Thread lifts

A thread lift covers procedures that aim to support the tissues of the face or neck with threads placed under the skin.¹ This article deals with how threads differ from one another, what the research measures, how much of the visible improvement is retained, and the unwanted effects. The limits of comparisons with surgical lifting, the authorisation framework in Türkiye and how expressions such as "permanent" or "approved" should be read are also assessed.

What is a thread lift?

In a thread lift the tissues are supported in a different position by the grip and pull of threads placed under the skin.¹ The barbs on the surface of some threads hold the tissue; the material used and the method of fixation vary between techniques.¹ The aim of the procedure is to change the appearance of laxity or sagging in particular parts of the face.²

The word "non-surgical" here describes the absence of a wide surgical opening; it does not mean that the skin is not entered or that no material is placed in the tissue.¹ That distinction matters for assessing the procedure. A procedure being carried out through small entry points does not mean that its effect or its risks can be understood from the name alone.

Are suspension threads all the same?

Threads may be manufactured from absorbable or non-absorbable materials; the structure of the barbs, the way the tissue is held and the method of fixation also differ.¹ Research carried out with a single thread system therefore cannot be read as the result of every procedure offered under the same name.

In the meta-analysis by Niu and colleagues, paraesthesia (changes in sensation such as numbness or tingling) was reported in 3.1 per cent with absorbable threads and 11.7 per cent with non-absorbable threads; thread extrusion was 1.6 and 7.6 per cent respectively.³ The review found these differences statistically significant; confidence intervals for these subgroup rates are not given in its abstract.³

This comparison shows that different groups of thread do not produce the same results in research.³ It does not on its own answer which thread should be chosen for a particular person. A subgroup relationship should not be interpreted as though different threads had been given at random to people who were alike in every other respect; nor is it a ranking of superiority covering all products.

How is mechanical suspension distinguished from the tissue response?

The thread holding the tissue is a mechanical effect; the fibrotic tissue response that develops around the thread is a separate process.¹ In the literature, the formation of connective tissue around the thread is one of the mechanisms used to explain the effect of the suspension.¹ But describing a mechanism is not the same thing as showing that the visible result will be retained for a particular length of time in everyone.

The tissue response, the appearance scale and a person's own assessment of the result are separate measurements. This distinction is also seen in clinical research; in the same study the visible lifting effect decreased while some three-dimensional volume measurements remained different from baseline.⁴ An explanation that "collagen forms" therefore does not on its own amount to a result lasting a set number of years.

Which changes are to be expected, and which are not?

Research has assessed changes in facial laxity and in the appearance of the jawline and of some facial folds.^4,5 The ASPS (American Society of Plastic Surgeons) lists early loosening of the facial structures and of the neck skin, and sagging eyebrows, among the areas a thread lift addresses.² An area appearing on that list does not show that every problem in that area can be corrected by the same procedure.

In a 2025 systematic review, improvement was reported in the assessments made immediately after the procedure in data from 12 studies and 818 people examining absorbable threads.⁵ The same review also states that long-term efficacy data are lacking.⁵ That an early change has been measured, and how much of that change will be retained, are separate questions; a favourable early result does not answer the second one by itself.

How does this differ from a face lift and a midface lift?

Holding tissue with threads is not the same procedure as surgically releasing and repositioning the tissues and, where needed, removing excess skin.^1,6 The face lift article deals with surgical correction, and the midface lift article with the surgical relocation of cheek tissue. The thread suspension described here is separate from the surgical suspension used after the tissues have been released in a midface operation.¹

The 2017 review by Tavares and colleagues concluded that, on the available evidence, a thread lift should not be adopted as an alternative to a face lift.¹ That was an evidence-based assessment at that date; it should also be taken into account that the 2025 review, while finding the early effect favourable, continues to report a lack of long-term data.⁵ Two procedures having a similar goal for appearance is not proof that they deliver a result of the same scope or the same durability.

What does the evidence on efficacy show?

