The synergistic effect of combining botulinum toxin with polydioxanone threads on the upper face static wrinkles.

With aging, facial lines on the forehead and glabella are sometimes converted from dynamic to static giving an aged appearance. Polydioxanone sutures are popular now as a management option in correcting deep static wrinkles on the upper face .This work was conducted to assess the synergistic efficacy of combining Botulinum toxin injection with Polydioxanone threads on the upper face static wrinkles. 30 adult patients with static wrinkles on forehead were included in this work. They were randomly distributed to one of two groups; threads insertion either alone or with Botulinum toxin injection. Treatment efficacy was evaluated after 2 months by using a Global Aesthetic Improvement Scale. Our results displayed a statistically significant improvement in forehead wrinkles in group II compared to group I (P=0.001). There was a trend toward improvement that did not reach significance in glabellar wrinkles in group II compared to group I, but this improvement did not reach the statistical significant level (P<0.112). Absorbable polydioxanone threads can be considered as a third line procedure for wrinkle correction beyond Botulinum toxin and soft tissue fillers. Threads alone don't fit all situations but their combination with Botulinum toxin can give a better natural-looking appearance with more patient satisfaction.