As we age, our skin naturally loses its firmness due to dwindling collagen and elastin production. Because of this, fine lines, wrinkles, and facial folds begin to form. And, living in a world obsessed with beauty (especially now in the age of Instagram and TikTok), it can be easy to look in the mirror and wish your face was a bit more lifted. While there’s absolutely nothing wrong with aging, there’s also nothing wrong with wanting to do something about it. And that’s precisely why facial cosmetic treatments like threading facelifts are on the rise. Unlike Botox and fillers, thread lifts aren’t as universally discussed, so we chatted with a few plastic surgeons for everything there is to know about the trendy treatment—including benefits and risks.
What Is a Threading Facelift?
Threading facelifts (aka thread lifts) are facelifts that utilize threads to promote lifting. “Thread lifts are minimally invasive, resorbable suspension sutures with bi-directional cones,” explains board-certified plastic surgeon Julius Few, who is a world leader in aesthetic plastic surgery and pioneer in minimally invasive aesthetics. “The sutures lift and reposition subdermal tissue while the bi-directional cones hold the suture and facial skin in an elevated position.” According to Few, both the suture and cone material are made with glycolide/L-lactide (PLGA), which stimulates fibroblasts for gradual collagen maturation over time. “They are designed to reposition volume in the mid-face with a goal of a natural-looking result,” he adds.
Do Threading Face Lifts Hurt?
Given threading face lifts literally thread sutures through the skin, you might assume that they’re incredibly painful. However, according to NYC-based board-certified plastic surgeon Dr. David Shafer, threads are usually placed using local anesthesia, so patients typically don’t feel much at all.
“Tiny needles (similar in size to Botox needles) are used to inject numbing medication, which numbs the surrounding skin,” he explains. “That said, the threads themselves generally don’t hurt but there is some poking with needles to inject the numbing medication—similar to any procedure which uses local anesthesia.”
Benefits of a Threading Facelift
- Instant lifted results
- Boosts the body’s natural production of collagen
- More affordable than invasive facelifts
- Relatively painless
“A threading facelift provides an immediate facelift effect as well as a regenerative effect for progressive and natural results,” Few says. “A huge part of the patient appeal is that the outcome is immediate, with results getting better over time. Data from Aesthetic Surgery Journal and The Journal of Drugs in Dermatology (JDD) found that patients are highly satisfied with thread lifting outcomes (Silhouette InstaLift).”
What’s more, Few points out that studies show that thread lifts boost the body’s production of natural collagen, which may account for the long-lasting improvements in skin quality.
Of course, with benefits come downsides, too. Namely, how long the results last. “The downside of threading facelifts is the longevity of the results and that threads can’t accomplish what a surgical facelift can in terms of tissue distribution, removal of excess skin, and the degree of results,” Shafer says. “Threads are also static, meaning they don’t stretch or accommodate the natural animation or movements of the face.”
Additionally, threading is a controversial procedure among many surgeons. According to Dr. Dara Liotta, a board-certified dermatologist and Byrdie review board member, many experts believe that threading may cause scarring, dimpling, and visible irregularities in the long run. “It can make facelifting surgery more difficult later on,” she says. With all medical procedures, it’s best to consult with your doctor to see if threading is right for you.
The Best Candidate for a Threading Facelift
According to Shafer, the best candidate for a threading facelift is someone with moderately loose skin who is looking for a short-term pick-me-up. Few adds on to this, noting that the ideal candidate is a man or woman, typically 35 years or older, who hopes to lift the mid or lower third of their face.
Facial plastic surgeon Dr. Sarmela Sunder has another take. “The best candidates for thread lifts are patients who are just starting to notice some collagen loss and would like to boost the structure of their skin,” she says. “It is ideal for patients who are starting to feel as if the skin is starting to lose some of its tautness, not for people who actually have skin that is visibly sagging.”
How to Prepare for a Threading Facelift
Considering threading face lifts are a minimally invasive cosmetic procedure (despite literally threading sutures through the skin), prep is quite approachable and the same as what you would expect for any injectable treatment.
“Refrain from taking any type of blood thinners, supplements, blood thinning vitamins, NSAIDS, and green tea for two weeks prior to the appointment as these may all cause increased bleeding and bruising,” Sunder says, noting that patients may want to take a Tylenol immediately prior to the appointment to make the experience more comfortable.
Additionally, Few says that cutting back on alcohol can have the same bruise-avoidant effect.
Lastly, if you have an active infection in their face/skin or a recent or upcoming dental surgery, Shafer says that you should delay the treatment for another time. “Patients should also prepare for moderate bruising and swelling. While usually very minimal, there is no way to completely predict how someone will look after the procedure,” he adds.
