Among viral cosmetic treatments, thread lifts — a nonsurgical treatment that lifts sagging skin with barbed sutures under the skin (yep!) — have gained a ton of attention. The treatment lends itself to hard-to-look-away videos on social media and is said to be the gravity-defying secret of many a red carpet regular. But is a thread lift, or “threading,” safe, effective, and worthwhile?
Some of the increased interest in recent years can be attributed to dramatic improvements in technology. Old thread lifts from past decades utilized permanent plastic that could result in awful side effects, including “rejection” of the threads, causing them to rise to the surface of the skin. They subsequently lost FDA approval in 2009. The new sutures — which arrived around 2015 — are made with dissolvable materials with far fewer complications. (Common thread brands in the United States include NovaThreads and Silhouette Instalift, and doctors also refer to them by their materials, PDO and PLLA.)
“I like it to address jowls, mid-face volume, and the neck,” says New York City plastic surgeon Dr. Yael Halaas, who helped bring Silhouette InstaLift to market. “It’s not surgery, it’s subtle, and it’s also very technique-dependent to get results.”
The thread lift’s most viral moment was arguably when Chicago plastic surgeon Dr. Julius Few performed the procedure in front of a live audience at Gwyneth Paltrow’s Goop Summit in 2017. Tabloids have speculated about which famous snatched faces can thank threads, but almost no celebrities have admitted to getting them. One exception is Eva Mendes, who posted an Instagram of her threading neck lift mid-procedure with the ends of seven threads sticking out around her jawline like tassels. “Here I am getting some Mono-Threads. Ayyyy Dios!” she wrote in the caption in November 2020 to her more than 2 million followers (she has since taken down all of her Instagram posts, but the image can still be found on the Instagram account of her doctor and aesthetic nurse practitioner, Dr. Mariana Vergara).
If you now have a ton of questions about thread lifts, you’re not alone. Below, TZR gathered the essential answers from top doctors and a real thread lift patient.
What Are These Threads Exactly?
“They’re filament-like sutures that have little barbs on them, so when you place them into the tissues and pull, you create a little bit of a lift,” Dr. Chaneve Jeanniton, a Brooklyn-based oculofacial plastic surgeon who does thread lifts sparingly in her office, says. “Some people actually call them ‘suspension lifts.’”
The “snatched” effect comes from the lifting capability of “barbed” threads, but smooth threads are used for some techniques (more on that below). The barbs can be hooks, cones, or knots, and they anchor into the subdermal skin layers to lock in the thread tension. It also stimulates collagen production by triggering your skin’s repair reaction — the barbs create controlled micro-injuries — and this helps a fraction of the results last even after the threads dissolve.
Why Do Some Doctors Dislike Thread Lifts?
“Surgeons can get the lifting results better with surgery,” says Dr. Catherine Chang, a Los Angeles-based plastic surgeon who has used threads on patients in the past but no longer treats with them. She also sees other issues: Initial swelling may lend the appearance of lift, but once that goes down, the results don’t seem to last more than a couple of months max (more on that below). She also says the formation of collagen is really the formation of a type of scar tissue, and that is more unpredictable than she’s comfortable with.
“I’ve performed facelifts on people who have had significant threading and there is so much scar tissue,” Chang says. “On one such patient recently, my scissors could not even cut through her tissue.” This isn’t the case with all patients as everyone scars differently, she notes, and just one or two thread lifts should not create this issue.
“There are pros and cons to everything, including surgery,” Chang adds. “If someone has a big event in a month, which isn’t enough time for surgery, that’s an occasion when threads may make sense.”
On the other hand, Halaas turns to this procedure for her own anti-aging and gets thread lifts about every 18 months. “This is what I use to maintain myself so I don’t have to have surgery,” she explains.
Who Is A Good Thread Lift Candidate?
Doctors say the best candidate is a youngish patient in their 30s or 40s. “More so it’s the quality of your skin and how much elasticity you have,” Dr. Ava Shamban, a Beverly Hills dermatologist who started using threads in her practice regularly two years ago, says. “It’s ideal for people noticing very early changes along the jawline or that the nasolabial fold is getting deeper, and they already have enough filler or a naturally full face.” If you plan to get a facelift in the next few years, it’s best to skip the thread lift and save for the surgery as you’re likely past being a good thread candidate — plus undissolved threads can get in the way during the eventual surgical procedure.
Every doctor interviewed was clear that patients should not expect facelift results from threads. “The industry has marketed this far and wide as a ‘noninvasive’ facelift, but we’re talking more like millimeters of lift,” Jeanniton says. “Most patients that request threads actually do better with a little bit of volume replacement.”
