Thread Lifts: A Detailed Examination
Thread lifts have garnered significant attention in the beauty industry. At aesthetic conferences, physicians express diverse views—proponents emphasize their non-invasive lifting benefits, while critics point out their inconsistent outcomes. Eager patients delve into online research, often ending up more puzzled or fatigued. Social media platforms like Instagram further fuel the discussion with vibrant visuals of colorful cannulae on brows and time-lapse videos showcasing threads being inserted into the jawline.
Much of the ambiguity surrounding thread lifts, also known as suture suspension lifts, originates from their tumultuous history. The permanent suture materials employed in the early 2024s were prone to breaking under the skin, leading to noticeable dimpling and even unsightly protrusions. The lifting effects they offered were notoriously fleeting. Since the procedure was frequently marketed as an alternative to facelift surgery, it often fell short of expectations.
Despite modern threads being absorbable, skin-friendly, and safer than their predecessors, there remains a dearth of research on them. "It's perplexing that more studies haven't been conducted," remarks Dr. Nazanin Saedi, a board-certified dermatologist in Philadelphia who routinely performs thread lifts. The scarcity of data is a concern for some practitioners. "The scientific literature on threads only dates back a few years and involves a few hundred patients," notes Dr. Evan Rieder, a board-certified dermatologist in New York City, who is hesitant to adopt the technology due to the limited understanding of its long-term risks and benefits.
Here, experts from both sides of the thread debate share insights on how threads are currently used to lift and smooth the skin, the importance of managing expectations, and what potential patients need to know about the associated risks and recovery periods before opting for a suture suspension lift.
What is a Thread Lift?
"I characterize it as a minimally invasive lifting and volumizing procedure," explains Dr. Saedi. Several suture suspension lift systems are available, each with distinct designs and delivery methods. Broadly, "a thread lift involves inserting an absorbable suture material beneath the skin's surface using a cannula [or needle] to provide tissue support and/or a biostimulatory effect to stimulate collagen production," elucidates Dr. Jessica Weiser, a board-certified dermatologist in New York City. Once anchored in the dermis, the threads lift and reposition tissues, smoothing the skin and enhancing features like cheekbones and jawlines. As the sutures dissolve over six months, they prompt an increase in collagen growth, slightly thickening the skin.
Our experts highlight that the volume gains from threads are relatively modest and generally less pronounced than the effects of injectable hyaluronic acid gels and biostimulatory fillers like Sculptra and Radiesse. "Every patient will experience some collagen stimulation, but achieving significant volumization with thread lifting often requires a substantial number of threads—at that point, I typically recommend fillers," Dr. Weiser notes.
What are Threads Made From and How Do They Work?
Today's threads are made from polydioxanone (PDO), poly-L-lactic acid (PLLA), or a blend of PLLA and polyglycolic acid (PGA)—all FDA-approved polymers that break down in the body over time. Beyond the resorbable materials, thread designs vary, ultimately determining their specific benefits.
According to our experts, PDO sutures are the most popular and versatile. They come in various configurations, allowing the treatment to be customized for multiple issues on both the face and body. With PDO sutures from brands like Nova Threads and Euro Threads, options include barbed threads for lifting, twisted threads for adding substance to the skin, and smooth threads for enhancing skin texture without creating additional volume.
PLLA threads, as Dr. Weiser describes, are "essentially a suture version of Sculptra—they create a scaffold biostimulatory process and are ideal for individuals with crepey skin and fine lines aiming to improve skin quality."
Silhouette Instalift utilizes PLLA/PGA threads embedded with bidirectional cones that grip tissue, providing a significant lifting effect on the skin. "The most substantial lift and support come from those bidirectional cones," Dr. Weiser explains. "They yield the most dramatic change."
However, Silhouette has its limitations. "It cannot be used in small areas due to the long placement needle and pre-made, loaded thread," Dr. Saedi adds. This makes it primarily suitable for lifting the midface. The Silhouette procedure is generally more expensive and time-consuming than other thread lifts and tends to cause more swelling and bruising, our experts note. Conversely, barbed PDO threads have tiny protrusions that "are much smaller than cones, resulting in a gentler tissue redistribution, a more gradual change, and less recovery time," Dr. Weiser observes.
On the horizon, Dr. Saedi informs us, are hyaluronic acid threads, currently used in Europe, which can hydrate the skin by attracting water to enhance its overall tone.
Where on the Face and Body Can Threads Be Used?
On the face, lifting-type threads can subtly raise a brow, enhance the cheeks, sharpen the jawline, streamline a double chin, or tighten the neck. "For the lower face, in particular, barbed suspension sutures effectively provide some lift to the skin—and when placed correctly, create a beautiful effect," says Dr. Janelle Vega, a board-certified dermatologist in Coral Gables, Florida. "I find that my thread patients are highly satisfied with the results, often resisting switching to other treatments due to their addiction to the immediate effect and improvement with threads."
