Thread Lift Complications in a Large Case Series

A 2021 study from a specialist hospital in Beijing reviewed 190 people who came in for help with problems after facial thread lifts done elsewhere. Skin dimpling was by far the most common issue, followed by uneven contours, visible threads, infection and threads poking through the skin. Most problems settled with simple measures or minor procedures, and the authors pointed to technique and anatomy knowledge as the main causes.

Why this was studied

Thread lifts have become popular as a less invasive alternative to surgery, and they are offered in many settings with widely varying training. As more people have them, more complications reach specialist clinics. The authors wanted to describe the types of problems they were seeing and share how they treated them.

What the researchers did

This was a retrospective case series. The team looked back at records of 190 patients, almost all women, aged 28 to 62, treated at their centre between 2014 and 2020. Every patient had received their thread lift at another hospital or clinic. Most had absorbable barbed polydioxanone (PDO) threads, a sizable group had threads of unknown type, and two had permanent threads. Follow-up was arranged for up to 24 weeks after treatment.

What they found

Among the 190 patients, the most frequent problems were:

• Skin dimpling in about 41%, most often on the cheek
• Contour irregularities in about 17%
• Visible or palpable threads in about 16%
• Infection in about 9%, most often after a thread had come through the skin
• Thread extrusion in about 5%

Less common problems included prolonged swelling, temporary partial facial weakness in five people, darkened skin, bruising collections (haematomas) and a single allergic reaction.

Treatment was usually conservative. Many dimples were corrected by gently repositioning the skin or with massage, and a large share of mild cases recovered without any treatment. Most contour irregularities improved with massage within about a month. Visible threads were often simply watched while they dissolved, with a few partially removed. Threads coming through the skin were taken out, sometimes through a small incision. Infections were treated with cleaning, antibiotics where needed and thread removal. All five people with facial weakness recovered within about three to six months, most of them sooner.

Why these problems happen

The authors linked most complications to technique. Threads placed too close to the surface or unevenly, threads crossing the natural ligaments that anchor facial skin, and forceful handling near nerves and blood vessels were all described as contributors. They also highlighted a mismatch between technique and the patient's facial structure and aesthetic goals.

In their words, the main factors are "the operating technique and lack of understanding of facial aesthetics." Our article on how PDO thread lifts work explains how threads are meant to sit under the skin.

The authors' advice on prevention

Beyond technique, the authors suggested that some people may be better served by combining approaches rather than relying on threads alone. They mentioned slower-dissolving thread materials and pairing threads with other treatments such as fat reduction, fat grafting, hyaluronic acid filler or wrinkle-relaxing injections, depending on the face. These are the authors' suggestions from their own practice rather than tested findings. The broader point is that thread lifts work best when they are one part of a plan built around a person's anatomy, not a one-size-fits-all procedure.

How strong is this evidence?

This is a large case series for this topic, which makes it useful for describing the range of problems. But it has important limits:

• It cannot give a complication rate. Everyone in the study already had a problem. The percentages describe what kinds of problems people had, not how often thread lifts go wrong.
• Selected patients. People referred to a specialist centre may have more troublesome problems than average.
• Mixed products. Threads varied, and many were of unknown type.
• Short, informal follow-up. Follow-up was by phone or message, for up to six months.

The setting, in China with procedures done in a variety of outside clinics, may also differ from practice in Canada.

What it means for you

The study is reassuring in one sense: most thread lift problems in this series were cosmetic, and many improved with simple care or time. It is also a reminder that results depend heavily on careful planning and technique.

If you are considering a thread lift:

• Ask about the injector's training and how many thread procedures they perform.
• Ask what type of thread will be used and keep a written record.
• Follow aftercare advice closely in the first few weeks.
• Know how to reach the clinic if something changes.

Thread lifts suit some people better than others. Our articles on who may not be a good candidate and PDO thread complications may help you decide.

Warning signs to report

Contact your clinic promptly for a dimple that deepens, a thread you can see or feel through the skin, or redness, warmth, increasing pain or discharge. Seek urgent care for facial weakness, fever, rapidly spreading swelling, or a swelling that grows quickly after treatment, which may be bleeding under the skin.

Questions to ask at your consultation

• How do you plan thread placement for my face shape and goals?
• What happens if I develop dimpling or a visible thread?
• Would another approach, or no treatment, serve me better?

Frequently asked questions

Does dimpling usually go away?

In this series, many mild dimples resolved on their own or with gentle massage or repositioning. Persistent dimples should be assessed by the treating clinician.

Is facial weakness permanent?

In this study, all five affected people recovered fully within six months. It is uncommon, and any new weakness should be reported right away.

Are some threads safer than others?

This study could not compare thread types fairly. Technique, placement and patient selection appear to matter more than any single product.

If you are weighing a thread lift or have concerns after one, HealthPark Medical Aesthetics can talk through whether it suits you and how complications are handled in a consultation.

Source

Li YL, Li ZH, Chen XY, Xing WS, Hu JT. Facial thread lifting complications in China: analysis and treatment. Plastic and Reconstructive Surgery – Global Open, 2021. Read the study