Thread Lifting Procedures - What You Need to Know

The thread lifting procedure is a technique that has been around for many decades, but has just began to gain recognition in the cosmetic industry. Thread lifting is used for lifting skin that has sunk due to aging or weight gain. Understanding this procedure can be complicated, as there are different types of threads at different prices. We're going to break down thread lifting procedures and those thread types now.

There are 3 characteristics for threads: Absorption, length and surface texture (Smooth vs barbed). Still confused? Don't worry, we'll explain.

When a thread is "absorbable" it means that over time the thread will break down and be absorbed into the body. The main absorbable thread used is Polydioxanone (PDO) thread, which traditionally was used for surgical stitches and is the material used in cosmetic procedures like the HIKO nose thread lift. This thread was proven to be extremely safe and dissolves around 6 months after the treatment.

There are other absorbable threads as well such as Silhouette Soft thread (popular in Europe and the US) which uses PLLA (Poly L Lactic Acid) and lasts around 12 months. PCL (Polycaprolactone) threads are absorbed 24 months after treatment.

Because the threads stimulate collagen production, choosing a thread with a longer lifetime can be beneficial. However, short-term threads and long-term threads serve slightly different functions. PDO thread lifting (6 months) is used for lifting skin while PLLA (12 months) gives the face a bit more volume. As an example, a person with hollow cheeks might request PLLA, but probably wouldn't use PLLA for their nose.

While absorbable threads will eventually dissolve and lose effectiveness, non-absorbable thread is used to permanently lift your face up . Non-absorbable threads like Aptos (one of the original threads developed for thread lifting), Woffles thread and Contour are made with polypropylene, a type of material that the body can't absorb.

The threads used for treatment will be determined by individual preference, location of procedure and desired length of effect. 

The texture of threads, both absorbable and non-absorbable, is really important to get effective results. Depending on the treatment area, some textures might work better than others or a combination of threads may be used.

The threads can be barbed in one direction only (called Uni-directional barbed threads), barbed in two directions (Bi-directional barbed threads) or non-barbed. Bi-directional threads are favored by doctors due to the thread being locked into the tissue in both directions, anchoring the thread and giving stability. 

These barbs not only make sure the thread doesn't move, but they cause small abrasions in the tissues, triggering the skin to produce collagen to repair itself. This collagen forms a new face shape or facial feature and make the effect more long lasting.

Uni-directional and non-barbed threads can be added to create a structure or a mesh-like net (shown in the diagram in the following section). These two threads can be moved to make adjustments and corrections after the procedure, but eventually must be anchored in the tissue by your doctor.

Non-barbed threads come in two types: monofilament plain and monofilament spiral. Both types are smooth and are used in regions with thin tissue such as around the eyes where you don't want the skin to scrunch up on the surface.

For PDO threads, which are the most popular in South Korea, there are 3 main textures: Mono, Cog and 360 Cog. Mono threads have a smooth texture and are usually used together with other thread types. Cog threads have similar structure as uni-directional barbed thread while Cog 360 has a similar structure to bi-directional barbed thread.

Finally, as research grows in the field, more and more textures are emerging that play on the above basic textures. Sometimes these threads can be braided and then inserted in to the skin to give a different structure and effect. All these techniques are usually unique to the clinic you receive treatment at.

The length of the threads are categorised as being long or short. PDO and all its thread types usually are short in length which is why it is really good for procedures like HIKO nose thread lifting. Barbed threads tend to be longer in length and can be used across the face, neck, chest and even parts of the body.

Thread lifting in Korea is usually done with absorbable threads, particularly PDO. The common thread types used are Mono, Cog, Cog 365, Silhouette and Blue Dia. Cog 365 is formed by the PDO thread being cut to form the cogs while Blue Dia thread is formed using a mold. The mold is shaped to have cogs and the liquid version of PDO is poured in to the mold and once it sets in, the Blue Dia thread is formed. This type of thread is very popular in Korea because the effects last around 2 years while other PDO threads last around 1 year. These threads are also stronger than other PDO threads.

Another popular thread used is Silhouette which uses PLLA, another type of absorbable thread that contains small bidirectional cones that holds on to the skin tissue and stops the thread from shifting. The cones also stimulate the collagen production in the skin and are used for lifting skin that has deep wrinkles and sagging. Clinics will often use a combination of the threads and combine them with other ingredients such as vitamins that are good for the skin and can help with the collagen regeneration process or using fillers to get the desired result.

When we age, our skin and facial fat tend to lose collagen and succumb to gravity, therefore sinking downwards. Youthful skin has that plump look due to the  Thread lifting techniques essentially use threads to pull the sagging skin upwards and promote collagen regeneration. Depending on the thread type used, the effect can be permanent or semi-permanent. 

As shown in the diagram above, the threads can be arranged in a crisscross pattern - always going upwards and to the side of the face, to create a support network for holding the sagging skin up and smoothing out deep set wrinkles. For those wanting a natural lifting effect or for smaller regions such as nasolabial folds, short threads such as PDO threads are used.