Neck Thread Lift

What Is a Neck Thread Lift?

In a neck thread lift, medical threads with small barbs on their surface that grip the tissue are placed under the skin of the neck and the area under the chin; these threads reposition the loose soft tissue. The procedure usually does not require a surgical incision, and no skin is removed. In this respect, it is a different method from a neck lift operation.

The basic idea of a thread lift is to lift sagging tissue by placing barbed threads along specific lines. The threads used for lifting are a different group of materials from ordinary surgical stitches; their composition, purpose and mechanical behaviour are different. Researchers stress that more studies are needed on the method’s safety and long-term effectiveness.

In research, the neck is mostly studied together with the face rather than on its own. According to a comprehensive review of face and neck treatments, thread lifting has spread rapidly; however, its effectiveness is being questioned, and safety and side effects are often not discussed.

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Under the Chin and the Neck Angle

There are two situations that a thread lift in the neck most often targets: fullness under the chin, and loss of definition in the angle between the area under the chin and the front of the neck (the cervicomental angle). A thread lift is known as one of the frequently used, minimally invasive options for fullness under the chin.

Fullness under the chin does not have a single cause. According to researchers who have studied the anatomy of this area, its appearance depends on more than one factor; for this reason, the plan should be tailored to the person’s anatomy, the amount of fat and the type of platysma (the thin, flat muscle at the front of the neck). For example, the platysma fibres from the two sides have been reported to cross over in the middle of the neck in 85% of Korean patients. An expert panel that assessed ageing of the neck and the area under the chin also considers platysma laxity, fat redistribution, bone remodelling and skin quality together.

Where the thread should be anchored is also debated. A technique in which the thread crosses the midline of the neck and runs between the areas behind the two ears was described in a retrospective series of 67 patients; it aims to deepen the angle between the neck and the area under the chin. More recent anatomical studies, by contrast, suggest a dense layer of connective tissue beneath the platysma muscle, below the angle of the jaw, as the anchoring point. Which technique makes sense for whom depends on the doctor’s anatomical assessment.

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Who Was Treated in the Studies?

The few studies of thread lifts in the neck and lower face were carried out in people with mild to moderate laxity or with early signs of ageing. Advanced sagging and marked excess skin were not the subject of these studies.

In one of the neck studies, the midline-crossing thread technique was described in a series of 67 patients; the authors found it most suitable for people with early signs of ageing. Another study, which used dissolvable barbed threads in the lower face, included only people with mild to moderate laxity (27 people in total); it reported improvement in volume measurements along the jawline and under the chin.

Evidence that choosing the right candidate affects the outcome comes from facial treatments. In a retrospective study of 1,500 patients treated with dissolvable polydioxanone (PDO) threads, 3.4% came back because of an unsatisfactory result. Older age and a larger number of threads were each independently linked to dissatisfaction. The researchers recommend a realistic conversation about expectations before the procedure. However, these data relate to the face and cannot be applied directly to the neck.

In short, the research does not set an age or measurement limit; the picture it describes is this: the laxity is mild or moderate, the excess skin is limited, and the expectation is a limited improvement. Whether this picture applies to you is established at a consultation, not from a photo or a description.

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How Much Neck-Specific Evidence Is There?

There is little scientific data on neck thread lifts, and most of it comes from small case series with no control group. No randomised controlled trial (a trial in which patients are randomly assigned to groups) looking only at the neck has been found.

Reviews of the field as a whole are also cautious. In a review that assessed 12 thread lift studies, all but two could show only very limited durability of the lifting effect; the two studies that reported positive results were supported by thread manufacturers. Another assessment covering a ten-year period noted that no new evidence supporting the method had been added. A further review concluded that thread lifting should not yet be adopted as an alternative to a surgical facelift.

Neck-specific publications do not change this picture. In the series describing the midline-crossing technique, the average follow-up was 18 months; the authors stated that their study was level IV evidence, which is one of the lower levels in the hierarchy of evidence. The study that used smooth (non-barbed) dissolvable threads together with hyaluronic acid for horizontal neck lines was limited to 10 patients, and the results were assessed at six months. Another study covering the lower face and the area under the chin noted that the visible lifting effect of dissolvable threads did not last as long as that of permanent (non-absorbable) threads, and that the threads began to be absorbed from the sixth month onwards.