Smooth and twisted threads can refine the skin's texture, Dr. Saedi notes, "so patients with acne scarring can also benefit from them." Smooth threads also excel "in the upper arms of women who develop crepiness with age, around the knees for uneven skin, in chest wrinkles common in side sleepers, and in fine lines on the cheeks and around the mouth," Dr. Weiser adds.
Exactly How Long Do Thread Lifts Last?
Proponents of thread lifts typically view the procedure as an annual task. "Silhouette provides the most lift and lasts the longest—usually over a year—while with PDO threads, the result is more like six months," Dr. Saedi explains. However, some providers find that the new collagen growth triggered by threads adds a few extra months to the overall duration of the results. "This biostimulatory effect can last anywhere from an additional three to nine months, so I usually advise people to expect a 6- to 15-month improvement, depending on their tissue response," Dr. Weiser notes.
Who's a Good Candidate for Threads – and Who's Not?
If you're considering a thread lift to address sagging cheeks, a droopy brow, or a less firm jawline, the severity of your sagging is the first factor to consider. "If you have severe laxity, threads won't get you to where you want to be," Dr. Weiser cautions. "But if you have early signs of skin laxity, they can be a good option for maintaining or reversing it gradually."
Ideal candidates are typically in the late 30s to early 50s age range; their skin is thick enough to conceal the threads but not so heavy that the sutures can't support it; and most importantly, they have realistic expectations. It's crucial to reiterate: threads are not equivalent to a facelift.
Since threads don't address all aspects of aging, "they work best in combination with other treatments, such as fillers, radiofrequency, and toxins," Dr. Vega advises. "Someone who needs significant volume replacement is not a good candidate for a thread lift alone."
Patients who achieve impressive results with threads often undergo other collagen-stimulating treatments, like radiofrequency microneedling or heat-based tissue tightening, because "their skin is a bit more resilient as a result," Dr. Weiser explains. Facial skin that's thin and inelastic from the start might give doctors pause: if the skin's collagen reserves are already depleted, "it makes me question if they will actually experience the [thread-induced] effect of building their own collagen," Dr. Saedi notes.
That said, if someone is adamantly opposed to surgery or is not a medical candidate for any reason, threads may be their best or only option for achieving a noticeable lift—even if it's subtle and short-lived.
Are There Risks with Absorbable Threads?
Like any medical procedure, thread lifts carry risks, but when performed correctly by an experienced provider familiar with anatomy, complications are rare and relatively minor.
"Threads are not a completely risk-free procedure because we're introducing a foreign object into the skin," Dr. Weiser cautions. "And once they're in, they're in—if there's a problem, you usually have to wait for the suture to dissolve." However, today's newer, more resilient polymers—many of which have an antibacterial coating—have mitigated the most common issues associated with older threads, such as suture rupture and high infection rates.
While bruising and swelling can occur whenever the skin is pierced, the main issues doctors watch for with threads are dimpling, asymmetry, and extrusion—which almost always result from poor technique, inserting threads in the wrong tissue layer, or performing the procedure on an unsuitable candidate (primarily those with thin skin).
"If placed incorrectly, threads may start to protrude, like a traditional suture would," Dr. Vega explains. "I've seen some inexperienced providers place threads that are actually visible because they are too superficial or placed in an area with a lot of movement, and they start to bunch up or create a pulling effect that doesn't look natural." Moreover, she adds, it's not uncommon for someone to have an adverse reaction to the suture material and develop some inflammation.
What's the Downtime After a Thread Lift?
The extent of post-operative discomfort, swelling, and bruising depends on what you're aiming to improve, the type and number of threads placed, and the intensity of the treatment. "You can perform the procedure so that people have little to no recovery time—they might just be sore and swollen for a few days—but if you're aiming for more of a texture change in the skin, like when treating acne scars, people can be swollen and bruised for up to two weeks," Dr. Saedi explains.
Dr. Weiser reports minimal bruising with threads in her practice, seeing it in less than 5% of cases, but notes "the more threads you insert, the more swelling and tissue reaction you'll get. When I'm doing a series of smooth threads, I get more swelling, bruising, and redness because there are so many small cannulas entering the skin."
As previously mentioned, the needle delivery and bidirectional-cone design of Silhouette tend to make the process more complex, our experts say, and may cause more swelling and bruising than PDO threads, which are commonly placed via blunt-tipped cannula.
What's the Bottom Line on Thread Lifts?
In essence, threads are not a substitute for surgery—and if you truly qualify for a facelift, chances are this procedure won't meet your expectations. "Suture suspension lifting is an intermediate option between fillers and facelift," says Dr. Lara Devgan, a board-certified plastic surgeon in New York City. "Surgery is undoubtedly the gold standard, but this is a good technique for someone who wants pure lifting without volume and isn't ready for the commitment and recovery time of surgery."
As with any cosmetic procedure, you'll want to weigh the pros and cons before committing. "Threads are temporary. They're costly. And if placed poorly, they look bad," Dr. Weiser cautions. "But when done well, they can provide a very nice, genuine skin improvement"—which is significant considering "that lifting effect on the skin is one of the most challenging things for us to achieve." When used in combination with other treatments, threads may offer just the boost you're seeking.
