Experts are split on thread lifts. While some love the procedure for its speed and minimal downtime, others find that the results are not long-lasting or consistent enough to justify choosing it over a traditional facelift.
To help you make a more informed decision, we asked experts to break down the pros and cons of the procedure and who may be an ideal candidate for a thread lift.
Who Thread Lifts May Be Best For
New York facial plastic surgeon Edward S. Kwak, MD, believes “more natural, lasting results” come from traditional surgical treatments. However, he notes that a thread lift may be a good option “for patients who want to ‘test drive’ a brow lift or facelift before committing to surgery.”
Thread lifts may also appeal to patients with mild laxity who want a quicker, minimally invasive treatment and understand that the results will be temporary.
Who May Want to Skip a Thread Lift
New York facial plastic surgeon John Kang, MD, notes that patients with moderate to severe jowling and neck laxity may not be ideal candidates because there is a limit to what threads can accomplish. Those seeking a more complete lift may be better suited to a traditional facelift.
However, Dr. Kang adds that a thread lift may still create more visible results than Ultherapy, Thermage and other radiofrequency energy-based devices.
The Pros of Thread Lifts
Pro: They’re Quick and Minimally Invasive
“Thread lifts or ‘the lunchtime facelift’ are attractive because the procedure is quick and much cheaper than surgery,” says Palo Alto, CA facial plastic surgeon Steven Curti, MD.
During the procedure, local anesthesia is used while the threads are placed beneath the skin. Altogether, the treatment generally takes no longer than 45 minutes.
Downtime is also limited. Dr. Kang says he has patients travel from out of town for a thread lift and fly or drive home that day or the next. Patients are generally able to return to work shortly after the procedure.
Pro: The Results Are Immediate
New York facial plastic surgeon Lee Ann M. Klausner, MD, points out that a thread lift can produce an immediate visible reduction in mild to moderate neck laxity, so there is no waiting around to see whether the treatment worked. That immediate change is a notable benefit for a procedure with minimal downtime.
Dr. Kang says he can also evaluate the placement as he works. He is “able to check how efficient the vectoring of thread has been in terms of lifting up the sagging facial skin without causing bunching up or dimpling of the skin.”
He also likes to show patients the mechanical lifting effect by “having the patients sit up and showing them how much of their sagging face has actually been pulled up using the thread after placement of each thread.”
Pro: Threads May Stimulate Collagen
While he does not believe thread lifts provide much true lifting, Salt Lake City, UT facial plastic surgeon P. Daniel Ward, MD, credits them with other potential benefits.
“Long term, I believe they help, but it’s because they increase the amount of collagen in the skin and add volume,” he says. “There have been several studies that demonstrate this to be the case.”
Dr. Curti notes, however, that the collagen response is localized to the thread.
Pro: The Treatment Can Be Customized
New York facial plastic surgeon Dilip D. Madnani, MD, notes that a thread lift can “easily address multiple areas and [be] customized per treatment.”
Thread lifts can also be incorporated into a broader treatment plan. According to Dr. Madnani, they can easily be combined with fillers and lasers for a more comprehensive facial refresh.
The Cons of Thread Lifts
Con: They May Not Provide a True ‘Lift’
According to Dr. Ward, thread lifts may not fully live up to their name.
“The name is a little bit of a misnomer because they actually don’t really lift. There have been several studies that show that they lead to some benefit, but the benefit that they provide comes from the volume enhancement that is added, and not necessarily an actual lift,” he explains.
Dr. Ward says this makes sense when the procedure is compared with surgery.
“Even when we are surgically lifting the face or neck, when we have opened up the skin, the deep tissue layers, etc. and use big, strong sutures, aka threads, we cannot get a good lift with that technique alone,” he explains. “With this knowledge in mind, one can see how foolhardy the idea behind threads is. If one thinks that they can insert a thread through the skin, and then pull the deep tissues of the face up without any rearranging of the tissue, they think they can accomplish something that we cannot even accomplish with surgery.”
