We present an original polydioxanone thread-lifting technique designed primarily for patients with a "heavy face." The reverse knot technique positions the knot in the anterior portion of the face, below the zygomatic cutaneous ligament, whereas anchoring the distal end of the thread in the temporal fascia, creating a lever mechanism that enhances lifting of the middle and lower thirds of the face. CONCLUSIONS: The technique provides immediate and effective midface soft-tissue support, representing a minimally invasive alternative for face lifting and resulting in high patient satisfaction and minimal morbidity. The procedure should be performed by professionals experienced in thread lifting, as positioning the knot in the medial portion of the face increases support but also raises the risk of localized depressions at the knot site.