Thread lift and skin sagging (skin laxity): How high can it lift? Effects and limitations

A Thread lift (Threadlift) is a method that passes dissolvable sutures with fine barbs (cogs) under the skin to lift sagging (skin laxity)[1]. While scarring is minimal and recovery is fast, only the skin and subcutaneous layers can be lifted, and both the magnitude of effects and their duration are limited[2]. Japanese guidelines also remain at a weak recommendation level, noting that while temporary improvement can be expected, the effects are not substantial and duration is short[3].

Up to which layer can the thread lift?

Up to the skin and the layer immediately beneath it. The basic approach is to place the thread in the subcutaneous layer, and when inserted in areas with significant movement, it tends to protrude or shift, and facial expression movements interfere with thread fixation, shortening the duration of effect, as reported[4]. Reviews point out that lifting only the skin and subcutaneous layers does not provide sufficient lasting results, and even surgically lifted skin loosens relatively quickly[2]. Skin lifted by threads tends to remain attached to the fascia (SMAS) beneath it and return to its original position easily, and pulling too forcefully can instead cause complications[2].

Textbooks also note that skin supporting heavy tissue stretches over time and the effects of a Facelift are lost[5]. The concept of lifting heavy tissue from its foundation using only threads is fundamentally flawed.

How long do the effects last?

Approximately six months to one year is the guideline, though there is considerable individual variation. The duration of effect can extend up to approximately one year as the dissolvable thread (PDO) undergoes degradation, but the actual range of perceived effects varies considerably[4]. In a 10-patient report combining PDO thread with botulinum toxin, 90% reported improvements in skin texture and brightness at four months, but this is not an evaluation of the lifting itself[6]. There is a prospective study evaluating the combination with hyaluronic acid at one year and two years[7].

What does the guideline say?

"While temporary improvement can be expected, effects are not substantial and duration is short, making thorough explanation necessary," with a recommendation level of 2 (weak recommendation)[3]. This is not a statement negating Thread lift, but rather requesting that it not be placed at the same level as surgical procedures with greater expectations. It is a choice to trade off larger and longer-lasting effects in exchange for shorter downtime.

What concerns is it suitable for?

Eyebrow drooping, nasolabial folds, lines extending downward from the mouth corners (marionette lines), and double chin, etc.[2]. It is noted as easy to use in areas difficult to reach with hyaluronic acid or botulinum toxin alone[2]. It is also used for sagging skin remaining after facial liposuction or for correction when fat drops after fat injection[2]. Data from over 110,000 cases across multiple facilities reports that trends in materials used and combined treatments have changed year by year[8].

What complications occur most easily?

Pain, marked swelling, skin dimpling, and difficulty opening the mouth are well known[4]. To avoid these, simple insertion and removal techniques—threading straight in and straight out—have become standard[4]. Measures to address the problem of thread shifting and movement have also been reported[4]. Research at multiple facilities has examined common factors in people who were unsatisfied, and pre-procedural expectations themselves, not just procedural complications, affect outcomes[9].

What is confirmed during consultation?

Whether your sagging (skin laxity) is within the reach of thread lift. If there is excessive loose skin and you want lifting from deep layers, threads alone are insufficient[2]. Comparative studies investigating the relationship between the number of threads and effects have been conducted, but there is no established answer yet for how many threads are needed[10].

It helps to clarify which area and direction will be lifted, how many months of benefit are anticipated, and what is planned next. If your physician's explanation stops at just "lifting," be sure to confirm the duration and limitations.