Research on thread lifts uses appearance scales, three-dimensional measurements and people's own assessments.^4,5 Because the measurements do not ask the same question, forming a single "success rate" is difficult. In reading a study it is necessary to look not only at the outcome figure but also at who produced it, at what point in time and by which criterion.

Are appearance, volume measurement and a person's own assessment the same outcome?

27 people with mild to moderate facial laxity were enrolled in the prospective study by Wanitphakdeedecha and colleagues, and 25 completed the 12-month follow-up.⁴ There is no untreated control arm in the study; the assessments were compared with the state before the procedure.⁴

At 12 months the blinded assessors reported no lifting effect in 56 per cent of the 25 people evaluated.⁴ At the same 12 months, 28 per cent of those same 25 people, assessing their own result, reported no lifting effect.⁴ These are results obtained at the same time and on the same denominator, from different sources of assessment. They show that the change a person reports and an assessment of appearance made from outside cannot be used in place of one another.⁴

In the same research, volume measurements in the jawline, the nasolabial folds and the submental area remained significantly different from baseline at almost all follow-up visits.⁴ This does not mean that visible lifting was retained to the same degree for everyone. The distribution of volume in a particular area, the score given to the sagging appearance of the face and a person's own assessment are separate outcomes.

The study was supported by a university; the manufacturer supplied the products used and paid the journal's rapid service fee.⁴ That information does not in itself invalidate the results. It should be read together with the absence of a control group, the small sample and the exclusion from the analysis of the 2 people who did not attend the final visit.⁴ Nor does the funding of this study mean that all thread lift research is supported in the same way.

Is there a direct comparison with surgery?

Comparative publications exist, but their design matters. In the retrospective study by Kim, 173 people had a thread lift alone and 196 had a limited scar face lift together with a thread lift.⁶ Both of the groups compared therefore received threads; the comparison is between thread lifting alone and an approach that also includes surgical release and skin excision, not between threads and surgery in place of one another.⁶ This observational comparison does not by itself establish the independent effect of adding surgery.⁶ Mean follow-up for the whole sample was 32.2 ± 5.2 months, range 22-43 months.⁶ The groups were not formed at random; their baseline characteristics and additional procedures differ.⁶

50 of the 74 people contacted for the FACE-Q questionnaire responded.⁶ In the research the limited scar face lift group had higher assessment scores for social and psychological function.⁶ This does not mean that all 369 people answered the questionnaire. Because of the baseline differences, the limited responding sample and the presence of threads in both groups, the result does not on its own show that one of the methods is more suitable for everyone.⁶

In the 2009 study by Abraham and colleagues, 10 people who had a thread lift alone, 23 who had a thread lift together with other procedures, and 10 controls selected from different procedures not using threads were assessed.⁷ The control group covers fat transfer, chemical peels and face lift procedures; it does not consist of face lift surgery alone.⁷ Mean follow-up was 21 months, range 12-31 months.⁷

Improvement was reported in all groups in the first month, and in the thread-only group the measurable result was found not to have been retained to the final follow-up.⁷ Controls being selected at random does not mean that people were assigned to treatments at random. Nor can this study be read as a test of all current threads against a standard face lift technique under equivalent conditions. Neither of these two publications compares a thread lift with surgical face lifting alone in a design that randomly assigns people to treatments.^6,7

How are authorisation and the suitability of the product assessed in Türkiye?

Are a certificate and a facility's authorisation the same thing?

