Pulling Strings: Threads 101
By Dr Victoria Manning, aesthetic and longevity doctor | Bournemouth, Lymington and Harley Street, London
Thread lifts were one of the hot topics when I joined Olivia Falcon, Professor Sandip Hindocha and Dr Dan Wright on the HELLO! Aesthetics Guide panel in October 2026. Here's what I shared, and what I tell patients in clinic every week.
I've been performing thread lifts since 2012, using both PDO threads and Silhouette Soft, and I train other practitioners internationally.
Key takeaways
A thread lift repositions sagging tissue. It doesn't replace lost volume or fix thin skin.
Facial ageing happens in three layers: volume loss, loss of collagen and elastin, and sagging.
Menopause and rapid weight loss speed all three up.
The best results come from treating every layer, for example Ultherapy, collagen stimulators and threads together.
Threads aren't right for everyone, and a good practitioner will tell you when they're not.
How does the face age?
Facial ageing isn't just wrinkles. Three things happen at once:
Volume loss. The fat pads that support your face shrink, and the bones of the face slowly lose density. Cheeks flatten and temples hollow.
Loss of the extracellular matrix. Collagen, elastin and hyaluronic acid give skin its strength and bounce. Skin collagen falls by around 1% a year from early adulthood.
Sagging. The ligaments that anchor the face stretch, and the deeper supporting layer (the SMAS) loosens. Tissue moves down, creating jowls and heavier folds around the mouth.
How do menopause and weight loss affect the face?
Menopause: oestrogen supports collagen production. Women can lose around 30% of their skin collagen in the first five years after menopause, so skin becomes thinner and laxer quite quickly.
Weight loss: losing weight quickly, including with weight-loss medication, reduces facial volume. Research suggests mid-face volume falls by around 7% for every 10kg lost. Early studies also suggest the thin layer of fat inside the skin, which helps it repair and renew, becomes less active. Skin doesn't bounce back on a schedule.
What does a thread lift actually do?
Dissolvable threads are placed under the skin to lift sagging tissue back into position. The two main types I use are PDO (polydioxanone) threads and Silhouette Soft, which is made from PLLA and PLGA and also stimulates collagen as it dissolves.
What a thread can't do is replace lost volume or rebuild thin skin. Without support underneath, the lift has nothing to hold on to, which is why threads alone can disappoint.
Who is a good candidate for a thread lift?
Early to moderate sagging, such as early jowls or a dropped mid-face
Reasonable skin quality and some facial volume, or both restored first
A stable weight
Wanting a natural refresh rather than a dramatic change
Who isn't suitable for a thread lift?
People with a lot of loose or excess skin, who are likely to get better results from surgery
Very thin skin with little volume, unless that is treated first
Anyone still losing weight
Anyone planning a surgical facelift in the next 18 months or so. Threads can leave scar tissue that makes surgery more difficult, so I'd usually advise saving for the operation instead.
People with autoimmune or connective tissue disease, or an active skin infection
Anyone hoping for the result of a surgical facelift
I also no longer use threads to lift the neck, as I don't feel the benefits outweigh the risks there.
When should you see a surgeon instead?
A good non-surgical practitioner should tell you when surgery is the better option. I'll refer you to a surgeon if:
You have significant excess skin or heavy jowls
You have marked loosening or banding in the neck
You're having the same treatment repeatedly with less and less benefit
You've lost a lot of weight and the skin is truly excess rather than just lax
You want a bigger, longer-lasting result than non-surgical treatments can give
Why combine treatments?
Because the face ages in layers, the best results come from treating each layer with the right tool. This is often called treatment stacking. My favourite combination is:
Ultherapy to tighten the SMAS, the deep supporting layer, using micro-focused ultrasound to stimulate new collagen
Collagen stimulators to restore volume and rebuild your own collagen over time: Ellansé for immediate support plus longer-term collagen, or Sculptra or Juläine for a more gradual improvement in skin quality and firmness
Threads (PDO or Silhouette Soft) to lift and reposition tissue that has descended
Together they address tightening, volume and lift. Each treatment helps the others work better and last longer.
What results can I expect, and how long do they last?
Expect a subtle, natural lift: people tell you that you look well, not that you look different. The lifting effect of dissolvable threads typically lasts around 12 to 18 months, and the collagen benefit can last longer. Results vary from person to person.
Frequently asked questions
Is a thread lift the same as a facelift?
No. A thread lift gives a modest, temporary lift without incisions. A surgical facelift removes excess skin and gives a larger, longer-lasting result.
Are thread lifts painful?
They're done under local anaesthetic. Most people feel some tightness and tenderness for a week or two.
What are the side effects of a thread lift?
Bruising, swelling, tightness and temporary dimpling are common and usually settle within days to a couple of weeks. Infection, asymmetry or a thread being felt under the skin are less common.
Can I have a thread lift after weight loss?
Yes, once your weight has been stable for a few months and any volume loss and skin quality have been addressed first.
Does menopause affect thread lift results?
Thinner, laxer skin after menopause holds a lift less well. Supporting collagen first, and considering hormonal health, gives better results.
I'm thinking about a facelift. Should I have threads first?
If you're planning surgery within the next 18 months or so, I'd generally advise against threads. They can leave scar tissue that makes surgery more difficult, and your budget is better spent on the operation.
Have you had a thread lift, or are you thinking about one? Share your questions or experiences in the comments, or come and see me for a consultation to find out which combination would suit you.
About the author: Dr Victoria Manning (Dr Vix) is a doctor with 30 years' medical experience and more than two decades in aesthetic medicine. She is a global trainer and Key Opinion Leader for Sinclair Pharma, manufacturer of Ellansé and Silhouette Soft, and author of Busting the Code to Ageing: How to Win the Inflammation Game. She practises in Bournemouth, Lymington and Harley Street, London.
This article is for information only and is not individual medical advice. Book a consultation to discuss whether a treatment is right for you.
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