Pretty mature woman smiling, black ruffled shirt | What You Should Expect With a Thread Lift | Masterpiece Skin Restoration

What You Should Expect With A Thread Lift

What Do You Do When You Look in the Mirror & the Face You See Looks Older - But You Still Feel Young?

It happens to us all eventually . . . some later than others (they're the lucky ones). Gravity and thinning skin. You start to lose bone, muscle and the fat pads underneath your skin. The skin on your face begins to sag. You develop jowls and the sides of your mouth turn down. Yes, it makes you look older; but it can also leave you looking sad, stressed, tired, and even depressed. UGH! But you're wiser, right?!

Fortunately, you're not stuck looking tired. You have a few options. You can get a surgical facelift or a liquid facelift. Fillers like Restylane® or Voluma® can restore the lost volume in your cheeks and temples. Botox® can relax the muscles that pull your face and neck down.

But what if none of those appeal to you?

Now there's another option. It's a new version of the thread lift called the Silhouette Instalift®. It was approved by the FDA in 2015, and it's advertised as a way to restore the contours of your face - in a way that looks very natural.

What’s a thread lift?

First, you need a little background. Thread lifts were first introduced in the late 1990s. They used nonbiodegradable string that was laced under the skin. These thread lifts allowed facial skin to be "winched up," but they caused lots of problems too.

What Kind of Problems Did the “Old” Thread Lifts Have?

One of the "old" thread lifts - the Contour Threadlift system - was FDA approved in 2005. The only qualification for buying and implanting this particular threadlift was a 1 day course given by the manufacturer. And thread lifts weren't easy to use. The threads needed to be anchored to the scalp, temple and brow and the skin could only be pulled in one direction. “This made the results appear two-dimensional,” says Chicago plastic surgeon Julius Few.

Needless to say, people got infections, skin dimpling, redness, swelling, persistent pain, and uneven results. Sometimes the threads even broke. Another problem - some people got a bad reaction to the threads that couldn't be successfully treated using noninvasive methods. Because the Contour Threadlift wasn't easily reversed, in cases like these, the only option to remove the threads was via a surgical facelift. So the Contour Threadlift approval was quickly rescinded by the FDA and thread lifts got a bad name.

But the new thread lifts are different.

“The new threads are fully absorbable, making it an absorbable suture lift, not a thread lift. They can also be lifted in two directions, which results in a more three-dimensional look. The old procedure required overpulling of the skin to get a good result, making the downtime several days and not too different from what is now called a mini-facelift,” explains Dr. Few.

They're also popular because they're easy for medical providers to use. The threads don't have to be anchored and the procedure can be done in the office. Patients like thread lifts because there's very little downtime. You're awake during the treatment, so you can collaborate with your doctor on the look of your thread lift.

But there's an additional effect that's not so obvious. New collagen fibers - which act as a scaffolding for your skin - form around the thread creating a lift that can last as long as 18 months.

Collagen gives our skin structure. As we age and lose collagen, our skin starts to thin and we get wrinkles. But if you can regain some of that lost collagen, you'll see your wrinkles start to recede. You'll look in the mirror and see a younger looking you!

There are different kinds of threads.

Below are a few of the threads manufactured for use in the United States. Images courtesy of NovaThreads.US and Silhouette Soft.

NovaThreads Smooth Thread Used in a Thread Lift

NovaThreads® Smooth Thread

NovaThreads Twist Thread used in a thread lift

NovaThreads® Twist Thread

NovaThreads Barb Thread Used in a Thread Lift

NovaThreads® Barb Thread

Closeup of Silhouette Soft Thread for Thread Lift

Silhouette Soft® Lift Thread

The Silhouette Instalift is a new generation of thread lift that uses threads that dissolve. Made of glycolic and polylactic acids derived from sugar, the threads are broken down and absorbed by your body over a period of about 6 months. The manufacturer says that their threads are well tolerated and no allergy testing is needed prior to the procedure.

The Silhouette threads are different from other brands of threads. They're stabilized by cones specially made to keep them in place.

Watch Dr. Z. Paul Lorenc, a plastic surgeon in New York City, do a thread lift using the Silhouette threads below. This woman is an actual patient. Pictures are unretouched. Results will vary:

NovaThreads are another brand of absorbable threadlift. NovaThread needles use a different kind of thread called polydioxanone.

What's polydioxanone (PDO)? It's a man made surgical suture often used in procedures like open heart surgery. Polydioxanone is also fully absorbed by your body after 4 - 6 months.

NovaThreads come in a variety of shapes. Some of these threads use barbs or a spiral. Others are smooth.

