Thread Lift Complications: Mechanisms, Management and Prevention

A 2025 review in the Journal of Cosmetic Dermatology gathered what is known about complications after facial thread lifting, from everyday bruising to rarer problems such as nerve or salivary gland irritation. Its main message for patients is reassuring but practical: most problems are minor and settle, and many of the more troublesome ones can be traced back to how deep the threads sit and how much tension is placed on them.

Why this was studied

Thread lifting uses fine absorbable sutures, often with small barbs or cones, placed under the skin to reposition soft tissue. It has become popular because it does not involve surgical incisions. That popularity has also brought more reports of side effects, and the techniques, thread designs and injector training vary widely.

The authors, Korean anatomists and clinicians who have published widely on facial anatomy, wanted to bring together the complications seen in practice and explain the anatomy behind each one. If a complication has a clear mechanism, it is usually easier to prevent.

What the researchers did

This is a narrative review. The authors drew on clinical studies, case reports and expert recommendations, along with their own clinical cases, and organized complications by type. They also discussed how ultrasound might help injectors see important structures before placing threads.

A narrative review is not the same as a systematic review. It did not follow a formal search protocol, and it does not combine data from many studies to give an overall complication rate. Think of it as an experienced team's structured explanation rather than a precise measurement of risk.

What they found

The review sorted complications roughly from common and short-lived to uncommon and more serious.

• Expected short-term effects: bruising, swelling, tenderness and a feeling of tightness, numbness or itching. These usually settle with routine aftercare.
• Dimpling and puckering: described as the most frequent problem needing correction, especially in the cheek. Threads placed too close to the surface, thicker threads and too much tension were the usual culprits. Mild dimples often fade as swelling settles; persistent ones may need a simple in-office correction.
• Bulging, visible or palpable threads, and thread migration: linked to over-tightening, shallow placement or poor anchoring. Threads that poke out can often be removed through a tiny opening.
• Infection and granulomas: small inflammatory lumps can form if threads are too superficial or if sterility is compromised. Removing the thread is often part of treatment.
• Nerve and gland irritation: the authors cite an incidence of about 6% for irritation of the great auricular nerve, a sensory nerve near the ear, when threads are placed in the neck region. Most cases recovered without surgery. Irritation of the parotid (salivary) gland can cause one-sided swelling a few days later, often worse around meals, and cited reports describe these cases improving with conservative care.

For prevention, the authors emphasised a few themes: keep threads in the correct tissue plane, avoid running threads along major blood vessels, use blunt cannulas where possible, keep strict sterile technique, and check patients one to two days after treatment because swelling can hide early dimpling. They also argued that ultrasound mapping before treatment could become more routine.

How strong is this evidence?

This review is useful for understanding why complications happen, but it cannot tell you exactly how often they happen to a typical patient. Apart from the nerve figure, it does not offer pooled rates, and much of the material comes from the authors' own clinical experience and from individual reports.

Complication rates also depend heavily on the type of thread, the area treated and the injector's training. A single figure from one setting may not apply elsewhere. The value of a review like this is that it gives patients and clinicians a shared vocabulary for what can go wrong and what reduces risk.

What it means for you

If you are considering threads, the most useful takeaway is that many of the bothersome outcomes, such as dimpling, visible ridges or bulging, relate to technique: depth, direction and tension. A cautious plan that does not try to pull too much in one session is generally safer than an aggressive one.

It also helps to know what is normal. Some tightness, mild swelling, bruising and a slightly uneven look in the first several days are common. Our article on what to expect during thread recovery walks through the usual timeline, and PDO thread complications covers warning signs in more detail.

Contact the clinic promptly if you notice increasing pain, warmth or redness along a thread path, fever, a thread poking through the skin, one-sided swelling near the jaw or ear that worsens with eating, or new weakness in facial movement. These are uncommon, but early review makes them easier to manage.

Threads are not for everyone. People with very heavy or loose skin, active skin infection, certain bleeding risks, pregnancy, or expectations closer to a surgical result may be better served by another option or by no treatment. Our article on who may not suit threads explains this further.

Questions to ask at your consultation

• What type of thread do you plan to use, and why that type for my face?
• Which complications are most relevant to the area I want treated?
• Will you check me in the first few days afterward?
• What would you do if a dimple, lump or visible thread appeared?
• Is there a reason threads might not be a good fit for me?

Frequently asked questions

Is dimpling after a thread lift permanent?

Not usually. The review notes that mild dimpling often improves as swelling goes down, and that persistent dimples can usually be corrected. Let your clinician see it rather than massaging or pressing on it yourself unless you have been told to.

Can a thread be taken out if there is a problem?

In many cases, yes. The authors describe removing protruding or palpable threads through a very small opening. How easy this is depends on the thread type and how long it has been in place.

Does ultrasound make thread lifting safer?

The authors believe ultrasound can help identify structures such as the parotid gland and larger vessels before treatment. It is a promising tool, but it has not yet been shown in large studies to reduce complication rates, and it is not standard everywhere.

If you are weighing whether threads suit your goals, HealthPark Medical Aesthetics can talk you through the realistic benefits, the risks above and alternatives, including choosing not to treat. A careful conversation before treatment is the most important safety step.

Source

Yi K-H, Park SY. Facial thread lifting complications. Journal of Cosmetic Dermatology, 2025. Read the study