Thread lifts are among the most talked-about procedures in beauty. Doctors debate their merits at aesthetics meetings—proponents celebrating their nonsurgical lifting powers and skeptics bemoaning their inconsistency. Curious patients research the ins and outs, Googling to the point of perplexion if not exhaustion. Instagram heightens the hype, with wild shots of colorful cannulae splayed across a brow and time-lapse videos of threads darting into a jawline.
Underlying much of the confusion surrounding thread lifts—or suture suspension lifts, as they’re sometimes called—is a fraught history: the permanent suture materials used in the early aughts were known to snap beneath the skin, cause obvious dimpling, and even protrude, garishly, from the face. Any lifting effect they gave was notoriously fleeting. And because the procedure was often touted as an alternative to facelift surgery, it was all but destined to disappoint.
While modern threads are absorbable, skin-friendly, and safer than old-school versions, the research behind them is still somewhat lacking. “It’s baffling to me that there aren’t more studies,” says board-certified Philadelphia dermatologist Dr. Nazanin Saedi, who performs thread lifts routinely. The dearth of data is a red flag for some practitioners. “The scientific literature on threads goes back only a few years and a few hundred patients,” says Dr. Evan Rieder, a board-certified dermatologist in New York City—a fact that currently makes him hesitant to adopt the technology in practice, since, as he notes, the true scope of procedural risks and rewards oftentimes takes much longer to come to light.
Ahead, doctors on both sides of the thread divide weigh in on how threads are being used today to elevate and smooth the skin, why expectation management is everything, and what you should know about the risks and downtime before signing up for a suture suspension lift.
What is a thread lift?
“I describe it as a minimally invasive lifting and volumizing procedure,” says Dr. Saedi. Several suture suspension lift systems exist—and each has its own unique design and mode of delivery. But generally speaking, “a thread lift entails using some form of absorbable suture material that is inserted with a cannula [or needle] underneath the skin’s surface, to offer tissue support and/or a biostimulatory effect, to create more collagen,” explains Dr. Jessica Weiser, a board-certified dermatologist in New York City. Once anchored in the dermis, threads can hoist and reposition the tissues, smoothing the skin and accentuating edges and angles like cheekbones and jawlines. As the sutures dissolve over the course of six months, they trigger an uptick in collagen growth, to thicken the skin slightly.
The volume gains offered by threads are fairly modest, our experts say, and are, typically, less appreciable than the swell of injectable hyaluronic acid gels and biostimulatory fillers like Sculptra and Radiesse. “Every patient will get some collagen stimulation, but I find the actual volumization from thread lifting requires a million threads—and at that point, I’m generally resorting to fillers,” Dr. Weiser says.
What are threads made from, and how do they work?
The threads used today 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 they’re made from, threads can differ by design—which is what ultimately determines their specific benefits.
According to our experts, PDO sutures are the most popular and versatile threads—they come in several configurations, and the treatment can be tailored to address multiple issues on both the face and body. With PDO sutures from brands like Nova Threads and Euro Threads, style variations include barbed threads, for lifting; twisted threads, for lending substance to skin; and smooth threads, for improving the skin’s texture without creating additional volume.
PLLA threads, according to Dr. Weiser, are “literally a suture version of Sculptra—they’re creating that scaffold biostimulatory process and are great for people with crepey skin and fine lines who are just looking to boost their skin quality.”
Silhouette Instalift uses PLLA/PGA threads studded with tissue-snagging bidirectional cones, which have a considerable hoisting effect on skin. “The most significant lift and support is coming from those bidirectional cones,” says Dr. Weiser. “They give the most dramatic change.”
Silhouette isn’t without drawbacks, however. “It can’t be used in small areas, because the needle for placement is very long, [as is] the premade and loaded thread,” Dr. Saedi adds. Which makes it suitable for little more than lifting the midface. The Silhouette procedure is typically pricier and more time-consuming than other thread lifts and tends to beget more swelling and bruising, our experts note. Barbed PDO threads, on the other hand, have tiny protrusions that “are much smaller than cones, so you’re getting a gentler tissue redistribution, a more gradual change, and less downtime,” Dr. Weiser says.
On the horizon, Dr. Saedi tells us, are hyaluronic acid threads, currently used in Europe, which can hydrate the skin by pulling in water in order to improve its overall tone.
Where on the face and body can threads be used?
On the face, lifting-type threads can subtly hike a brow, boost the cheeks, sharpen a jawline, streamline a double chin, or tighten the neck. “For the lower face, in particular, barbed suspension sutures work nicely to help give some lift to the skin—and when placed properly, will create a beautiful effect,” says Dr. Janelle Vega, a board-certified dermatologist in Coral Gables, Florida. “I find that my thread patients are so happy with results, they’re often resistant to changing to other treatments, because they are addicted to the immediate effect and improvement with threads.”
