Thread Lift Dimpling and Extrusion: What Research Shows

A short 2020 report described three women who had problems after barbed thread lifts: two developed dimpling of the skin and one had threads working their way out through the skin. Each problem was managed without major surgery, using massage, a needle technique to release tethered skin, or thread removal. It is a tiny series, so it cannot say how often these issues occur, but it is a helpful look at two of the more common thread lift complications.

Why this was studied

Thread lifts use dissolvable sutures with small barbs or cogs, placed under the skin to lift and support tissue. Because the barbs grip tissue, they can sometimes pull the skin in unevenly, creating a dent or dimple. Threads placed too close to the surface, or that are too thick to dissolve well, may also become visible or poke through the skin, which is called extrusion.

The author, a physician writing for an international aesthetic medicine forum, wanted to share practical ways of handling these problems.

What the report describes

The three patients were women in their late twenties to early forties:

• Extrusion. One woman had received threads abroad, of an unknown type. A thread had been coming out through the skin for about a week. The author believed the threads were too thick to absorb properly. They were removed by pulling them out gently in the opposite direction to placement, and the skin returned to a normal appearance.
• Mild dimpling. A second woman developed dimpling from the thread barbs. It was treated with hands-on manual therapy to ease the tension in the thread. The report does not clearly state the result.
• Severe dimpling. In a third woman, the skin was hooked too tightly where the thread exited. Massage did not help, so the dimple was released with a needle technique called subcision over three sessions across three months. The final outcome is not fully described in the available text.

The author also stresses careful planning of how many threads are used, their position, depth and direction, and avoiding key blood vessels, facial nerve branches and the salivary duct in the cheek.

How strong is this evidence?

This is a letter describing three cases, which is about as limited as clinical evidence gets. It cannot tell us:

• how often dimpling or extrusion happens
• which thread types or techniques carry more risk
• whether massage or subcision works reliably

The explanations for each problem are the author's interpretation rather than tested findings, and follow-up was not consistently reported. Larger studies, such as a published series of 190 patients treated for thread lift complications, give a broader picture and suggest dimpling is among the more common problems.

What is subcision?

Subcision is a simple technique in which a needle is passed under the skin to release fibrous strands that are pulling the surface downward. It is also used for some acne scars. In the thread lift setting, it can free skin that has been caught too tightly by a barb or the end of a thread. It is usually done with local anaesthetic, may cause bruising and swelling for several days, and sometimes needs to be repeated, as it was in this report. Like any procedure, it carries small risks, including bleeding and infection.

What it means for you

Dimpling after a thread lift is usually a cosmetic concern rather than a dangerous one. Mild dimples often relax as swelling settles and tissue adjusts. When they do not, gentle manual techniques or, less often, a minor procedure may help. A thread that becomes visible or comes through the skin should be assessed promptly, because an opening in the skin can let bacteria in.

A few practical points:

• Do not pull or cut a thread yourself. Removal should be done by a clinician under clean conditions.
• Follow aftercare advice. Avoiding wide mouth opening, heavy facial massage and pressure on the face in the early weeks helps threads settle.
• Keep records. The first patient's threads were of unknown type, which makes problems harder to manage. Ask for details of what is used.
• Report problems early. Many issues are simpler to fix when caught soon, and an early check costs little if all turns out to be well.

Thread lifts are not right for everyone. People with very loose skin, or those hoping for a surgical-level result, may be better served by other options. See our article on who may not be a good candidate for PDO threads, and our overview of PDO thread complications.

Warning signs to report

Contact your clinic promptly for a thread end you can see or feel poking through the skin, a dimple that is getting deeper, or increasing redness, warmth, pain, swelling or discharge, which may point to infection. Seek urgent care for facial weakness, fever, or swelling that spreads quickly.

Questions to ask at your consultation

• What type of thread would be used, and how long does it take to dissolve?
• What is the plan if I develop dimpling or a thread becomes visible?
• Am I a good candidate, or would another approach suit me better?

Frequently asked questions

Is some dimpling normal right after a thread lift?

Mild bunching or small dimples can appear in the first days and often settle as swelling goes down. Dimples that persist or deepen should be checked.

Can a thread be removed if there is a problem?

Often, yes, especially if it is near the surface or poking through. Removal is easier in the early weeks, before tissue grows firmly around the thread.

Does extrusion mean the lift has failed?

Not necessarily. Removing one problem thread may reduce the lift in that area slightly, but other threads continue to support the tissue.

If you are considering a thread lift or have concerns after one, HealthPark Medical Aesthetics can discuss whether it suits your goals, what the risks are, and how problems are managed.

Source

Wang CK. Complications of thread lift about skin dimpling and thread extrusion. Dermatologic Therapy, 2020. Read the study