How health services for aesthetic and cosmetic purposes are to be provided in private outpatient diagnosis and treatment facilities is governed by the Regulation on Private Health Facilities Providing Outpatient Diagnosis and Treatment, dated 19 April 2025.⁸

The provision in force requires three conditions together. Health services for aesthetic or cosmetic purposes may be provided within a medical centre, a polyclinic or a doctor's practice; within the competences physicians have acquired through their training curriculum or through a certificate; within the medical procedures permitted at the facility where they work; and provided that the physical space and minimum medical equipment defined for a polyclinic room are in place.⁸

The certificate referred to in the regulation is one registered under Ministry legislation.⁸

The name of the thread lift does not appear in the curriculum of the Ministry's Standard for the Certified Training Programme in Aesthetic and Cosmetic Applications, dated 3 September 2025.⁹ That observation concerns only the content of that standard. No nationwide prohibition, and no automatic authorisation to perform the procedure for any professional group, can be derived from it.^8,9

The physician's competence and the facility's authorisation are separate things and both are required.⁸ A diploma alone, or any course certificate alone, does not show that all of these conditions are met. Nor is a training centre's authorisation to provide training the same thing as a physician's authorisation to carry out the procedure.^8,9

This provision covers private outpatient diagnosis and treatment facilities. A complete list of authorisation by profession and title, for every type of institution, cannot be derived from this text.⁸

What does a thread's registration information and intended purpose show?

The Communiqué of the Turkish Medicines and Medical Devices Agency dated 14 March 2024 concerns the groups of products without an intended medical purpose listed in Annex XVI of the Medical Device Regulation.¹⁰ Article 5(3) points to the common specifications in Annex III for products intended to be introduced into the human body, wholly or partly, by surgically invasive means for the purpose of modifying the anatomy.¹⁰

Within that frame the intended purpose of the product is what determines the position; it cannot be concluded from the word "thread" alone that all suspension products fall under the same provision.¹⁰ A product with a medical purpose and a product for anatomical modification without a medical purpose should not be treated as the same.¹⁰ The current registration and scope of use of a particular product in Türkiye has to be understood separately; no product's registration is presented here as verified.

The Ministry of Health's Product Tracking System (ÜTS) is a system for the registration and traceability of medical devices and cosmetic products.¹¹ A product's registration information does not take the place of a physician's competence or a facility's authorisation. The traceability of a product and the benefit and risk expected in a particular person are also separate assessments.

That a product is traceable does not answer the question of which outcome was shown in a piece of research. The subject of the research may be mechanical lifting, an appearance score or unwanted effects; these have to be read separately from registration information. In the same way, a document about a product is not a document that covers all the questions relating to the physician and the facility.^8,11

What are the risks and unwanted effects?

In the 2025 review of absorbable threads, complications were reported as mild and the risk of serious complications was stated to be low.⁵ In the review by Pham and colleagues assessing threads in the face and neck, serious adverse effects were likewise described as rare, and most adverse effects as transient, self-resolving findings.¹² This favourable frame does not mean that the problems below never occur.

The published figures of the meta-analysis by Niu and colleagues, covering 26 studies, give the pooled rates below.³ Each row rests on a different number of studies; the rates cannot be added together to calculate a person's total complication risk.

Outcome	Number of studies	Pooled rate	95 per cent confidence interval	I²
Swelling	10	35 per cent	20-51 per cent	96.5 per cent
Skin dimpling	12	10 per cent	5-14 per cent	88.3 per cent
Paraesthesia	11	6 per cent	3-9 per cent	77.3 per cent
Visible or palpable thread	7	4 per cent	2-6 per cent	91.7 per cent
Infection	7	2 per cent	1-4 per cent	58.5 per cent
Thread extrusion	6	2 per cent	1-3 per cent	50.8 per cent

These are separate outcomes combined within a review of 26 studies; the follow-up periods and event definitions of the studies do not form a common measurement window.³ I² summarises differences between study results that are not explained by chance alone. A high value indicates greater inconsistency between the results; it is not a person's probability of having a complication. Nor does the confidence interval show the lowest and highest rates seen in the individual studies. In the analysis of visible or palpable threads the weight of 1 study is 31.79 per cent; each study therefore does not contribute equally to the pooled estimate.³

Swelling, bruising, pain and changes in sensation

Alongside swelling and bruising, the ASPS lists pain that could persist, usually temporary difficulty opening the mouth, and sensitivity to light among the reported risks.¹³ Paraesthesia is also one of the unwanted effects reported in research.³ The name of these symptoms does not on its own explain how long they will last or whether intervention will be needed in that person.