There are other brands of barbed sutures also.

Watch Charles Small, a registered Nurse in Scottsdale, do a thread lift using PDO threads below. This woman is an actual patient. Pictures are unretouched. Results will vary:

What’s the treatment like?

Your skin is marked so the doctor or nurse knows exactly where to put each thread. Anesthetic shots or a cream are used to minimize your pain. Then a long, thin, hollow needle called a cannula is used to inject the thread under your skin and into your subcutaneous tissue, parallel to your skin's surface.

In the diagram on the right, the subcutaneous tissue is labeled "Hypodermis." It's yellow and lies just below the dermis.

The needle is removed leaving the thread underneath the skin. (The thread is essentially “hooked” to the tissue underneath your skin). Next gentle tension is used on each string to move your skin and reshape your face. Your skin will look smoother immediately. The thread is pulled tight, your skin is lifted, then the thread is cut at the insertion point leaving about 5 - 8 centimeters of thread beneath your skin. Once the end of the thread is cut, it becomes hidden within your skin.  This process is repeated with each thread.

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Usually 1 - 5 threads are placed on each side of your face, depending on the skin condition being treated. A full face thread lift uses about 18 barbed threads:

Keep in mind that each doctor will have his or her own preferred technique. Here's what Dr. Harold Lancer said in an interview with on 6/27/2018:

"For the past few years, we’ve used dissolvable Silhouette Instalift threads to nonsurgically lift sagging skin on the jawline, inner arms, elbow and knees and to diminish tree trunk lines in the neck and cellulite dents. In the last few weeks, they’ve released smaller threads. With the bare-butt look in fashion, you don’t want dents. Surgical removal has a very high failure rate, so we put in some of these micro-threads and hatch-weave them underneath to bring up the dents. It’s a volumizing agent in the form of a micro-thread that is injected with a micro-needle. You might use 50 threads for a jawline treatment. It lasts three to six months and collagen and elastic tissue form around the threads for longer-term improvement. The cost is $2,500 up to $5,000 once or twice a year, as opposed to a $25,000 to $250,000 face-lift."

Barbed and cone threads are left free floating within your subcutaneous tissue. (The barbs and cones keep them in place.) They're the kind of threads most commonly used to lift sagging skin. Smooth threads are more difficult to use because they need to be anchored to a stable part of your scalp or face in order to "lift" sagging skin.

Does it hurt?

An injectable or cream anesthetic is used, but there is still some pain. People seem to be most uncomfortable when the threads are tightened. This procedure is more uncomfortable that injectable fillers.

How long does the thread lift take?

Your appointment will last 1 - 2  hours.

Is there any downtime?

Contrary to what you may hear, the thread lift is not something you can do on your lunch hour. Most people return to work the next day or after a few days of rest.

Are there any side effects?

A stinging or “pulling” pain or discomfort is normal. Some people say it hurts to laugh or smile for about 2 weeks after their thread lift. Another common side effect is soreness, particularly in or near the hairline or jaw line, that can last up to 2 weeks. Expect some swelling, redness and bruising. Some people get dimpling in their skin, but this usually goes away on its own. Sometimes people can feel their threads. It's more common with barbed threads, but it usually goes away after several days.

RARELY, there is a reaction to the suture called a granuloma.

If not done properly, there can be assymetry, infection, rippling, dimpling and / or puckering of the skin, and thread breakage. Superficially placed sutures may be visible.

Less Common Side Effects:  hematoma (a collection of blood outside the blood vessels, but underneath the skin), nerve damage, sensory impairment, chronic pain, and hypersensitivity / allergic reaction.

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How do I care for my face after the thread lift?

  1. After a thread lift, you'll apply a topical antibiotic to the thread insertion points.
  2. Patients are advised to avoid strenuous exercise.
  3. You also shouldn't open your mouth wide and chew (like when you eat an apple) for 5 - 7 days.
  4. Keep your head slightly elevated for about 24 hours to reduce swelling.
  5. Eat a soft diet for 7 days to reduce stress on your threads.
  6. Most doctors allow you to take Tylenol to reduce any pain.
  7. Avoid sun and use SPF 30 sunscreen or higher.
  8. Your doctor may prescribe antibiotics to help prevent an infection.

How long does a thread lift last?

Results vary for each person. They're dependent on the looseness of your skin and the type, number and location of the threads used. Facial aging is caused by bone, fat and muscle loss. Skin thins and loses collagen and elastin. This all leads to facial volume loss and sagging skin. So fillers are often used to restore the lost volume - and they work really well with thread lifts.

