Thread lift: how PDO threads work, results and risks
How a thread lift works: PDO and other absorbable threads, what they lift and what they only stimulate, recovery, how long it lasts and the real risks.
7 min readEducational content by RejuvelookUpdated in October 2026
In short
A thread lift places absorbable sutures, usually PDO, under the skin with local anaesthetic. Barbed threads lift sagging tissue straight away; smooth threads mainly stimulate it. Satisfaction falls from 98% to 88% by six months, and studies follow patients for two years at most. Complications are usually mild. Marked sagging is better served by surgery.
Key points
- In a 2025 review of 12 studies, absorbable threads improved aesthetic scores immediately in all of them, but follow-up reached two years at most.
- In a meta-analysis of 26 studies, satisfaction was 98% straight after treatment and 88% at six months.
- Swelling (35%) and skin dimpling (10%) are the most common complications; infection and thread extrusion occur in about 2%.
- Barbed threads cause more side effects than smooth or coned threads, and floating threads more than fixed ones.
- Nerve or parotid gland injury is rare and depends on anatomy and technique.
A thread lift promises something many people want: a lifted jawline or cheek without an operation. It can deliver a visible change in the right face. It also has clear limits, and the evidence on how long it lasts is thinner than most advertising suggests. Here is what absorbable threads do, what they cannot do and how to decide whether they suit you, whether you live on the Costa del Sol or spend the winter here.
If you are still comparing every non-surgical option, start with our overview of the non-surgical facelift. This guide goes deeper into threads alone.
What a thread lift is
A thread lift uses fine absorbable sutures placed under the skin through a needle or a blunt cannula. There are no incisions to stitch and no general anaesthetic. The material most studied is polydioxanone, which gives the PDO thread lift its name, followed by poly-L-lactic acid (PLLA) and polycaprolactone (PCL) [2]. All three are broken down by the body over time.
Permanent threads were used in the past, but they fell out of favour. In a meta-analysis of 26 studies, permanent threads caused altered sensation in 11.7% of patients and extrusion in 7.6%, against 3.1% and 1.6% with absorbable threads [1].
Smooth threads and barbed threads
The design of the thread matters as much as the material.
- Smooth threads have no grip. They are laid in the skin in a fine mesh and act mainly by prompting a healing response. They do not lift.
- Barbed or cogged threads carry tiny barbs or cones along their length. These catch the tissue, so the doctor can draw it upwards and hold it in a new position.
Barbed threads produce the lift people come for, but they also cause more side effects. A 2025 systematic review of 19 studies and 1,406 patients found more complications with barbed threads than with smooth or coned ones, and more with floating threads than with threads fixed at one end [3].
What threads lift, and what they only stimulate
The lift from a barbed thread is mechanical. You see it at once, because the barbs are holding the tissue where it has been placed. This is useful for mild to moderate sagging of the cheeks, the jowls and the jawline, which is where most studies have been done [2].
The second effect is stimulation. As the body reacts to the thread, it forms new tissue around it. In an animal study, a barbed PDO thread caused a fibrous capsule to form, and type 1 collagen stayed raised throughout the seven months of the study [7]. How much this adds to a human face is not known. It is a gradual, modest effect on firmness, not a substitute for a lift.
What threads cannot do matters just as much. They do not remove excess skin, and they do not reposition the deeper muscle layer the way a surgical facelift does. They also do not replace lost volume. A face that has lost fat and bone support often needs that support restored first, sometimes with hyaluronic acid dermal fillers, before a thread has anything firm to lift.
How you are assessed
At your consultation the doctor looks at how much the tissue has descended, how thick and elastic the skin is, and where volume has been lost. They pinch and lift the skin by hand to see how it moves, which gives a fair idea of what a thread could achieve. Skin that is very thin or sun-damaged, common after years in the Spanish sun, tends to show threads and dimples more easily.
You will be asked about bleeding or bruising tendencies, medicines that thin the blood, autoimmune conditions, previous threads or fillers, and any facial surgery. Age is not a bar, but it changes the conversation. In the meta-analysis above, patients older than 50 had more dimpling (16% against 5.6%) and more infections (5.9% against 0.7%) than younger patients [1].
The procedure under local anaesthetic
The skin is cleaned and the vectors, the lines along which the tissue will be lifted, are marked with you sitting upright. Local anaesthetic is injected at the entry points and along each path. The doctor then passes the threads at the planned depth, lifts the tissue, checks the symmetry and trims the ends. You are awake throughout and go home the same day.
