A Surgeon’s Take

Thread lifts: where does the extra skin go?

I do not perform thread lifts. This page explains why, because the reasoning is worth having before you spend money on one.

A thread lift removes no skin, and the tissue being lifted is never freed from the connective tissue holding it down. That second point is the difference between a thread lift and an operation.

Henry D. Sandel IV, MD, FACS

Double board-certified in facial plastic and reconstructive surgery and in otolaryngology, head and neck surgery. Fellowship trained. Practicing in Annapolis since 2008.

Last reviewed 11 September 2026

Two claims used to sell thread lifts, each weighed against what the technique does and does not do. Two further claims — on downtime and on how long results last — are held back until they can be sourced.

The position

Dr. Sandel, in his own words.

What’s trending

Thread lifts are marketed as minimally invasive facelifts. No skin removed, no long incisions, a short appointment, and a lift you can supposedly see. It is an appealing offer, and it is the reason patients ask about them.

I do not perform thread lifts. This page explains why, because the reasoning is worth having before you spend money on one.

What the procedure actually is

A thread lift uses barbed permanent sutures. The barbs face one direction, so the thread advances when pulled one way and grips when pulled the other. Each thread is introduced through a small incision and pushed into position with a needle. The thread is then drawn up, which lifts the tissue with it, and secured to the fascia beneath the skin.

You may be offered either permanent threads or absorbable ones, which dissolve over months to a few years. The difference matters for how long anything lasts, and not at all for the argument on this page.

Two things do not happen. No skin is removed. And the tissue being lifted is never freed from the connective tissue holding it down.

That second point is the one that matters most, and it is the difference between a thread lift and an operation. In a facelift, the supportive layer is released from its attachments before it is repositioned and anchored. A thread lift skips the release entirely and pulls on tissue that is still tethered.

Where does the extra skin go?

This is the question I would want answered before agreeing to one.

If the threads lifted your skin far enough to make a visible difference, the excess skin would have to go somewhere. Nothing has been removed. So it gathers. That bunching is exactly the pulled, operated appearance thread lifts are marketed as helping you avoid.

Which leaves the procedure caught between two outcomes. Lift enough to see and you get the appearance you were trying to avoid. Lift gently enough to look natural and there is not much to see. In my judgment that is why results are not impressive. The literature does not contradict that: an evidence-based review of the commonly used threads found longevity ranging from months to years, driven more by technique and patient selection than by the thread itself, and concluded that high-quality long-term studies are still needed.⁴

The problems are harder to fix than they look

The problems I see are extrusion of the thread, and erosion at the distal tip through the skin. Visible pulling or tethered skin. Inflammation and swelling around the threads. Infection. None of those resolve on their own, and correcting them is not straightforward.

The published incidence supports that these are not rare events. Pooling 26 studies and 2,827 patients, threads were visible or palpable under the skin in roughly one in ten patients and the skin dimpled in about one in fourteen, alongside swelling in about a third of cases and bruising in a quarter.¹ Other series put thread extrusion at around 2 percent.²

That is a meaningful consideration for a procedure being sold on the basis that it is minor. A treatment marketed as low-commitment should not leave you with something that needs another procedure to put right.

What I do instead

I perform facelifts every week, and the operation is structural. The supportive layer is fully released, repositioned, and anchored to sturdy fixed points, and the skin carries no tension. Excess skin is removed rather than gathered. That is what produces a lift you can see without a result that announces itself, and it is why the result lasts.

For patients who are not ready for surgery, there are non-surgical treatments I do offer and will discuss honestly, including what they can and cannot achieve. What I will not do is offer a procedure I do not believe delivers.

We are candidacy-first. At your consultation Dr. Sandel will examine your face and tell you what would actually change it, what would not, and whether surgery is the right answer for you right now. If it is not, he will say so.

Questions

What patients ask about thread lifts.

Sources

What this page is built on.

Every link is checked to resolve and to support the claim it backs.

Changelog

This page is updated, not replaced.

Reviewed every six months, and whenever the evidence or the conversation changes.

Last reviewed 11 September 2026.

What we do at Sandel-Duggal

I’ll tell you what would actually change your face, and what wouldn’t.

At your consultation I will examine your face and tell you whether surgery is the right answer for you right now. If it is not, I will say so.