The Pros and Cons of Thread Lifts

Experts are split on thread lifts. While some love a thread lift for its speediness and low down-time, others find that the results are not long-lasting or consistent enough to justify choosing the treatment over a traditional facelift. “I love to do thread lifting because I am enamored by all the positives as far as this procedure is concerned,” says New York facial plastic surgeon John Kang, MD. On the other hand, New York facial plastic surgeon Edward S. Kwak, MD, says, “I really don’t have anything positive to say about threads.” To help you make a more informed decision, we learned about the pros and cons of the procedure and the best kind of candidate for thread lifts.

Who a thread lift might be best for

Ultimately Dr. Kwak believes “more natural, lasting results” come from traditional surgical treatments. However, he notes that a thread lift is a good option “for patients who want to ‘test drive’ a brow lift or facelift before committing to surgery.”

Who a thread lift might not be the best for

Dr. Kang notes that patients with moderate to severe jowling and neck laxity may not be the most ideal candidates since there is a limit to what threads can do. If you want a full lift, you should probably opt for a traditional facelift. However, Dr. Kang adds that a thread lift will still have more visible results than Ultherapy, Thermage and other radio-frequency energy-based devices.

Pro: Thread lifts are minimally invasive

One of the biggest benefits of thread lifts is that they’re quick in-office procedures, says New York facial plastic surgeon Dilip D. Madnani, MD. Dr. Kang points out that “It’s the only minimally invasive procedure that can actually mimic open surgery results in terms of actually mechanically lifting the sagging facial skin.” During the procedure, local anesthesia is used while the threads get placed beneath the skin. Altogether the experience generally doesn’t take longer than 45 minutes.

Con: Results of thread lifts don’t last very long

If you’ve ever wondered why there isn’t a deluge of before and afters beyond the first few hours, Salt Lake City, UT facial plastic surgeon P. Daniel Ward, MD says it’s because “they look great, but within a few hours that benefit has gone.” Dr. Kwak also notes thread lifts have a relatively short duration as compared to other options. 

While a thread lift generally only lasts one to three years, a traditional facelift can last up to a decade. “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 explains that this concept is similar to that of getting a refresh of neurotoxin and fillers in a timely fashion.

Pro: Threads boost collagen

While he doesn’t feel thread lifts really do much lifting (more on that in a moment), Dr. Ward does credit them for other 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.”

Con: Threads don’t truly lift

According to Dr. Ward, thread lifts don’t necessarily 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 have been performed 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.

This logically makes sense, Dr. Ward says. “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.”

Pro: Thread lifts can be customized per patient

Another positive attribute of thread lifts is the way they can be tailored to a patient in ways not every treatment can. Dr. Madnani notes that the procedure can “easily address multiple areas and [be] customized per treatment.”

Con: There can be complications

The challenging nature of the procedure, keeping in mind not every expert is skilled in this technique, makes it a bit riskier when it comes to complications. Dr. Madnani warns of complications like bumps and pain. Other possible complications include dimpling from an extruding thread, trouble opening your mouth, infection and bruising.

Of course, there is also the potential risk involved in introducing a foreign object to your body which may result in a reaction, says Dr. Ward. He adds that there’s also the risk of anatomic damage during the procedure.

Pro: There is limited downtime

“All this significant lifting can be achieved with almost no downtime,” says Dr. Kang. He adds that he has patients come from out of town to get a thread lift. They’re often able to fly or drive back home that day or the next. Patients are generally able to return to work right after a thread lift.

Con: Thread lifts are costly to repeat

Although a thread lift may be less expensive than a facelift, the cost adds up when you have to get a refresh every few years. “When fracturing outcomes, cost and downtime, I still believe patients are better off with traditional surgical procedures,” says Dr. Kwak.

Pro: Doctors can check their work

During the procedure, Dr. Kang says he’s “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 of their skin 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.”

Con: There are bad doctors performing thread lifts

This can be the case with any surgery. However, 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 such as bunching up or dimpling of skin as well as prolonged bruising and swelling.” Dr. Kang says it’s not easy to nail efficient vectoring, but it’s essential because there’s no way to remove excess skin. 

“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.”

Pro: Thread lifts work well with fillers and lasers

If you’re looking to mix and match treatments, a thread lift might be a good pick for you. According to Dr. Madnani, a thread lift can easily be combined with fillers and lasers for a full facial refresh.