What is the Difference Between a Thread Lift and a Suture Suspension During a SMAS Facelift?

What is the Difference Between a Thread Lift and a Suture Suspension During a SMAS facelift procedure? Is there another (or longer lasting) way to secure the SMAS in the neck and face? Is this something a patient should be concerned about when deciding on a facial plastic surgeon?

Doctor Answers 8

Differences in facelift techniques: what works best for your surgeon

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I am always impressed by the fund of knowledge that is shown by the people asking questions on this site!

There are different facelift techniques, all seem to handle the firm tissue under the skin (the SMAS) a little differently. You should leave the decision for facelift technique up to your surgeon. Ask to see their patient photos and talk to their former patients before making a decision. Check on the credentials of your surgeon. Both plastic surgeons and facial plastic surgeons are trained in facelift surgery, however, the training of facial plastic surgeons focuses entirely on the face. 

Since you asked about threadlifts, you should know these were taken off the market. This procedure involved the placement of barbed permanent sutures (like fishing line) under the  skin and then the skin was pulled up to hook on the barbs. There were problems with extrusion of the sutures and the results only lasted about 6 months.

Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Thread lift vs SMAS suspention

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are several major differences:

Thread is lifting under the skin in a loose fatty tissue level plane and SMAS is a tought fibrous layer able to better support facial tissues.

Thread lifts are still quite polupar in Europe but not in US because of short lived results - about 6 month.



Boris Volshteyn, MD, MS
East Brunswick Plastic Surgeon

Thread Lift vs SMAS Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

With a thread lift sutures are placed under the skin to lift the skin and underlying muscle. It is easier for the surgeon and patient, but the results are not as good and the duration of the improvement is significantly less. In a SMAS lift the deeper layers of the face are actually mobilized, repositioned, and excess sagging tissue  is removed if necessary.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Thread lift vs smas lift.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
A threadlift is using a suture to lift the tissue under the skin without removal of deep tissue. A smas lift means the skin is elevated, the deep tissue (SMAS) is elevated and trimmed of the excess and sutured. Those of us who have used facelift techniques for more than 30 years feel tha SMAS lifts give better and longer lasting results.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

What is the Difference Between a Thread Lift and a Suture Suspension During a SMAS Facelift?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I have performed Face Lifts for well over 20 years and IMHO, a SMAS Face Lift should not use a suture suspension technique which is the method of lifting the SMAS.  For a Face Lift to be effective, IMO it must have the following characteristics:

  1. There must be some type of incision that contours around the front of the ear allowing removal of excess skin.
  2. The SMAS must be dissected, lifted, trimmed and sewn back together in its elevated position.
  3. The midface (cheeks) must be properly shaped by removing excess fat and'or creating the proper aesthetic cheek shape.

A typical SMAS Face Lift should meet the first 2 criterea however, if they use a suture or thread to lift and fold the SMAS on itself it does not dissect, lift and trim the SMAS but merely suspend it.  The thread or suture will eventually wear through the SMAS and it will sag back down.

Thread Lifts don't meet any of the above criterea as there's no incision with which to remove excess skin, nor is the SMAS dissected, elevated etc.  As such, IMO, thread lifts are a very poor 3rd or 4th option to any Face Lift technique meeting the three criterea listed above.  IMHO, you'd be far better off having a minimal incision Face Lift that does all three of the above.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

SMAS Lift vs Thread Lift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thread lifts are basically Sutures used alone with out a lifting procedure in my experience and those of many other plastic surgeons "thread lift" do not have much longevity and not worth the effort. They may look great for months but not years.

A SMAS lift in general refers to any facelift technique that tightens the SMAS layer using suture suspension along with the overlying skin in a more youthful position making you look younger. Specifically, the SMAS face lift does its magic by lifting and tightening the jowls, neck, and cheeks to a more youthful position. These techniques generally produce more natural and long-lasting results than the “skin only” face lifts, and now considered by most board certified plastic surgeons as the most preferred method.

Difference Between a Thread Lift and a SMAS Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

A thread lift is a barbed suture repair and if done alone will last weeks to a few months only. It is not as secure as direct suture suspension during a SMAS facelift procedure. I would be quite concerned about doing a thread lift suture suspension only of the SMAS. It is much better to use direct sutures with permanent sutures if performing  a  suspension or SMAS plication while doing a facelift to give you increased longevity.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Face lift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thread lifts have come and gone. They do not hold, get infected and do not last.

SMAS face lift is longer lasting, and more natural. There are many ways to deal with the SMAS, lateral samsectomy, suture suspension , plication of the SMAS all work well and which method will depend on your plastic surgeon and what your specific aging needs.



Samir Shureih, MD
Baltimore Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.