For this reason, it would not be accurate to give a specific duration for how long a neck treatment lasts: the results in the research were obtained with different threads, different techniques and different follow-up periods. If you are considering this procedure, you need detailed information about side effects, how long the effect lasts and the limits of the effectiveness data; researchers also explicitly recommend this.

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Does a Thread Lift Get Rid of Platysma Bands?

No. The vertical bands that appear at the front of the neck when the muscle contracts are not a problem that a thread lift targets. These bands are linked not to excess skin but to the platysma, the thin neck muscle just beneath the skin, becoming more prominent.

In people with little skin laxity but prominent platysma bands when the muscle contracts, botulinum toxin injections are considered as a non-surgical option. An analysis that combined three randomised controlled trials and 912 people reported that botulinum toxin produced a significant improvement in platysma prominence compared with placebo (a dummy treatment with no active ingredient), in both doctors’ and patients’ assessments; the frequency of adverse effects was not found to differ from the placebo group. The everyday word ‘Botox®’ comes from a product name; the scientific name of the substance is botulinum toxin.

According to an expert panel that assessed the neck and the area under the chin, laxity and banding are more often the main feature in people of European descent, and volume build-up in people of African and Asian descent. Laxity and bands can be present in the same neck. In that case, the two findings are assessed separately: a thread lift is not a substitute for a treatment aimed at the bands, and botulinum toxin does not reposition loose tissue.

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Horizontal Neck Lines and Skin Quality

Skin quality and laxity are two separate issues; a thread lift is aimed at laxity. Thinned, wrinkled or dull neck skin does not improve on its own just because the tissue has been moved; skin quality is assessed separately.

Very few publications have looked at using threads for lines running horizontally across the neck. In one study, injections of non-cross-linked hyaluronic acid and smooth dissolvable threads were used together on these lines; 10 patients were assessed at six months and no serious adverse event was reported. However, the study had no control group, and because the two treatments were given together, the contribution of the threads alone cannot be separated out.

A review of fillers and collagen stimulators used in neck rejuvenation, covering 24 studies and 887 patients, reported that hyaluronic acid gels, poly-L-lactic acid and calcium hydroxylapatite showed improvement in neck wrinkles and skin laxity. However, the measures used in the studies were inconsistent, patient numbers were small and long-term evidence is limited. For treatments aimed at skin quality, see the neck and décolletage rejuvenation page.

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Limits of This Treatment

A neck thread lift does not remove excess skin, does not reach the structures beneath the platysma muscle and is not a substitute for a surgical neck lift. Research on neck surgery shows that these deeper structures are dealt with surgically.

A review of deep-plane neck lift operations, covering 57 studies and 8,648 patients, defines the ageing neck by increasing laxity in the soft tissue and displacement of the structures of the neck. According to the researchers, surgical solutions are needed because the response to non-surgical methods varies. The structures most often treated in these operations are the salivary gland under the chin (the submandibular gland), the digastric muscles and the fat beneath the platysma muscle. These structures are not in the layer that a thread placed under the skin targets.

In practice, this means the following: if sagging, folding excess skin in the neck is obvious, a thread does not remove that skin. If fullness under the chin comes from fat beneath the muscle or from the salivary gland, a thread does not reduce that fullness. Vertical bands that appear when the muscle contracts are related to the muscle and are addressed with a separate method. Changes in skin quality are also assessed separately.

Surgery has its own risks too. The same review reported nerve paralysis at rates of 0.2–12% and a collection of blood under the skin (haematoma) at rates of 0.2–4%. The aim of this comparison is not to promote one method, but to help you see what each route offers and at what cost. Your doctor assesses you; the decision is yours.

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The Difference Between Dissolvable and Permanent Threads

Dissolvable threads break down in the body over time, while permanent threads stay in the tissue. Over the years, thread lifting has shifted from permanent threads to dissolvable threads, and this change is being assessed together with safety data.

According to a comprehensive review of thread lifts, early studies using permanent barbed threads reported high rates of repeat procedures and complications; newer techniques using dissolvable threads reported fewer adverse events, but their long-term effectiveness remained unclear. Researchers who have studied thread materials also discuss the effectiveness and duration of dissolvable and permanent threads, and stress that duration is not the only criterion when choosing a thread.

A review covering only dissolvable threads, which included 19 studies and 1,406 patients, found that complication rates varied with the material, the thread’s surface structure and the way it was anchored. Barbed threads were associated with more complications than smooth threads or threads with cones, and threads left unanchored were associated with more complications than threads anchored to a fixed point.

