Thread lifts are a versatile treatment that can be used to rejuvenate and enhance various areas of the face, neck and body, although they are particularly effective to lift the lower face and improve the jowls. However, they can be used in any area prone to sagging or volume loss due to ageing.

• Cheeks
• Jowls/jawline
• Eyebrows
• Nasolabial folds (nose to mouth lines)
• Marionette lines (lower corners of mouth)
• Neck
• Abdomen
• Buttocks
• Inner thighs
• Breasts
• Knees
• Upper arms

Ensure your practitioner is experienced in performing thread lifts.

Threads are fully biocompatible and biodegradable and depending on thread characteristics and thickness are gradually reabsorbed over the course of 6–12 months. The threads naturally break down into water and carbon dioxide, which are safely absorbed by the body and as the threads dissolve, the collagen framework they stimulated remains, maintaining the skin’s improved appearance for an extended period.

There are various types of PDO threads designed for specific purposes:

• Mono Threads: Smooth threads that stimulate collagen production and improve skin texture without a specific lifting effect. These are often used in conjunction with lifting threads to provide more structure and support.
• Barbed, Cog or Anchor Threads: Threads with tiny barbs or projections that grip the tissue, providing a physical lifting effect. As the threads are pulled or tightened, they pull the tissue and skin up and hook onto the tissue above, creating a lifting effect. Depending on the manufacturing process (extruded or cut sutures, 3D or 4D positioning, single or double barbs) and thread thickness gives the lifting capacity of the thread.
• Screw Threads: Threads twisted into a spiral shape to add volume and stimulate collagen in targeted areas, they provide increased collagen compared to mono threads and some can be tightened when they are inserted to create a temporary lift.

Often multiple threads are inserted at the same time, either through the same entry point or in different areas. When inserted through the same site, the lifting effect can be much greater due to the combined action of the individual threads.

Your practitioner will choose the appropriate type of threads and number required based on your treatment goals and the area being treated.

Thread lifts are generally well-tolerated, as they are minimally invasive procedures, but are usually more uncomfortable than other non-surgical cosmetic procedures. Anaesthesia is often used, which might include either a topical anaesthetic, such as LMX4 or Emla™, which can be applied for 20-30 minutes to provide some numbness if large amounts of mono threads are being applied. Alternatively, local anaesthetic is often injected at the entry site for threads, particularly if a blunt-ended cannula is being used and a needle entry point is made. Some practitioners will also inject local anaesthetic along the path where the threads will be inserted to provide more comfort during the procedure. You are likely to feel some discomfort during the actual lifting, which feels like a tugging or pulling sensation and can be a little unpleasant but is short lived.

After the procedure, mild soreness, swelling, or tenderness may occur, but these effects usually subside within a few days. Over-the-counter pain relievers, such as paracetamol, can be used if needed, but your practitioner will provide detailed aftercare instructions to help ensure a smooth recovery.

Some patients may experience more pain than others after the procedure, including discomfort with opening and closing the mouth and eating, leading to the possibility of needing a softer diet in the first few days. It is not uncommon to feel a sudden, snapping type sensation in the days following treatment, this is momentary and nothing to worry about and is usually caused by some repositioning of a thread and not from it snapping.

Finally, there may be nerve irritation or damage during the insertion of the threads which can cause nerve pain that may last several months.

Thread lifts are generally considered a safe and minimally invasive procedure when performed by a trained and qualified practitioner. However, as with any cosmetic procedure, there are risks and considerations to keep in mind.

Side-effects may be more likely due to the following factors:

• Patient factors: Unrealistic expectations, too much or too little sagging, large volume loss, considerable sun damage or crepey skin, certain medical conditions, lifestyle/downtime issues.
• Practitioner factors: Training, years of experience, number of procedures performed.
• Premises factors: Suitability of the premises, registered premises.

Ensure that you are provided with an out of hours number in case of an emergency.

While thread lifts are generally considered safe, like any procedures, there are possible risks.