Smooth and twisted threads can refine the texture of the skin, says Dr. Saedi, “so patients with acne scarring can benefit from them as well.” Smooth threads also shine “in the upper arms of women who develop crepiness with age, around the knees for bunchy skin, in chest wrinkles commonly seen in side sleepers, and in fine lines on the cheeks and around the mouth,” Dr. Weiser adds.
Exactly how long do thread lifts last?
Thread loyalists typically see the procedure as a yearly to-do. “Silhouette gets you the most lift and lasts the longest—usually over a year—whereas with PDO threads, it’s more like a six-month result,” says Dr. Saedi. However, some providers find that the new collagen growth triggered by threads contributes an extra few months to the overall longevity of results. “This biostimulatory effect can last anywhere between an additional three and nine months, so I usually tell people to expect a 6- to 15-month improvement, depending on their tissue response,” Dr. Weiser says.
Who’s a good candidate for threads—and who’s not?
If you’re mulling over a thread lift, to address fallen cheeks, a droopy brow, or a less-than-taut jawline, consider, first and foremost, the severity of your sagging. “If you have dramatic laxity, threads are not going to get you where you want to be,” says Dr. Weiser. “But if you have early signs of skin laxity, they can be a nice option for maintaining or turning it back slowly.”
The best candidates fall 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 important, they have reasonable expectations. We can’t stress this enough: threads are not even in the same league as a facelift.
Since threads aren’t addressing every aspect of aging, “they work best in combination with other treatments, such as fillers, radiofrequency, and toxin,” says Dr. Vega. “Someone who needs a lot of volume replacement is not a good candidate for a thread lift alone.”
Patients who see impressive results with threads tend to be those who are simultaneously partaking in other collagen-stimulating treatments, like radiofrequency microneedling or heat-based tissue tightening, because “their skin is a little bit more robust as a result,” Dr. Wesier explains. Facial skin that’s thin and inelastic at baseline may give doctors pause: if the skin’s collagen reserves are already waning, “it makes me question if they’re actually going to have the [thread-induced] effect of building their own collagen,” says Dr. Saedi.
That said, if someone is dead set against surgery or simply isn’t a medical candidate for whatever reason, threads may be their best or only option for getting a legitimate lift—even if it is understated and short-lived.
Are there risks with absorbable threads?
As with every medical procedure, threads carry risks, but when they’re placed properly by an experienced provider who knows anatomy, complications are rare and relatively minor.
“Threads are not a completely benign procedure, because we are introducing a foreign body into the skin,” says Dr. Weiser. “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 come with an antibacterial coating—have served as an analgesic for the most common headaches associated with threads of old, namely suture rupture and high infection rates.
While bruising and swelling can happen anytime you pierce the skin, the main things doctors watch out for with threads are dimpling, asymmetry, and extrusion—which almost always result from poor technique, inserting threads in the wrong tissue plane, or attempting the procedure on someone who’s not a suitable candidate (thin-skinned patients, primarily).
“If improperly placed, threads may start to spit out, like a traditional suture would,” explains Dr. Vega. “I have 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 or create a tugging effect, which does not look natural.” Moreover, she adds, it’s not unheard of for someone to react to the suture material and develop some inflammation.
What’s the downtime after a thread lift?
The extent of your post-op discomfort, swelling, and bruising will depend on what you’re aiming to improve, the type and number of threads placed, and the aggressiveness of the treatment. “You can do [the procedure] so people have little to no downtime—they might just be sore and swollen for a few days—but if you’re aiming for more of a textural change in the skin, like when treating acne scars, people can be swollen and bruised for up to two weeks,” says Dr. Saedi.
Dr. Weiser reports minimal bruising with threads in her practice, seeing black-and-blues in less than 5% of cases, but says “the more threads you insert, the more swelling and tissue reaction you’re going to get. When I’m doing a series of smooth threads, I’m getting more swelling, bruising, and redness, because there are so many little cannulas going into the skin.”
As noted earlier, the needle delivery and bidirectional-cone design of Silhouette tends to make the process a bit more involved, 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?
Plainly put, threads are not a substitute for surgery—and if you truly qualify for a facelift, odds are, this procedure will leave you wanting. “Suture suspension lifting is an intermediate solution between fillers and facelift,” says Dr. Lara Devgan, a board-certified plastic surgeon in New York City. “Surgery absolutely remains the gold standard, but this is a nice technique for someone who wants pure lift, without volume, and who is not yet ready for the commitment and downtime of surgery.”
As with every cosmetic undertaking, you’ll want to weigh the pros and cons before committing. “Threads are temporary. They’re expensive. And if poorly placed, they look terrible,” Dr. Weiser says. “But when done well, they can give a very nice, true skin pick-me-up”—which is no small thing, considering “that lifting effect on skin is one of the hardest things for us to achieve.” When used in tandem with other treatments, threads may offer just the boost you’re looking for.