The clinic uses dissolvable threads (PLLA/PDO). PLLA stands for poly-L-lactic acid and PDO for polydioxanone. ‘Thread lift’ is the general name for lifting treatments carried out with threads; the French Thread Lift is one of the techniques within these methods.

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Why Does Neck Anatomy Call for Care?

The angle of the jaw and the upper part of the neck form a transition zone: along the path of the thread lie facial blood vessels, nerve branches, the lower tip of the salivary gland below the ear (the parotid gland) and sensory nerves running close to the skin. In this area, safety depends above all on the thread travelling in the correct layer.

According to researchers who have studied the anatomy of the thread lift under the chin, anchoring the thread to the deep connective tissue layer below the angle of the jaw helps it stay clear of structures such as the great auricular nerve and the parotid gland, and is safer than traditional anchoring behind the ear. In an anatomical study on cadavers, however, the thread path running towards the back of the ear was seen to come close to the deep layers near the angle of the jaw and to pass right next to facial blood vessels; in one specimen, an artery had been pierced directly. The authors of this study state that their recommendations need to be confirmed by prospective clinical studies.

In patients, the consequences of this closeness have been reported at the level of individual cases. In a series of nine patients diagnosed with injury to the parotid gland or its duct after a thread lift, some had tenderness and swelling and others had no symptoms at all; the patients who were followed up improved with conservative (non-surgical) treatment. A single case has also been published in which damage to the nerve of the tongue and throat (the glossopharyngeal nerve) developed due to compression after a lifting procedure on the jowls (sagging along the jawline).

Research on facial anatomy also stresses that knowing the paths of blood vessels and nerves, the fat compartments and the ligaments that hold the tissue in place is necessary to reduce complications. This information is not meant to put you off, but to show why the procedure requires a detailed anatomical assessment.

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Known Risks

The most commonly reported effects after a thread lift are swelling, bruising and pain; these are usually temporary. Problems that appear later and may need correction have also been reported, such as visible or palpable threads (threads you can see or feel under the skin), skin dimpling and uneven facial contours (contour irregularity).

In a review of face and neck treatments covering 59 publications and 14,222 patients, the most commonly reported findings were asymmetry (6,143 reports), swelling (oedema; 453 reports) and bruising (407 reports). Serious effects are rare; they include altered sensation, hair loss and injuries to blood vessels or glands. Most findings go away on their own; the exceptions are contour irregularities, blood vessel and gland injuries, infection and inflammatory reactions.

An analysis that combined a total of 26 studies and 2,827 patients reported the following rates: swelling 34%, bruising 26%, visible or palpable threads 10% and skin dimpling 7%. However, there are large differences between the results of the studies. In the review covering only dissolvable threads, the least frequently reported complications were haematoma (0.64%), altered sensation (1.14%) and infection (2.49%). Another analysis comparing non-surgical facial treatments calculated the rate of treatment-related adverse events after lifting with dissolvable threads as 20%; pain and bruising were reported most often.

These figures relate mainly to facial treatments; no separate rate specific to the neck has been found, and these figures are not the clinic’s own data. According to researchers who have studied complications, common problems often result from unsuitable technique or anatomical factors; persistent or severe cases are treated with massage, injections, botulinum toxin or surgery.

Before the procedure, you will be asked about blood thinners (anticoagulants), antiplatelet medicines (which stop blood platelets from clumping together) and supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor. These risks must be explained to you before the treatment.

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Effect of a Thread Lift on Later Neck Surgery

Non-surgical neck treatments can make a neck lift operation more difficult if one is considered later on. This issue, which is often not discussed when people make their decision, has been reported in research and includes thread lifts.

In a retrospective study of 180 neck lift operations performed by a single surgeon over one year, 123 of the patients (68%) had previously had a treatment aimed at the neck. These included previous neck operations as well as fat-dissolving injections, fat reduction by cooling, energy-based devices and lifting with polydioxanone threads. In patients who had previously had non-surgical treatments, tissue hardening (fibrosis), loss of the natural tissue layers, stiffness of the platysma muscle and deep connective tissue, and unpredictable fat distribution were found during surgery; in all cases, the operation took longer.

The limits of this study are clear: the findings were not analysed separately for thread lifts, the study covers the patients of a single surgeon, and the authors rated it as level IV evidence. Even so, the authors recommend anticipating this situation and informing the patient before the procedure. For this reason, when you are considering a thread lift, a possible future operation should also be discussed.

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