In the Niu review, dimpling was reported in 16 per cent in the group over 50 years of age and in 5.6 per cent in the younger group; infection was 5.9 and 0.7 per cent respectively.³ The review described the differences as significant, and does not give confidence intervals for these comparisons in its abstract.³ This relationship does not mean that 50 years of age is a threshold of suitability for everyone; nor can it be said that people in the same age group carry the same risk.

Dimpling, asymmetry, a visible thread or thread extrusion

Dimpling that can arise as the thread pulls the skin at particular points, contour irregularity and asymmetry have been reported in the literature.^1,3 A thread becoming visible or palpable is different from its coming out through the skin; for that reason they were assessed as separate outcomes in the meta-analysis.³ Superficial displacement can also be recorded as a separate event.¹⁴

None of these problems is the same thing as the visible lifting effect decreasing over time. While a thread becomes visible, a separate assessment of the suspension effect may be needed; nor does a study following only an appearance score mean that it measured the position of the thread directly. Preserving the name of the outcome in the research prevents different problems from being combined under the heading "thread slippage".

Some contour irregularities and material-related problems may not resolve on their own and may require treatment.¹² Threads being made of absorbable material cannot therefore be presented as a guarantee that every problem arising will pass without intervention.^1,12

Infection and more serious injuries

Alongside infection, injuries to vessels or glands, nerve-related problems and inflammatory reactions have been reported.^1,12 The ASPS also keeps anaesthesia risks and the possibility of an unfavourable result on its list of risks.¹³ That more serious events have been reported does not mean they are common; the Pham review describes serious effects as rare.¹²

In the 21-person series by Wattanakrai and colleagues, no serious complications were reported.¹⁵ That finding is favourable, but no event being seen in a small series does not show zero risk for all future procedures. On the other hand, presenting rare severe events as being as frequent as ordinary swelling also distorts the frame the research provides.

Increasing pain, redness, discharge or a thread becoming visible should not be assessed merely as the effect wearing off; they should be reported to the physician assessing the procedure. Thread extrusion and infection are risks distinct from a simple change in appearance.¹³ A newly developing problem with facial movement should also be assessed without delay; nerve injury is a complication reported in the literature.¹

How is the duration of the result assessed?

Does a follow-up period mean the effect was retained?

In the 21-person study by Wattanakrai and colleagues, follow-up ranged from 6 months to 2 years, and the improvement was reported to have been maintained in 14 people at 1 year and in 8 people at 2 years.¹⁵ By contrast, in the retrospective series of 160 consecutive people by Bertossi and colleagues, the improvement seen in the first month was reported to have declined noticeably by 6 months and to be no longer visible at 1 year.¹⁴ These are different methods and samples; combining their periods does not give a single average duration of effect.

In the 2025 review the longest assessment is at 2 years, but the authors separately note the lack of long-term efficacy data.⁵ A final check being made in the second year does not mean that everyone experienced the same degree of improvement up to that date. In the same way, an outcome score still differing from baseline at a given time does not show that the whole of the initial effect was retained.

In the Niu meta-analysis the pooled satisfaction rate immediately after the procedure was reported as 98 per cent and at 6 months as 88 per cent; the decrease was found to be statistically significant.³ The rate remained high at the later assessment, but it is not at the same level.³ The abstract does not give confidence intervals for this comparison.³ This is satisfaction as measured in research; it is not a measurement of how far the facial tissue was raised or of the effect ending at 6 months.

How are loosening, thread displacement and re-treatment distinguished?

A decrease in the visible effect, displacement of the thread, extrusion of the thread and further intervention are separate outcomes.^1,14 The extrusion rate in a study does not show that the same proportion of people asked for a repeat procedure. In the same way, no improvement being seen at the final check does not necessarily mean the thread has moved out of position.

