CLINICAL

A FINE THREAD

Anna Dobbie considers if it’s time for threads to make a comeback

Thread lifts have long occupied an uneasy position within the sector. Once regarded as the future of non-surgical lifting, they subsequently acquired a mixed reputation fuelled by inconsistent outcomes, over-marketing and poor patient selection. Yet quietly, many experienced practitioners never stopped using them. Instead, they refined their technique, narrowed their indications and integrated threads into layered treatment plans. Today, many practitioners also incorporate multiple thread types within combination protocols, using regenerative threads to improve skin quality before introducing lifting threads where appropriate.

So, is it time for threads to make a comeback?

Four experienced clinicians share their approach, offering insight into how different thread types compare, where they excel and why careful selection remains the single biggest determinant of success.

THE MODERN THREAD LANDSCAPE

Today’s thread market is broadly divided into three categories: polydioxanone (PDO), poly-L-lactic acid (PLLA) and polycaprolactone (PCL) threads.

Each has distinct mechanical and biological properties, and each practitioner interviewed has developed a clear preference.

REGENERATION BEFORE REPOSITIONING

While many conversations around threads centre on lift, Dr Sabika Karim’s main emphasis is increasingly on dermal integrity.

She uses Definisse Revitalise threads, composed of PCL and polylactic acid (PLA), which she places directly beneath the skin to stimulate collagen and improve dermal integrity.

“These are ideal when the goal is improving skin quality rather than lifting,” she explains.

Her preferred indications include the under-eye area, the neck and generalised skin thinning, areas traditionally difficult to treat with volumisation or energy devices alone. Rather than mechanically repositioning heavy tissue, Definisse threads are used to enhance texture, density, and elasticity.

The distinction is important. Where some practitioners view threads primarily as a lifting tool, Dr Karim increasingly sees regenerative threads as a way to strengthen the canvas before considering repositioning.

“If the concern is poor skin texture, thinning skin or early laxity, then revitalisation threads are often the better option,” she says.

This does not mean she has abandoned lifting threads. For structural repositioning, she continues to use Silhouette Soft, a PLLAbased device with cones that anchor and lift superficial tissues. These are reserved for brow elevation, nasolabial fat pad repositioning, jawline tightening and improvement of the submental area in appropriately selected patients.

However, she is clear that lifting threads are not deployed in isolation: “I often describe them as the icing on the cake, not the foundation.”

Before considering Silhouette Soft, she ensures that volume loss is addressed, skin quality is supported, and expectations are aligned. In many cases, Definisse threads may be used before any lifting intervention, particularly where skin thinning would compromise mechanical results, reflecting a broader shift towards regenerative aesthetics rather than purely structural correction.

Her patient selection criteria are strict. Ideal candidates demonstrate moderate laxity, reasonable tissue weight and good baseline integrity. Heavy jowls, significant submental adiposity or severe laxity are a no-no.

“It’s not the patient who chooses the threads,” she adds, “the threads choose the patient. Regenerative support first, structural repositioning second, and even then, only when the patient’s anatomy permits.”

MECHANICAL LIFT WITH COLLAGEN STIMULATION

Dr Zunaid Alli favours Mint PDO threads, manufactured by Hansbiomed, valuing their consistency and the regulatory reassurance that comes with their FDA approval.

“The general rule is to use as many threads as possible to achieve a good degree of lift,” he says, although vector design and placement patterns are individualised.

PDO threads offer an immediate mechanical lift followed by collagen stimulation as the material resorbs over approximately 12 weeks. Clinically, he observes longevity of around 12 to 18 months.

Dr Alli considers the procedure a minor surgical intervention requiring years of refinement, including cadaveric dissection training and a deep understanding of tissue planes: “It takes quite a number of years to become really good and competent.” The most common complication he encounters is asymmetry, followed by puckering from superficial placement. “Surprisingly, there is very little evidence that PDO threads create scar tissue,” he notes, adding that many former thread patients have gone on to successful surgical facelifts.

However, he is unequivocal on limitations: “If there is too much laxity and the lower third is too heavy, PDO threads will not work.”

PDO threads can offer an immediate mechanical effect in some configurations, but they are also widely used for collagen stimulation and improvements in skin quality as the material resorbs.

