Абстракт

Objectives: To present a hormone-informed, pathophysiology-based thread lifting strategy for the treatment of postmenopausal structural facial aging, with emphasis on patient selection, vector planning, and tissue-adapted technique to achieve predictable and durable outcomes. Introduction: Postmenopausal facial aging represents a distinct structural phenotype driven primarily by estrogen deprivation rather than chronological aging. Rapid collagen loss, elastin degradation, fascial weakening, and descent of fat compartments result in horizontal tissue tiering and progressive facial ptosis. Conventional aesthetic approaches often fail to address these deep structural changes. The author proposes a hormone-informed, pathophysiology-based thread lifting technique using advanced PCL/PLA threads enriched with hyaluronic acid, aimed at restoring facial structure and tissue competence Materials / method: A structured clinical protocol was applied based on systematic evaluation of skin quality, ptosis pattern, tissue mobility, and prior biostimulation history. Treatment was performed using barbed and smooth PCL/PLA threads placed with a personalized multi-vector, dual-layer technique. Deep-plane threads were used for structural repositioning, while superficial threads supported dermal redensification. Vector planning and anchorage were adapted to estrogen-depleted tissue behavior and illustrated through representative clinical cases. Results: The combined mechanical and biostimulatory approach produced immediate improvement in facial contour, followed by progressive enhancement of tissue firmness and cohesion. Sustained hyaluronic acid release supported fibroblast activation and collagen remodeling. Clinically, patients showed improved midface support, jawline definition, and reduction of jowls and marionette lines. Outcomes were stable and natural at 12-month follow-up, including in cases with heavy or estrogen-depleted tissues when appropriate anchorage and thread numbers were applied. Conclusion: Postmenopausal facial aging is a hormone-driven structural condition that requires a shift from surface-oriented aesthetic correction to biologically informed intervention. A hormone-informed thread lifting technique using PCL/PLA threads enriched with hyaluronic acid allows restoration of facial architecture while respecting tissue behavior. When applied with appropriate patient selection, vector planning, and controlled tension, this approach provides predictable, durable, and natural outcomes in estrogen-depleted facial tissues.