The planned depth is where anatomy matters. Thread paths cross areas with blood vessels, branches of the facial nerve, fat compartments and the retaining ligaments that hold the face in place. Reviews of thread complications link most problems to technique and anatomy, and report that ultrasound guidance helps reduce gland and vessel injuries [6].
Recovery
Swelling is the most common effect, reported in 35% of patients across 26 studies [1]. In a review of absorbable threads only, bruising, swelling and tenderness were the most frequent complications, while bleeding under the skin and infection were the least frequent [3]. Small puckers near the entry points and a feeling of tightness are also common in the first days.
Your doctor will give you written aftercare. It usually means sleeping on your back, avoiding wide mouth opening, facial massage, dental work and hard exercise for a period, and keeping the entry points clean. Most visible signs settle within days to a couple of weeks. A review appointment checks the result once swelling has gone down.
How long does a thread lift last?
This is where honesty matters most. The lift is real at the start: a 2025 systematic review of 12 studies and 818 patients found that aesthetic scores improved immediately after treatment in every study [2]. But the longest follow-up was two years, and the authors concluded that long-term efficacy data are lacking.
Satisfaction also falls with time. In the meta-analysis of 26 studies, it was 98% immediately after treatment and 88% at six months [1]. An earlier systematic review was more critical: all but two studies showed at best very limited durability of the lift, and those two were sponsored by thread manufacturers [5].
In practice, think of a thread lift as a result measured in months rather than years, which softens as the threads are absorbed. Anyone who quotes you a fixed duration is going beyond what the studies show.
Risks, and who should consider surgery instead
Across 26 studies, after swelling, the most frequent complications were skin dimpling (10%), altered sensation (6%), a visible or palpable thread (4%), infection (2%) and thread extrusion (2%) [1]. A larger review of 59 articles and 14,222 patients found asymmetry, swelling and bruising the most common effects [4]. Most settled on their own. Contour irregularities, infections, inflammatory reactions and injuries to vessels or glands were the exceptions that did not resolve alone.
Serious complications are uncommon but known. They include nerve injury, granulomas, thread migration and injury to the parotid gland, the large salivary gland in front of the ear [6]. In a series of nine patients with parotid injury from threads, all improved with conservative treatment, and the authors suggest locating the gland with ultrasound before treatment [8].
A thread lift is not advisable in pregnancy or while breastfeeding, with an active skin infection in the area, with an uncontrolled bleeding disorder or autoimmune condition, or if you have reacted badly to threads before.
Surgery is usually the better route if your skin hangs in folds, the jowls are heavy, there are marked bands in the neck, or you want one procedure with a long-lasting result. Threads in that face give little, and the change fades. A good consultation tells you this plainly.
How we approach it at Rejuvelook
At our clinic in Fuengirola, absorbable threads are one of the tools our non-surgical mini-lift can use. Whether they suit you is decided at a medical consultation. We look at your face as a whole, explain what threads can and cannot change for you, and often plan them alongside volume or skin treatments within our facial rejuvenation approach.
When threads are part of the plan, we keep it conservative and review the result once it has settled. If your sagging is beyond what threads can reasonably improve, we will tell you, and suggest seeing a plastic surgeon. We see patients in English or Spanish.
What the evidence says
Each statement shows its level of evidence and the sources behind it.
With caveats
- Absorbable threads give an immediate improvement in sagging of the mid and lower face, and most complications are mild and short-lived.[1][2][3]Moderate evidence
- Absorbable threads carry a lower risk of altered sensation and extrusion than permanent ones; barbed and floating threads cause more side effects than smooth, coned or fixed threads.[1][3]Moderate evidence
Not enough support
- A lasting lift has not been shown: follow-up reaches two years at most, and older positive studies were sponsored by manufacturers.[2][5]Low-quality evidence
- New collagen around the thread has been shown mainly in animal studies; how much it adds in people is uncertain.[7]Experimental
- Mapping the parotid gland with ultrasound before treatment may reduce gland and duct injuries, based on case series and expert reviews.[6][8]Low-quality evidence
When to see a doctor
Book a medical consultation, or go to A&E if it is severe or sudden, if you notice:
- Increasing redness, heat, swelling or pain at an entry point or along a thread, or a fever, in the days or weeks after treatment: contact the clinic that treated you the same day.
- The end of a thread showing through the skin, or a lump, ridge or dimple that has not settled after a few weeks.
- Painful swelling in front of the ear or near the angle of the jaw, especially when you eat: this can involve the parotid (salivary) gland and needs checking.
- Weakness when you smile, close your eye or move your mouth, or numbness that is not improving.
- A hot, rapidly spreading swelling with fever and feeling unwell, or sudden facial weakness with difficulty speaking: go to A&E (urgencias) or call 112.