PLA AND PCL HYBRIDS: BEYOND SUTURES

Dr Shirin Lakhani prefers Aptos threads, composed of PLA, PCL and hyaluronic acid.

“PDO threads primarily act as surgical sutures that create fibrosis to stimulate collagen. PLA and PCL-based threads stimulate more organised collagen synthesis and tend to last longer. They are best described as tissue repositioning, not a facelift.”

Her ideal patients are typically aged 35 to 55 with mild to moderate laxity and relatively slim facial structures. She performs both static and dynamic assessments, including vector testing to determine realistic lift potential.

“Only what can be gently lifted with minimal force is realistically achievable long term.”

Some practitioners aim for a mild degree of immediate overcorrection to compensate for early tissue settling, although this must be carefully judged. Patients should return for reassessment at around three months, once swelling has resolved and collagen remodelling has begun.

According to Dr Lakhani, complications such as dimpling, asymmetry and thread extrusion are largely attributed to practitioner error, though incorrect plane placement or vector miscalculation.

STRUCTURED COMBINATION

Dr Pam Benito has used Silhouette Soft since 2014 and prefers it over cheaper PDO options. While PDO threads are often used to improve skin quality through collagen stimulation, they do not typically reposition sagging tissues in the same way as suspension devices such as Silhouette Soft.

“Just because it’s cheaper, a lot of patients go for that option and then don’t get the results or longevity they expect,” she says.

PDO treatments may also involve significantly higher thread numbers, sometimes 10 to 40 threads, compared with two to four Silhouette Soft threads per side. This higher volume can increase the degree of inflammatory response and tissue trauma, while suspension threads rely on fewer devices to mechanically reposition tissue.

Her protocol is staged and deliberate. She frequently uses biostimulatory fillers such as Ellanse first, waiting two to three months before introducing threads. Alternatively, she may perform a thread lift for immediate repositioning and reassess volume needs later.

She prefers separate sessions rather than combining everything into one appointment, allowing collagen stimulation to develop before layering further treatments: “There is an immediate lift, but the collagen stimulation takes longer to see.”

PDO threads generally resorb within around six months, whereas Silhouette Soft treatments may deliver results lasting between 12 and 18 months, particularly when integrated into a broader treatment plan.

Follow-up typically occurs at four to six weeks and again at two to three months, allowing practitioners to assess how the threads have settled and determine whether additional treatments or adjustments are required. Many patients experience visible benefits for up to a year, sometimes 18 months, particularly when adjunctive treatments maintain skin quality.

WHY THE REPUTATION FALTERED

The reputation of thread lifting procedures began to falter largely due to over-marketing, particularly the widespread use of the term “non-surgical facelift,” which created unrealistic expectations, leading patients to anticipate surgical-level lifting from a minimally invasive treatment.

In addition, poor patient selection, especially in individuals with heavier lower faces or significant skin laxity, led to predictable disappointment when outcomes failed to meet expectations.

Cost-driven decisions also played a role. Some patients opted for lower-priced treatments, in some cases resulting in treatment by practitioners without sufficient expertise in facial anatomy, which contributed to increased complication rates. As more providers began offering the treatment without advanced anatomical training, outcomes became inconsistent.

Thread lifting is a technically demanding procedure. It requires a detailed understanding of retaining ligaments, the SMAS layer, fat pad dynamics, and safe insertion planes. As Dr Karim reflects, “Clinical experience refines technique. I now use fewer threads, placed more strategically, than I did a decade ago.”

SO, COMEBACK OR CAUTION?

Threads will never replicate surgery, nor should they attempt to. However, when used selectively, integrated into combination plans and matched carefully to anatomy, they offer something distinct: subtle repositioning and biologically driven skin improvement without surgical downtime. The difference may not be the technology itself, but the maturity of its application.

Patient selection is stricter, regeneration is prioritised, and expectations are managed. Perhaps this is not a loud comeback, but a quieter evolution. A fine thread indeed – one that, in experienced hands, may still hold its tension.

ANNA DOBBIE

Anna Dobbie is the editor of the patient safety platform Twiqk and the former editor of Aesthetic Medicine magazine. She studied Biological Natural Sciences at the University of Cambridge, and has more than 20 years of experience in journalism. Dobbie now works as a freelance editorial consultant specialising in medical aesthetics.