Con: Results May Be Short-Lived
Dr. Kwak notes that thread lifts have a relatively short duration compared with other options.
“You may like how it looks, but the benefits will wear off in six months,” says Dr. Klausner.
Dr. Curti also questions the durability of the results. “Thread lifts rarely deliver on their promise, and the reason for that is structural. They don’t address the underlying physiology of facial aging, which means even a promising initial result tends to fade within six months as the threads dissolve, and tissue continues with its natural descent,” he says.
While thread-lift results generally fade within a year, a traditional facelift typically offers significantly longer-lasting results.
“In about a year, roughly half of the thread lifting effect will have dissipated, at which time many patients will want to undergo ‘maintenance vectoring’ of a few additional threads to maintain the optimal result,” says Dr. Kang.
He compares this maintenance approach to refreshing neurotoxin and filler treatments on a regular schedule.
Con: Complications Can Occur
“Thread lifts, in general, have quite a few adverse effects,” says Scottsdale, AZ facial plastic surgeon Kelly Bomer, MD, who does not perform or recommend them.
“There are some risks associated with threads. Minor complications like bruising and infection are well-documented,” says Dr. Curti. “More significant concerns like skin changes, scarring and hair loss are less common but also not rare.”
Delray Beach, FL facial plastic surgeon Miguel Mascaró, MD, who sees more cons than pros with thread lifts, warns about possible puckering. Dr. Madnani also cautions about complications such as bumps and pain.
Other potential complications include dimpling, thread extrusion and difficulty opening the mouth.
“I have had many patients get thread lifts at outside offices and have been disappointed with the protrusion of the thread extruding out of the skin like a pimple. This string then needs to be trimmed, and there is often a dimple or bump,” says Dr. Bomer.
Although the risk is low, Dr. Klausner and Dr. Bomer also note the potential for asymmetry. Dr. Ward adds that there is a risk of anatomic damage during the procedure.
Con: The Body May React to the Threads
There is also a potential risk involved in introducing a foreign object into the body, which may trigger a reaction, says Dr. Ward.
Dr. Bomer notes that while threads are marketed as a way to improve skin quality, she is not in favor of the skin changes that can occur from this type of foreign-body reaction. She feels it is “much better to reach for medical-grade skin care, PRF injections and medical skin treatments like topical PRF with microneedling to improve skin.”
Con: Results Depend Heavily on the Provider
Thread lifting is highly technique-dependent and not every provider has the same level of experience.
Dr. Kang warns that “almost anyone can be taught to perform thread lifting.” He says the key to success is efficient vectoring “to make all the individual thread vectors come together to achieve an excellent result without any side effects.”
According to Dr. Kang, efficient vectoring is difficult to master but essential because there is no way to remove excess skin during the procedure.
“There is a steep learning curve to be an excellent thread-lifting surgeon,” says Dr. Kang. “Due to the complexity of the anatomy and thin skin of the forehead, it’s more difficult and challenging. However, excellent results can be achieved in proper hands to achieve visible brow and forehead lifting.”
Con: Threads May Complicate a Future Facelift
Dr. Curti considers this one of the most significant potential drawbacks of thread lifts.
“The threads are placed in the subcutaneous and sub-SMAS planes, the same tissue planes a surgeon needs to work through during a deep plane facelift. The fibrosis that forms around dissolving threads can create adhesions that make dissection less predictable, increase operative complexity and affect how tissue re-drapes and heals,” he explains.
Ultimately, he says, “A procedure marketed as a stopgap may quietly narrow your options for the intervention that would actually offer the most natural change.”
Con: Maintenance Can Get Expensive
Although a thread lift may cost less upfront than a facelift, the expense can add up when repeat treatments are needed to maintain the result.
“When factoring outcomes, cost and downtime, I still believe patients are better off with traditional surgical procedures,” says Dr. Kwak.
For patients considering a thread lift, the decision may ultimately come down to whether the appeal of a quicker, less invasive treatment outweighs the temporary nature of the results, potential complications and need for ongoing maintenance.
