What the research shows
Threads are sutures with tiny barbs or cones, passed under the skin through needle punctures to catch the sagging tissue and pull it upward. Early permanent threads had high rates of revision and complications (Tong 2019), and the field has moved to threads that dissolve (Ojha 2025).
The lift is real at first and does not last. In a large consecutive series, the improvement had faded by six months and was gone by one year (Bertossi 2019). Blinded facial plastic surgeons found that thread-only results disappeared over time while results of facelifts, fat grafting and peels held, and they attributed much of the early change to swelling (Abraham 2009). In one surgeon's practice, about a third of thread patients had revision surgery within a year (Garvey 2009). Two reviews a decade apart found no solid new evidence that threads work over the long term (Gülbitti 2018, Atiyeh 2021), and the longest follow-up for absorbable threads is two years (Riopelle 2025).
Most problems are minor, and some last. Bruising and swelling are common; threads that can be seen or felt affect about 1 in 10, and skin dimpling about 1 in 14 (Zhou 2026). Across many clinics, about 1 in 8 had a complication, and the risk rose with each added thread and with age, highest at 60 and older (Okumura 2026). A clinic that repaired threads placed elsewhere treated dimpling, visible threads, infection and some cases of facial nerve weakness (Li 2021). Thread products vary in strength and quality, and some were toxic to cells in laboratory testing (Aitzetmueller 2019).
Energy devices tighten skin by heating it. In a blinded comparison, one fractional radiofrequency treatment improved skin laxity about a third as much as a surgical facelift (Alexiades-Armenakas 2010). A multicenter trial of the same device found about a quarter improvement in wrinkles and laxity at six months, with redness and swelling gone in days (Alexiades-Armenakas 2013). Earlier surface radiofrequency tightened skin gradually over about three months with no downtime (Ruiz-Esparza 2003).
These treatments can make later surgery harder. Necks treated with threads, fat-dissolving injections or radiofrequency devices were scarred inside at a later neck lift; the operation took longer and contour irregularities were common afterward (O'Daniel 2026).
Where surgeons disagree
- How long threads last. A prospective study reported lifts that held for two years with few complications (Ali 2018); consecutive series found the lift gone at a year (Bertossi 2019). In one review, the two favorable studies were sponsored by thread makers (Gülbitti 2018).
- Threads or filler for the fold beside the mouth. In a randomized comparison, cheek filler satisfied more patients than threads (El-Mesidy 2020).
- Suture suspension of the neck. A suture placed through small punctures under light guidance tightened mild neck laxity and cords with few complications, but it does not treat extensive loose skin or excess fat (Gomez 2023).
What is new
- Dissolving threads have replaced permanent ones; barbed threads caused more problems than smooth or coned ones (Ojha 2025).
- Pooled across studies, side effects after dissolving thread lifts were about as common as after upper-face toxin and less common than after lower-face filler (Cruz 2026).
- A risk score built from the number of threads and the patient's age now predicts who is likely to have a complication (Okumura 2026).
What is still unknown
- How long dissolving threads keep any lift: there are no long-term efficacy data (Riopelle 2025).
- How threads and devices compare with a facelift over years: reviews find too little solid evidence to say (Atiyeh 2021).
Key papers
- Ruiz-Esparza 2003: early radiofrequency skin tightening without surgery.
- Abraham 2009: blinded reviewers found thread-only results did not last.
- Garvey 2009: high, early revision rates after thread lifts.
- Alexiades-Armenakas 2010: radiofrequency against a facelift, graded blind.
- Gülbitti 2018: a decade of thread studies added little evidence.
- Bertossi 2019: the thread lift was gone by one year.
- Okumura 2026: complication risk rises with thread count and age.
- O'Daniel 2026: nonsurgical neck treatments complicate a later neck lift.