No interval for re-treatment applicable to everyone can be derived from this research.^5,15 Which outcome was recorded during follow-up, and how it was compared with the initial goal, is what matters. Whether the phrase "the effect has worn off" describes an assessment of appearance, a problem with the material, or the person's expectation, has to be made clear.

What matters in an assessment?

The ASPS calls for a person's goal for their appearance, their medical conditions, their allergies, the medicines they use and their previous operations or treatments to be addressed in the assessment.¹⁶ Problems relating to the eyes are also listed separately by the organisation.¹⁶ Defining the expected result from the name of the procedure alone, without understanding which area and which change the goal relates to, is not enough.

A previous thread lift or another facial procedure appearing in the history means that this information is included in the assessment.¹⁶ No numerical result on how far a previous thread affects later surgery is given in this article. That baseline characteristics affect the interpretation of a result is also seen in the different patient groups in the comparative studies.⁶

People who were pregnant or breastfeeding were not enrolled in the Wanitphakdeedecha study.⁴ That exclusion is not data showing that a thread lift is safe in those periods; the results for the group who did take part cannot be carried directly over to these people. What a piece of research did not examine matters as much as whom it gives information about for benefit or risk.

How should marketing language be read?

What do "non-surgical face lift" and "permanent" not prove?

The phrase "non-surgical face lift" is not a research definition proving a result equivalent to surgery. The thread lift literature treats surgical release and support provided by passing threads through the skin separately.¹ Research showing only an early change in appearance cannot be used as proof that the procedure meets all the goals of the operation.

The name "lunchtime lift" is also used on the ASPS page.² Naming a procedure as though it fits into a lunch break is not a measure of its risks or of the burden of recovery. The same organisation's list of risks, which includes pain, swelling, infection and thread extrusion, should be read alongside it.¹³ A short name does not take the place of the information needed for a decision.

For the word "permanent" it is necessary to explain which outcome was followed, by whom and for how long. A person's response on a scale, an assessment of appearance made from outside and a volume measurement are not the same outcome.⁴ Nor is the absorbability of the thread material, on its own, a research result determining the end date of the visible improvement.^1,5

What information may be missing from the word "approved"?

The United States Food and Drug Administration (FDA) explains that registration or listing information is not the same as approval or marketing authorisation.¹⁷

This distinction matters particularly in statements where a product's registration is presented as evidence for every claim about appearance. A registration document does not explain a particular person's result, nor that the efficacy shown in a study can be carried over to every area of use. The conditions for physicians and facilities in Türkiye are likewise not met by a registration record in the United States.^8,17

In an assessment, what the product is, the purpose for which it is used and which finding has been shown for that purpose have to be kept separate. Use of the word "approved" alone does not mean that the conditions for authorisation and the clinical evidence have been explained together.^8,17

How should the figures in this article be read?

A pooled rate is an estimate derived from different studies; it is not a person's own risk. The rows in the risk table cover different events and different sets of studies, and for that reason cannot be added. The confidence interval helps in interpreting the uncertainty of the estimate and I² the variation between studies; the two are not the same information.

The number of people, the number of people who took part in an assessment and the number of events also have to be kept apart. The sample of 369 people in the Kim study and the group of 50 who answered the FACE-Q are not the same denominator.⁶ The 56 per cent and 28 per cent in the Wanitphakdeedecha study, on the other hand, are different assessments of the same 25 people at the same time.⁴ A satisfaction rate, a score given to appearance and a number of further interventions cannot be used in place of one another.^3,6

The periods here do not form an individual treatment schedule. Early improvement, the effect remaining at the final check and the total follow-up period of a piece of research should be read separately. When a favourable finding in the evidence is assessed together with which people and which period it extends to, expecting a firm conclusion from a single figure can be avoided.