Most thread lifts last 18 months to 2 years. Fillers combined with thread-lifts have been shown to lengthen the life of a thread lift - possibly because the fillers stimulate collagen production also.

Do people like thread lifts?

The Silhouette InstaLift has a 71% "Worth It" rating based on 28 reviews over the past 2 years.

How much does it cost? lists the average price in the U.S. for the Silhouette InstaLift as $3,875.

Who is the ideal candidate for a threadlift?

The thread lift works best for women and men who have sagging skin and volume loss but don't want surgery. The skin cannot be too thick or too thin. People who get the best results have moderate sagging in the mid face, jaw line and neck. They have visible nasolabial folds (lines from the nose to mouth) and marionette lines (from the corners of the mouth down to the chin). See the photo below.

Is there anyone who should NOT have a thread lift?

You should not have a thread lift if:

  • you're pregnant or nursing
  • you have an infectious disease
  • you have benign or malignant tumors
  • you have a history of keloid scarring (a large raised scar that goes beyond the borders of the original injury)
  • you have a bleeding disorder
  • you have a serious chronic disease
  • you have a foreign body sensitivity or known allergy to plastic implants
  • you have an autoimmune disease
  • you're under the age of 18
  • you're unwilling to follow the care instructions after treatment
  • you have an excessive amount of loose skin
  • you have thin skin
  • you have thin skin combined with a lack of fatty tissue beneath the skin
Closeup of woman's face with arrows pointing to and naming the different kinds of wrinkles
Image courtesy of Allergan.

Are there any clinical studies?

There was a study published in JAMA Facial Plastic Surgery in 2009, that did a retrospective review of 33 patients who had a traditional thread lift. 23 of the patients had a thread lift combined with other facial rejuvenation procedures and 10 others had only a thread lift. There were also 10 control patients who had skin rejuvenation without a thread lift. The study followed the patients for a mean of 21 months. Independent, blinded, board-certified facial plastic surgeons evaluated pre and postoperative photos and compared the patients' results.

What were the results?

  • All the patients had improvement at 1 month.
  • All the patients had measurable results through the end of the study - EXCEPT the patients who had ONLY a thread lift.
  • People who had skin rejuvenation procedures without a thread lift got significantly better results than the people who only had a thread lift.
  • People who had a thread lift combined with other skin rejuvenation procedures got significantly better results than the people who only had a thread lift.
  • The authors concluded that the thread lift alone gave only short term improvement. They felt that thread lifts weren't as effective because they only superficially repositioned the soft tissues without addressing excess skin or adding volume.

Conclusion:  Thread lifts have higher patient satisfaction and better outcomes when they are combined with fillers, radiofrequency, fractional lasers, and neuromodulators (like Botox). So barbed threads can be combined with fillers or fat grafting to add volume to the face. And radiofrequency or micro-needling can help to tighten excess skin and reduce wrinkles after a thread lift. There are lots of possibilites!

So are doctors recommending combining a thread lift with another skin treatment?

Thread lifts alone can't fix excess skin or a loss of facial volume. In order to get the very best result, doctors do combine the thread lift with other skin treatments.

Dr. Few often combines thread lifts with other treatments in his own practice:

“Used alone, results can last up to 18 months. But we often use the absorbable suture lift in combination with fillers, lasers and other nonsurgical facial treatments to create a ‘stackable treatment.' The results are expected to last several years when combined with other treatments and wear off gradually.”

These new, absorbable thread lifts are another great option for skin rejuvenation. As more medical providers offer this treatment and gain experience, I would expect the results to get better and better - especially when combined with other treatments! Thanks for reading! And good luck!

Head shot, Amy Takken, RN & Founder, Masterpiece Skin Restoration

Amy Takken, RN

Amy Takken is a registered nurse with 20+ years of experience helping people improve their health. Her in-depth skincare articles have been featured on Nazarian Plastic Surgery and The Palm Beach Center for Facial Plastic & Laser Surgery. She's also been quoted on Amy loves research and constantly watches for new products and treatments to help you improve your skin’s health – because healthy skin is beautiful! To reach Amy, visit our contact page.

Masterpiece Skin Restoration is your online resource for all things medical aesthetics, skincare, beauty and wellness. We keep you up to date on leading edge technology and the services available to help you restore your natural beauty.

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The Information provided on our website is not medical advice and should not be viewed as such. By law, only a medical doctor can diagnose or give medical advice. As a registered nurse, my goal is to educate, so I provide information on skin care, skin care products, and skin care treatments. If you have any condition that concerns you, please see a medical doctor. While most skin conditions are benign, some - like melanoma - can be deadly. If there is any doubt, please, please consult your physician. Thank you!

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