• Swelling/Oedema: Swelling is very common immediately after treatment due to the trauma and inflammation caused by the procedure. It may be more obvious on one side compared to the other resulting in some distortion and asymmetry. This usually settles within about 48 hours, and you may be advised to take anti-inflammatory medication if it is safe to do so or to apply a cool pack.
• Bruising: This is very common and may be a small bruise at the entry site or a large bruise extending down the whole area. It may be caused when the threads are inserted or more commonly when the threads are tightened and the barbs snag a small blood vessel, so it might only be noticeable after the procedure has finished. Bruising usually settles within a few days but can take several weeks.
• Haematoma: A haematoma is a collection of trapped blood beneath the skin which can result in a solid lump, often along the course of a thread. They resolve completely on their own but can take a few weeks. Although uncommon following treatment, if you can feel a thread, it is usually due to this phenomenon.
• Skin irregularities: Following treatment, there may be some dimpling at the entry or exit sites or some ruffling or puckering along the course of the thread lift due to the skin contraction. The risk is higher when a greater lift is achieved, when the skin is thinner, there is less volume and if there is a lack of collagen and elastin. A small amount of irregularity will usually settle spontaneously within a few days but for more significant problems, some massage or reverse traction may be needed, and you should contact your practitioner for further advice.
• Infection: Infection can take several days to become apparent and often develops as a warm, red, swollen area, sometimes with a yellow, pus-like discharge, over the area that has been treated. If this happens, make sure you contact your practitioner for a review as soon as possible.
• Asymmetry: This can be caused by asymmetric traction, increased swelling or bruising on one side compared to the other or a pre-existing problem. If it does not settle within a few days, it is recommended to arrange a review with your practitioner for further advice.
• Pain/Neuralgia: Discomfort following the procedure is quite common and the treatment area may be quite tender and particularly with facial expressions, eating and talking, however, in most situations any pain is easily manageable with analgesia and settles relatively quickly. If a thread causes some inflammation or damage to a nerve, this can result in neuralgia which can be painful and last for weeks or months in some situations.
• Visible thread: Sometimes you may be able to see the thread through the skin or an outline where it has been tightened, this is usually due to incorrect placement of the thread, and you should see your practitioner for help in the management of this complication.
• Thread palpable: If the thread has not been trimmed correctly if may be felt at the surface of the skin or just below the surface. This can create irritation and infection and may need to be trimmed further. If this occurs, you need to arrange a follow up appointment with your practitioner.
• Thread breakage/slippage: It is important to diligently follow your aftercare to prevent any thread slippage or migration. Breakage is extremely rare with modern threads.
• Parotid gland injury: This may manifest as pain in the cheek, pains with eating or drinking or swelling and redness of the cheek. If this occurs, see your practitioner as you may need a referral.

If you develop any unexpected side-effects after treatment, it is important to contact your practitioner for a review as soon as possible, as they may be able to offer some corrective treatment. Although your practitioner may contact you by telephone or video call initially or you may send your own photographs, this is no substitute for a face-to-face review to provide an accurate diagnosis.

Prior to your treatment you should be given a full consultation, complete a medical questionnaire and be offered a cooling off period to enable you to make an informed decision with full disclosure of the possible risks and side effects specific to you. You should also be given an indication of the cost of the treatment. Before you receive any treatment, you will be required to sign a consent form, this may be on paper or electronic, and be given the opportunity to ask any further questions. Photographs should be taken and kept as part of your medical record. These should not be used for any other purpose without your explicit permission.

For thread lifts, we do not recommend having the procedure on the same day as the consultation.

The practitioner will perform an examination of the area to determine the most appropriate treatment plan.

They will advise on what type and number of threads that will be required to perform the treatment as well as whether they will be using a needle, a cannula or both. It is important to have realistic expectations about what thread lifts can achieve.

If a topical anaesthetic cream is to be used, this will be applied and removed after 20-30 minutes to allow it to take effect. The area to be treated will be cleaned, makeup removed if worn and then disinfected.

During the procedure, thin threads are inserted just beneath the skin using a needle or cannula. Prior to applying the threads, local anaesthetic may be injected at the entry point and further anaesthetic may be deposited along the area of the face or body where the threads are going to be administered. You should allow a few minutes for the anaesthetic to take effect. The threads are strategically placed to lift and tighten specific areas of the face or body. There may be several threads, at different sites, including a combination of barbs, monos and screws.

Once the threads are in place, they need to be tightened, this involves applying some forward traction on the threads and some backword traction on the skin. This process may need to be done several times in each area and the practitioner may use forceps to aid this tightening. It can also be quite an unpleasant sensation for the patient. The placement of the threads creates an instant lifting effect, improving sagging skin and facial contours. The physical structure of the PDO threads provides mechanical support to the skin, helping to lift and hold it in a more youthful position. This immediate effect is particularly beneficial for areas with mild to moderate sagging, such as the cheeks, jawline, or neck. After achieving an acceptable lifting result, the threads need to be trimmed so the ends are below the surface of the skin and buried within the tissue where they will not cause any irritation. This may involve applying further traction to the threads whilst pushing the skin down with a pair of curved scissors prior to cutting. It is important to trim the threads accurately to reduce the risk of complications. The practitioner may sit the patient up to review the lifting to either further tighten or slacken off the threads and ensure symmetry during the procedure.

Following the procedure, the skin is cleaned again, pencil marks that may have been used for marking out wiped off and a topical antibiotic may be applied at the injection sites.