References

1. Tavares JP, Oliveira CACP, Torres RP, Bahmad F. Facial thread lifting with suture suspension. Braz J Otorhinolaryngol. 2017;83(6):712-719. doi:10.1016/j.bjorl.2017.03.015 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷

2. American Society of Plastic Surgeons. Thread Lift. plasticsurgery.org ↩ ↩² ↩³

3. Niu Z, Zhang K, Yao W, et al. A Meta-Analysis and Systematic Review of the Incidences of Complications Following Facial Thread-Lifting. Aesthetic Plast Surg. 2021;45(5):2148-2158. doi:10.1007/s00266-021-02256-w ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵

4. Wanitphakdeedecha R, Yan C, Ng JNC, Fundarò S. Absorbable Barbed Threads for Lower Facial Soft-Tissue Repositioning in Asians. Dermatol Ther (Heidelb). 2021;11(4):1395-1408. doi:10.1007/s13555-021-00569-x ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴

5. Riopelle AM, Geisler AN, Eber A, Dover JS. Update on Absorbable Facial Thread Lifts. Dermatol Surg. 2025;51(5):509-514. doi:10.1097/DSS.0000000000004521 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹

6. Kim CH. Evaluating the Compartment-Specific Effects in Superficial Facial Fat Compartments After Thread-Lifts by the Tensiometer and FACE-Q. Aesthet Surg J Open Forum. 2022;4:ojac065. doi:10.1093/asjof/ojac065 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³

7. Abraham RF, DeFatta RJ, Williams EF. Thread-lift for facial rejuvenation: assessment of long-term results. Arch Facial Plast Surg. 2009;11(3):178-183. doi:10.1001/archfacial.2009.10 ↩ ↩² ↩³ ↩⁴ ↩⁵

8. Republic of Türkiye Ministry of Health. Regulation on Private Health Facilities Providing Outpatient Diagnosis and Treatment. Official Gazette, 19 April 2025, no. 32875. Articles 4(1)(j) and 6(10). saglik.gov.tr ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

9. Republic of Türkiye Ministry of Health. Standard for the Certified Training Programme in Aesthetic and Cosmetic Applications. 3 September 2025. saglik.gov.tr ↩ ↩² ↩³

10. Turkish Medicines and Medical Devices Agency. Communiqué on the Determination of Common Specifications for the Groups of Products Without an Intended Medical Purpose Listed in Annex XVI of the Medical Device Regulation. Official Gazette, 14 March 2024, no. 32489. Article 5(3). resmigazete.gov.tr ↩ ↩² ↩³ ↩⁴

11. Republic of Türkiye Ministry of Health. The Product Tracking System has come into operation. saglik.gov.tr ↩ ↩²

12. Pham CT, Chu S, Foulad DP, Mesinkovska NA. Safety Profile of Thread Lifts on the Face and Neck: An Evidence-Based Systematic Review. Dermatol Surg. 2021;47(11):1460-1465. doi:10.1097/DSS.0000000000003189 ↩ ↩² ↩³ ↩⁴ ↩⁵

13. American Society of Plastic Surgeons. Thread Lift Risks and Safety. plasticsurgery.org ↩ ↩² ↩³ ↩⁴

14. Bertossi D, Botti G, Gualdi A, et al. Effectiveness, Longevity, and Complications of Facelift by Barbed Suture Insertion. Aesthet Surg J. 2019;39(3):241-247. doi:10.1093/asj/sjy042 ↩ ↩² ↩³

15. Wattanakrai K, Chiemchaisri N, Wattanakrai P. Mesh Suspension Thread for Facial Rejuvenation. Aesthetic Plast Surg. 2020;44(3):766-774. doi:10.1007/s00266-019-01561-9 ↩ ↩² ↩³

16. American Society of Plastic Surgeons. Thread Lift Consultation. plasticsurgery.org ↩ ↩² ↩³

17. U.S. Food and Drug Administration. Are There "FDA Registered" or "FDA Certified" Medical Devices? How Do I Know What Is FDA Approved? fda.gov ↩ ↩² ↩³