Beauty expert and journalist Mickey Williams, 48, received Silhouette InstaLift twice at ages 43 and 46, with Few and Halaas, respectively. “I wanted to get it because I was seeing these jowls forming above my jawline but under my cheekbone, especially when I was talking,” she says. “I only got one thread on each side, but it was like it relocated the cheek fat — everyone thought I lost weight. I loved my results.”
The number of threads used is somewhat dependent on the preference of the practitioner, but the doctors interviewed for this story tend to use more than three as the results become more significant but less than 10 — double-digit threads likely means a patient is more of a facelift candidate.
How Do You Find A Good Practitioner To Do Thread Lifts?
Depending on the state, estheticians and nurses are also allowed to use threads in addition to doctors. But rather than only searching for the cheapest option (never a wise strategy in cosmetic treatments) seek someone with before and afters that match your own aesthetic, and ask to see after photos that are six or more weeks post-procedure. “Never ever trust an after picture that’s immediately after a thread lift because they had to get pumped full of anesthetic to do the lift and that creates volume,” Jeanniton says.
Williams suggests doing research before any consultations, starting with word of mouth recommendations. “You usually pay for a consultation, which many doctors offer as a deposit toward your treatment,” she says. “This can sway you, so keep that in mind.” And if anyone makes you feel pressured or uncomfortable asking questions, that’s always a red flag.
What Happens During A Thread Lift Procedure And Does It Hurt?
All thread lift patients receive injectable local anesthesia and can request topical anesthetic as well. The thread is pre-loaded into a large needle or large cannula that acts as a tube. After making a small incision with a scalpel or needle (a “pilot hole”), the cannula or needle is inserted into the skin at point A, is navigated along the path under the skin where the string will be pulled, and either stops or exits around point B where the end of the thread self-anchors. Then the doctor pulls the cannula out and massages the skin to encourage the cones and barbs to engage.
Other than the feeling of pressure and some “jostling,” patients usually report no pain. Many doctors stop halfway through to show the patient the progress (see Williams’ below). All in all, the entire treatment takes about 45 minutes. You can also do a thread lift and other procedures, such as filler, at the same appointment, which is a common way doctors like to land on a balanced result.
Where Do Doctors Use Threads?
Doctors have license to use threads in all kinds of locations other than lifting the cheeks, such as the neck (like Eva Mendes), along the jawline, along the bridge of the nose to lift the tip, on the outer corners of the eyebrows, and even cross-hatched along the forehead to thicken skin and reduce wrinkling. Some of these uses require the aforementioned smooth threads rather than the barbed ones. Thread lifts are also used to create the “fox eye” look, which pulls and lifts the outer corners of the eyes, but this use has come under scrutiny for appropriation of Asian features.
What Should One Expect For Thread Lift Recovery?
The recovery period is about two weeks, during which you may have bruises and swelling. “I was told to avoid smiling too big for the first two weeks,” Williams says. “When I accidentally would, I would feel a little twinge where the barbs were still settling into the skin. It wasn’t too painful, but I could definitely feel it.”
The real results should be clear in about two to three weeks as the swelling goes down and the threads settle, according to Jeanniton. If you have an event coming up, aim to see your doctor about two to three months before the day (and plan for a couple checkups in between).
How Long Do Thread Lift Results Last?
Depending on the material, they should last from one to three years, according to the American Society of Plastic Surgeons. PPLA threads take longer to dissolve than PDO. The claims on the Silhouette InstaLift site say results peak around six months and can last for up to two years. A 2019 review in the Aesthetic Surgery Journal of 160 patients who received PDO threads found that results declined sharply after six months and were completely absent by one year. Some doctors say results only last a few months regardless of material. Advancements in development include threads coated in hyaluronic acid that can stimulate more collagen production and help the lifting last even longer after the threads dissolve.
What About Risks From A Thread Lift?
Not everyone can stomach the Google search called “thread lifts gone wrong,” but if you’re close to choosing this procedure, it may be worth the education. Compared to many treatments, threads are considered low-risk, but the risks include infection, irritation, too deep of insertion (which could go into the mouth), too shallow of insertion (which could show on the surface of the skin), and too tight of pulling. This is where an experienced practitioner is critical, who will warn you of these risks during your consult.
How Much Will A Thread Lift Cost?
The average national cost is $2,025, according to RealSelf, but this price is dependent on the number of threads used, the experience of your practitioner, and their city of operation. At Shamban’s office, it typically costs $3,000 to $4,000. There are also tales of well-heeled practices that will recommend $20,000 dollars worth of threads, which is nearing the price of an actual facelift with very little likelihood of living up to surgical results. While going cheap is never a good idea with cosmetic treatments, it’s important to weigh the value of the outcome across your spectrum of options.