Multicenter Review of More Than 110,000 Facial Thread Lifting Cases From a Cosmetic Surgery Group

Abstract

Background:

Thread lifting is a minimally invasive aesthetic procedure that has gained popularity for facial rejuvenation. However, large-scale multicenter studies assessing trends, patient characteristics, and procedural variations are limited. This study aimed to evaluate longitudinal changes in facial thread lifting use, patient demographics, procedural composition, and combination treatments across a nationwide cosmetic surgery network during a 5-year period.

Methods:

We retrospectively analyzed 111,948 facial thread lifting procedures performed between 2020 and 2024 across more than 100 Tokyo Central Cosmetic Surgery Group clinics. Statistical analyses included the Kruskal–Wallis test with Bonferroni-adjusted post hoc comparisons for age-related trends.

Results:

Procedure volumes increased during the 5-year period, as did the median patient age (P < 0.001), with procedural patterns shifting toward an older demographic. Seven procedural combinations were identified, with polydioxanone + polycaprolactone threads being the most common. The use of nonabsorbable threads increased substantially, with more than 60% of patients undergoing thread lifting with additional treatments, such as fillers or toxins.

Conclusions:

Thread lifting is increasingly used as part of multimodal facial rejuvenation strategies, with trends toward older patient populations and broader procedural integration. These findings highlight the evolving role of thread lifting in evidence-based aesthetic medicine.

Takeaways

Question: How has the use of facial thread lifting evolved during a 5-year period in terms of patient demographics, procedure types, and combination treatments?

Findings: In a 5-year multicenter analysis of more than 110,000 cases, thread lifting procedures increased annually, with an increase in patient age and the use of combined thread types and adjunctive treatments such as fillers and botulinum toxin.

Meaning: Facial thread lifting has shifted from a simple lifting technique to a core strategy in personalized, multimodal facial rejuvenation, particularly for older patients, highlighting its role in modern aesthetic medicine.

INTRODUCTION

Thread lifting is a minimally invasive aesthetic procedure used to improve sagging in the midface and jawline by inserting specialized threads under the skin to lift and support soft tissues mechanically. Unlike surgical face lifts, thread lifting can be performed without incisions and has a shorter downtime, making it increasingly popular across a wide range of age groups.

Thread lifting originated in the 1990s using nonabsorbable polypropylene threads, which maintain tensile strength over long periods. These threads offer prolonged lifting effects; however, they are associated with risks such as infection, extrusion, and foreign body sensation. Nevertheless, with appropriate patient selection and precise techniques, nonabsorbable threads remain a viable option, particularly for older patients or those requiring stronger support.^1,2

Since 2000, absorbable threads made of materials such as polydioxanone (PDO), poly l-lactic acid, and polycaprolactone (PCL) have become prevalent. Facial rejuvenation using absorbable threads such as PDO threads is a safe and effective procedure.³ These materials reduce foreign body reactions and promote collagen production during degradation.^4,5

Advances in thread technology, including barbed design, thread thickness, flexibility, and anchoring techniques, have enabled more complex lifting procedures, particularly for the middle and lower face. Clinicians currently customize the thread type, insertion depth, and vector based on patient-specific factors such as age, skin thickness, skeletal structure, and fat distribution.

The existing literature on thread lifting is largely limited to small-scale, single-center studies focusing on technical variables or short-term outcomes. Comprehensive multicenter analyses evaluating procedural trends, age variations, treatment patterns, and combination therapy use are lacking.⁶

This study aimed to retrospectively analyze 111,948 thread lifting procedures performed between 2020 and 2024 by the Tokyo Chuo Cosmetic Surgery Group, which operates more than 100 clinics nationwide. It also aimed to evaluate the annual procedural volume, patient age trends, treatment type distribution, and frequency of combination procedures. This large-scale dataset provides valuable insights that may contribute to the further advancement of evidence-based thread lifting practices.

METHODS

This retrospective observational study used anonymized clinical records in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the institutional review board (approval no: UMEDAERB2025May002). All cases included patients who underwent thread lifting procedures at the Tokyo Chuo Cosmetic Surgery Group clinics between January 2020 and December 2024 (n = 111,948). Data included the year of treatment, patient age, occupation, procedural pattern (based on thread type or combination), and the use of additional cosmetic procedures.

In our dataset, we counted each thread lifting procedure individually, regardless of whether it was a primary treatment or a touch-up, as our system is procedure-based rather than patient-based. However, we did not include visits for the correction of complications such as dimpling, asymmetry, or unsatisfactory results.