What to Expect During a Threading Facelift Treatment
During the actual thread lift, Sunder says patients should expect for the treatment area to be cleansed, assessed, and marked as to where the threads will be placed. Once finalized, topical numbing cream will be applied and/or injectable local anesthesia is placed.
“The threads are then inserted,” she says. “Some types of threads have a ‘tail’ that need to be cut off once the tissues have engaged with the thread. Other types of threads are inserted using a sort of introducer, which is then removed as the thread is then pushed into place.” Once all threads are placed, the treated area is cleaned gently and the patient can return to relatively normal activities for the day but should refrain from strenuous activity. The entire treatment takes about an hour.
Threading Facelift vs. Classic Facelift
The biggest difference between threading facelifts and surgical facelifts is that thread lifts are non-invasive and the results are temporary, given thread lift effects only last for three to nine months on average. “There is no equivalence between a thread lift and a facelift,” Shafer says. “Threads are a temporary treatment for a localized issue and are static structures anchoring issues. Unfortunately, despite claims otherwise, threads have a very short clinic effect. The threads are also static and don’t stretch or accommodate to natural movements of the face. Threads have short-term monetary savings, but long term it can be quite costly due to repeat treatments.”
Shafer says that a classic facelift, on the other hand, gives dramatic, natural, and long-lasting results. “Facelift does have more investment upfront in terms of recovery and cost, but spread out over a decade or so of the longevity of results, it’s actually a savings over thread lift,” he adds. “Unfortunately, some people fall victim to the marketing of thread lifts or get confused since the term ‘facelift’ is sometimes used interchangeably. They save up a couple thousand dollars to pay for a thread lift and are expecting long-term facelift results.”
Shafer isn’t the only one who shares this view, though. “All plastic surgeons and dermatologists will agree that thread lifts, honestly, do not compare to facelifts,” Sunder says. “Facelifts rely on entire muscle or fascial planes being lifted and repositioned, while the skin is also lifted and redraped. This extensive lifting cannot be replicated by a few threads, especially ones that are free-floating like the ones used in thread lifts. So, if someone needs a facelift, they will be sorely disappointed with the thread lift results.”
While Few also agrees that facelift remains the gold standard, he also developed a unique thread lifting technique, called Inverso Suspension which has its own benefits. “It is a non-surgical treatment to incorporate non-surgical thread lifting with the restoration of lost volume in the jawline with Micro BotoxⓇ (or Xeomin) to the frown muscles of the mouth to create a graceful appearance that is not “done” or unnatural in nature,” he explains. “The results of this approach may last two years or more and in many patients produce facelift-like outcomes without surgery.”
Potential Side Effects
The most obvious side effect of threading facelifts is that the threads can actually be visible if they are placed too superficially or if the patient’s skin is super thin. “There is also the possibility of bunching of the skin as the skin is pulled, but the excess skin can’t be removed or redraped as it can be done with a surgical facelift,” Shafer says. “Also, the threads are static and not dynamic which has the potential to affect normal animation.”
Then there’s the chance of infection. “Both with permanent and temporary threads, there have been reports of infection, foreign body reaction, suture extrusion (where the suture comes out of the skin), and puckering of the skin,” Sunder says. “There are also reports of prolonged pain or discomfort with permanent thread lifts.”
As Dr. Liotta mentioned earlier, there may also be some longterm effects to threading, including scarring and dimpling, therefore you should talk to your medical professional to weigh out your risk before getting the procedure.
Aftercare
As with any minimally invasive cosmetic treatment, Shafer says that ice is recommended to minimize bruising and swelling. “We also recommend sleeping with the head elevated and on your back to prevent any pressure on your face from sleeping on your side,” he adds. “This is a good recommendation in general for anyone wanting to reduce wrinkles and asymmetry in their face.”
Additionally, Sunder says that patients should refrain from washing or even touching the treatment area for at least 24 hours. “After that, very gentle cleansing of the face is allowed,” she says. “There should be no vigorous rubbing of the face or massaging the face for two to three weeks following treatment, so as to limit the chances of the suture dislodging or losing its grip.”
She also says that strenuous exercises should be limited for one to two weeks. “The activity limitations are much stricter for the lifting type threads as opposed to the solely collagen-stimulating ones,” she notes.
How long does it take to recover from facial thread lift?
The recovery period for a PDO thread lift is approximately two weeks; however, the majority of your restrictions and limitations will apply during the first 24 to 72 hours immediately following treatment. During this time, temporary soreness or face swelling can be expected, and it will fade quickly within the week.
What can go wrong with thread lifts?
The complications includes minor pain, swelling, rippling, dimpling, bruising, bleeding at the entry or exit sites, edema, asymmetry, dysesthesia, skin irregularities, and inflammatory reactions.
