Is thread lift alone enough? How to decide on combining with other treatments

Thread lift is a treatment that is more often used in combination with other treatments rather than alone. In a Japanese aggregate of 111,948 cases collected from 2020 to 2024, more than 60% of patients received thread lift along with other treatments such as fillers and botulinum toxin[1]. Whether thread lift alone is sufficient depends on whether the concern is sagging (skin laxity) alone, or if it is combined with loss of volume and wrinkles[1].

In practice, how many people combine treatments?

More than half—in fact, over 60%. An aggregate of 111,948 cases from over 100 clinics shows that more than 60% of patients received treatments other than thread lift in combination, indicating that thread lift functions not as a standalone treatment but as part of a composite plan involving multiple approaches[1]. During the same period, the use of non-absorbable threads also increased significantly[1]. The key takeaway is that "thread lift alone" is not the standard.

What happens when combined with ultrasound (HIFU)?

There are reports showing improvement with each successive session. In a retrospective observational study dividing 58 patients into two groups of 29 each, the treatment involved inserting 4 threads with 17 cm of cog threads on one side and performing 200 lines of ultrasound with a 4.5 mm probe, repeated 3 times[2]. Physician-assessed appearance showed significant improvement both between sessions 1 and 2, and between sessions 2 and 3[2]. The measured distance of the descended cheek fat position also decreased with successive sessions[2].

Interestingly, the order did not matter. Whether thread or ultrasound was performed first, there was no difference in the degree of lift[2]. The key issue is not the order, but whether both are included in the treatment plan[2].

What about combining with hyaluronic acid or botulinum toxin?

Both have reports, though small-scale. For mid-face treatment combining cross-linked hyaluronic acid filler with cog-bearing PDO thread, a pilot study was conducted evaluating efficacy and safety in blinded fashion at 1 and 2 year timepoints[3]. In a 10-patient study combining PDO thread with botulinum toxin A, 90% reported improvements in skin texture and brightness at 4 months, with mild and temporary swelling and no major complications[4]. Both are at the preliminary stage with small numbers rather than conclusive evidence[4].

Can we say that combining treatments always leads to better results?

Not quite. Most combination studies are small-scale or retrospective and lack comparative controls[2][4]. There is also research in the direction of improving the thread material itself; in a 180-day experiment in pigs with poly(lactic-co-caprolactone) thread coated with hyaluronic acid, it outperformed uncoated thread in many tissue markers[5]. However, this is an animal experiment, and the authors note that human confirmation is still pending[5].

Ultimately, the conclusion of the review is that the result is determined more by patient selection and individualized planning than by thread type[6]. The same applies to combining treatments—adding more does not necessarily lead to better results[6].

Determining which approach is right for you during consultation

The distinguishing factor is the nature of the concern. If descended contours are the main issue, threads play a larger role; if hollowness or depression is prominent, volume-adding treatment takes the lead; if wrinkles form from movement, a different treatment becomes primary. Point to the area of concern in front of a mirror and discuss with your physician whether it is "descended," "reduced (in volume)," or "formed by movement."

It is more realistic to also communicate your budget. There is no need to do everything at once; you can discuss the order—which to do first so that the next step becomes clear.