From 981 procedures recorded in 2020 to 43,817 in 2024 — thread lifting has experienced a 44-fold increase in five years. That growth reflects not just patient demand but the accumulating body of peer-reviewed evidence supporting the safety and efficacy of polydioxanone (PDO) and other absorbable thread technologies. The science is now considerably more robust than critics suggested a decade ago.
Two Mechanisms, One Treatment
Thread lifts deliver results through two distinct but complementary mechanisms. The first is mechanical lifting: barbed or cogged threads inserted under the skin catch the soft tissue and reposition it superiorly, creating an immediate improvement in facial contour. The second — and arguably more durable — mechanism is collagen stimulation: the presence of a foreign body in the dermis triggers a controlled fibrotic response, producing new collagen around the thread over the following weeks and months.
PDO (polydioxanone) is a well-established biocompatible material with a long surgical history — it has been used for sutures in cardiac surgery for decades. When used in aesthetic thread lifts, its gradual absorption by the body (typically over six to eight months) does not mean the end of the result. The collagen scaffolding it leaves behind maintains the improvement for 12 to 24 months or longer, depending on the patient's age, skin quality, and lifestyle.
What the 2023 Research Shows
A 2023 ultrasound analysis published in the Journal of Cosmetic Dermatology provided direct imaging evidence of the tissue changes produced by PDO threads. The study measured soft tissue architecture at baseline and at multiple time points following thread insertion, documenting measurable collagen induction beginning at four weeks and progressing through 120 days. Fibroblast proliferation was observed between weeks 0 and 24, with fibrous connective tissue formation confirming the regenerative mechanism.
A separate 2023 systematic review in the same journal analysed the existing literature on thread techniques, complication rates, and patient satisfaction. While acknowledging that high-quality randomised controlled trials remain limited, it confirmed that thread lifting — when performed with appropriate technique by a trained practitioner — has a favourable safety profile and clinically meaningful outcomes.
Thread Technology Has Advanced Significantly
Early thread lift systems were associated with high complication and revision rates, giving the procedure a mixed reputation in the early 2000s. Modern PDO and PLLA threads bear little resemblance to their predecessors. Molding cog threads (360° moulded barbed designs) provide substantially greater anchoring force than earlier barbed threads, maintaining tissue repositioning more reliably over time. Thread diameter, flexibility, and coating technology have all improved, enabling more complex lifting procedures for the mid and lower face — areas that require both precise tissue purchase and smooth, natural-feeling results.
At Cosmetica, both PDO and Silhouette Soft (poly-L-lactic acid cone threads) are available. Silhouette Soft uses bidirectional cone anchors rather than barbs, providing a different and often more powerful lifting force — particularly for significant mid-face ptosis. The choice between thread types is guided by the degree of laxity, the target anatomical area, and the patient's overall treatment history.
Realistic Expectations and Combination Approaches
Thread lifts are an excellent solution for patients with mild to moderate facial laxity who are not candidates for, or do not want, surgical intervention. They are not a substitute for a facelift in patients with significant skin excess. The best outcomes typically occur when threads are used as part of a planned combination approach — for example, using dermal filler to restore volume loss before threading, or following threads with a course of Profhilo to optimise skin quality and tissue hydration. Tracy will always advise on the sequencing and combination of treatments most likely to produce the result you are looking for.