Be prepared, you may have some over-correction, swelling, bruising, puckering, tethering and asymmetry when you look in the mirror immediately after treatment, your practitioner will advise you on aftercare, downtime and when you can expect these side effects to settle.

Treatment results are often more successful when the skin is in a good condition, with minor sagging and without significant volume loss. Thread lifts are ideal to be used in conjunction with other aesthetic procedures such as dermal fillers, anti-wrinkle treatments, laser skin tightening and skin surface treatments.

You may not be suitable for treatment if any of the following apply:

• Thread lifts should not be performed on pregnant or breast-feeding women and is not recommended if you are actively trying to get pregnant or undergoing IVF.
• Allergic reaction to a previous thread lifts treatment or allergy to anaesthetic agents.
• If you are suffering from any skin infection in or near the treatment area, including cold sores.
• If you are unwell, including coughs and colds, on the day of treatment.
• If you have certain medical conditions, such as diabetes, rheumatoid arthritis, autoimmune conditions, blood clotting disorders, cancer, immunosuppression (either medical or drug-related).
• If you are taking any medicines which affect bleeding, such as aspirin or warfarin.
• If you suffer from keloid scarring or have active skin conditions, such as acne or psoriasis.
• If your practitioner does not feel they can meet your treatment expectations.
• If you have had Roaccutane or isotretinoin in the past 6 months.
• Recent facial surgery or other dermal fillers in the same area.

It is important to be honest about your medical history, previous surgery, previous or planned dental treatment and any medication taken, so that you can have a safe and effective treatment.

• Avoid taking anti-inflammatories (such as aspirin, ibuprofen, naproxen) for 3 days prior to treatment (unless this has been prescribed by your doctor) as this increases the risk of bruising.
• Alcohol, fish oils, St. John’s Wort, Gingko Biloba, garlic and Vitamin E should also be avoided for 3 days prior to treatment to lessen the risk of bruising.
• If you are prone to bruising, taking arnica orally for a few days prior to treatment may lessen the risk.
• If you are unwell on the day of your appointment, contact the practitioner to reschedule.
• Ensure your practitioner is informed if there are any changes in your medical history or medication taken before receiving any treatment.
• Make sure you have allowed some days after treatment for downtime for any side-effects to settle.

Do not plan to have treatment within 3 weeks of an important social event or holiday as this may not allow enough time for side-effects, such as bruising to settle, or to have a review appointment.

Immediately after treatment there may be some swelling, redness, itching and tenderness.  This is a normal result of the procedure and will settle.  The swelling may remain for up to a few days, the other symptoms usually settle more quickly. There can be bruising after the procedure and the risk of this is higher if you have used aspirin or anti-inflammatory drugs such as ibuprofen within the last two weeks.  Bruising can be quite marked in some instances and the application of ice following treatment may reduce this.

Attention to aftercare is paramount to achieve your desired results!

Many practitioners advise the following:

• Do not apply make-up for 12 hours after treatment to reduce the risk of infection.
• Impact exercise, such as running, should be avoided for up to 3 weeks.
• Avoid heavy lifting, vigorous exercise, or activities that increase blood flow to the face, such as saunas or hot baths, for at least 2 weeks.
• Try to avoid touching or massaging the area for 3 weeks unless specifically instructed to do so.
• Avoid applying pressure to the face and try to sleep on your back and slightly elevated at 30 degrees for the first 3 nights.
• Keep facial movements to a minimum for 3 weeks, this includes excessive chewing, talking and yawning.
• Avoid drinking through a straw and keep smoking or vaping to a minimum.
• If touching the face or applying make-up, ensure you do this in an upward motion in the same direction as the lifting effect.
• Cleanse your face gently with a mild cleanser and avoid scrubbing or exfoliating the area.
• Refrain from facial treatments like massages, facials, or chemical peels for at least two weeks.
• Contact your practitioner if you experience any unwanted side-effects.

Ensure you know the following information:

• Practitioner’s full name
• Practitioner’s profession (doctor, dentist, nurse, midwife, or pharmacist)
• Practitioner’s contact details (address, telephone number, and email)
• An emergency contact number if a complication arises.

Practitioners should be registered with a professional body (General Medical Council, General Dental Council, Nursing and Midwifery Council, General Pharmaceutical Council or Health and Care Professions Council) and you can check their current registration status online. Practitioners are accountable to these bodies and are legally required to have indemnity insurance in place for all the treatments they perform.

If you are not happy with your treatment outcome, you should attempt to resolve this with your treating practitioner in the first instance. If you need to see a different practitioner, you are entitled to receive a copy of your treatment record outlining the product used, areas injected and dosage, as well as any photographs that were taken, to have your concerns addressed safely. However, remedial treatment may not always be possible and sometimes it may be necessary to allow time for the treatment to wear off.