Frequently asked
Does a thread lift hurt?
The entry points and the paths of the threads are numbed with local anaesthetic, so most people feel pressure and a tugging sensation rather than pain. For a few days the face can feel tight and tender, especially when chewing or yawning. Simple pain relief agreed with your doctor is usually enough.
When can I go back to work and social plans?
Many people return to desk work within a few days, using make-up for any bruising once the entry points have closed. For a wedding, a party or photographs, leave two to three weeks so that swelling has settled and your review has taken place.
Can I sunbathe, swim or fly after a thread lift?
Keep away from saunas, hot sun, swimming pools and the sea until the entry points have healed, and use a high-protection sunscreen. Flying is fine, but if you are here for the season, do not plan treatment for the days before you travel home: you need to be around for the review.
Will I be able to feel the threads?
In the first weeks you may feel a slight firmness along a thread, particularly where the skin is thin. This usually fades as swelling goes down and the material is absorbed. If a thread remains noticeable or uncomfortable, tell the clinic: it can often be adjusted.
What if I do not like the result?
Wait for your review first, because early unevenness and small puckers often settle on their own. Unlike hyaluronic acid filler, threads cannot be dissolved with an enzyme, but a thread that is causing a problem can usually be repositioned or removed.
Can threads be combined with fillers or anti-wrinkle injections?
Yes, and it is often more effective than threads alone. Threads reposition, fillers replace lost support and anti-wrinkle injections soften expression lines. Your doctor decides the order and whether anything can be done in the same appointment.
Can a thread lift be repeated?
Yes. Once the threads have been absorbed and the lift has softened, the face can be reassessed and treated again if it still makes sense. There is no fixed interval; it depends on how your face responds and how it continues to change.
References
Sources checked against PubMed or Crossref. Cited as plain text, without links.
- 1.Niu Z, Zhang K, Yao W, Li Y, Jiang W, Zhang Q, et al. A Meta-Analysis and Systematic Review of the Incidences of Complications Following Facial Thread-Lifting. Aesthetic Plast Surg. 2021;45(5):2148-2158. doi: 10.1007/s00266-021-02256-w. PMID: 33821308.Verified on 19 October 2026
- 2.Riopelle AM, Geisler AN, Eber A, Dover JS. Update on Absorbable Facial Thread Lifts. Dermatol Surg. 2025;51(5):509-514. doi: 10.1097/DSS.0000000000004521. PMID: 39662017.Verified on 19 October 2026
- 3.Ojha AS, Farahbakhsh N, Saikaly SK. An Assessment and Comparison of Adverse Effect Rates in Differing Absorbable Thread Lift Suture Materials. Dermatol Surg. 2025;51(3):272-276. doi: 10.1097/DSS.0000000000004466. PMID: 39442180.Verified on 19 October 2026
- 4.Pham CT, Chu S, Foulad DP, Mesinkovska NA. Safety Profile of Thread Lifts on the Face and Neck: An Evidence-Based Systematic Review. Dermatol Surg. 2021;47(11):1460-1465. doi: 10.1097/DSS.0000000000003189. PMID: 34699439.Verified on 19 October 2026
- 5.Gülbitti HA, Colebunders B, Pirayesh A, Bertossi D, van der Lei B. Thread-Lift Sutures: Still in the Lift? A Systematic Review of the Literature. Plast Reconstr Surg. 2018;141(3):341e-347e. doi: 10.1097/PRS.0000000000004101. PMID: 29481392.Verified on 19 October 2026
- 6.Yi KH, Park SY. Facial Thread Lifting Complications. J Cosmet Dermatol. 2025;24(1):e16745. doi: 10.1111/jocd.16745. PMID: 39760325.Verified on 19 October 2026
- 7.Kim J, Zheng Z, Kim H, Nam KA, Chung KY. Investigation on the Cutaneous Change Induced by Face-Lifting Monodirectional Barbed Polydioxanone Thread. Dermatol Surg. 2017;43(1):74-80. doi: 10.1097/DSS.0000000000000925. PMID: 27748691.Verified on 19 October 2026
- 8.Kim JS, Yang EJ, Kim WR, Lee W, Kim HJ, Yi KH. Ultrasound-guided thread lifting for the prevention of parotid gland and diagnosing parotid duct complications. Skin Res Technol. 2023;29(12):e13535. doi: 10.1111/srt.13535. PMID: 38093502.Verified on 19 October 2026
Educational content. It does not replace a medical consultation or provide a diagnosis. Tests and treatments are indicated only after medical consultation and in line with regulation.