Standardized Protocol for Thread Lift

All thread lift procedures in this study were performed according to a standardized protocol across our nationwide group of clinics. All procedures were conducted under local anesthesia, using absorbable barbed threads made of PDO or PCL, as well as nonabsorbable threads, depending on the indication. Before insertion, thread vectors were designed based on individual facial anatomy and aesthetic goals, and each thread was marked and placed so that its endpoint lay lateral to the lateral canthus. An 18G needle was used to create an entry port, and threads were introduced into the subcutaneous plane using blunt-tipped cannulas, targeting the midface, jawline, and nasolabial regions. Threads were anchored subcutaneously, and adjustments were made as necessary for symmetry. No deep fixation to the SMAS or periosteum was performed. We have illustrated the typical placement designs for absorbable threads and nonabsorbable threads. (See figure, Supplemental Digital Content 1, which displays standard protocol for absorbable thread lift, https://links.lww.com/PRSGO/E526.) (See figure, Supplemental Digital Content 2, which displays standard protocol for nonabsorbable thread lift, https://links.lww.com/PRSGO/E527.) The number and location of inserted threads were adjusted as needed based on individual patient preferences and clinical considerations. Standard postoperative care, including cold compresses and rest instructions, was provided. All practitioners were trained in this protocol, ensuring consistent technique and quality across all participating facilities.

Statistical Analyses

Statistical analyses were performed using IBM SPSS Statistics (version 30.0.0.0) software. As age data were not normally distributed, the Kruskal–Wallis test was used to compare age distributions across years and procedure types. If a significant difference was observed, post hoc Bonferroni-adjusted multiple comparisons were performed. Procedural volume and combination procedures were analyzed using descriptive statistics, with a significance threshold set at a P value of less than 0.05.

RESULTS

Overall, 8.78% of the patients were men (n = 9346), and 91.22% were women (n = 97,062). The occupational distribution was as follows: company employees accounted for the largest proportion of patients (n = 40,733; 45.58%), followed by housewives (n = 8770; 9.81%), self-employed individuals (n = 8007; 8.96%), medical professionals (n = 7672; 8.58%), others (n = 7360; 8.23%), service industry workers (n = 5690; 7.37%), public servants (n = 3166; 3.54%), part-time workers (n = 2669; 2.99%), students (n = 1749; 1.96%), unemployed individuals (n = 1577; 1.76%), night shift workers (n = 1547; 1.73%), and entertainment industry workers (n = 435; 0.49%) (Fig. 1). There was a 44.7-fold increase in the number of thread lifting procedures during 5 years: 981 in 2020; 10,624 in 2021; 20,714 in 2022; 35,812 in 2023; and 43,817 in 2024 (Fig. 2).

Fig. 1.

Occupational distribution of patients undergoing thread lifts.

Fig. 2.

Annual changes in the number of facial thread lift procedures.

The median patient age increased each year during the 5-year study period, as follows: 2020, 34 (range, 25–47) years; 2021, 36 (27–48) years; 2022, 39 (28–52) years; 2023, 42 (30–52) years; and 2024, 42 (29–52) years. Kruskal–Wallis testing confirmed statistically significant year-over-year differences in age (P < 0.001), with post hoc Bonferroni-adjusted comparisons showing significance between all year pairs. The most notable differences were between the years 2020 and 2023 and between the years 2021 and 2023 (both P < 0.001) (Fig. 3). Seven procedural patterns were identified based on thread type: PDO thread + PCL thread (39.18%), PDO thread alone (36.74%), PCL thread alone (21.07%), nonabsorbable thread alone (1.40%), PCL + nonabsorbable (1.10%), PDO + nonabsorbable (0.31%), and PDO + PCL + nonabsorbable (0.20%) (Fig. 4).

Fig. 3.

Annual change in the age distribution of patients undergoing facial thread lift.

Fig. 4.

Procedural composition of thread lift types.

Age distribution differed significantly according to the thread lifting type (Kruskal–Wallis test, P < 0.001). Procedures involving nonabsorbable threads tended to be selected for older patients (Fig. 5). There was a 31.3-fold increase in the number of procedures using nonabsorbable threads (in 2020, 48 procedures; in 2024, 1504 procedures) (Fig. 6).

Fig. 5.

The relationship between thread lift procedure and age. A, Distribution of patient age according to thread lift procedure type. B, Pairwise comparison of the thread lift procedure types.

Fig. 6.

Annual trends in the use of nonabsorbable threads in thread lift procedures.

In relation to the combination procedures, hyaluronic acid filler was the most common additional aesthetic treatment (31.68%), followed by botulinum toxin (22.47%), transconjunctival orbital fat removal (8.30%), extracellular matrix–based injectables (5.72%), liposuction (4.96%), growth factor injection (4.94%), and rhinoplasty (4.57%). These findings indicated that thread lifting was often used as a part of a multimodal rejuvenation strategy (Fig. 7).

Fig. 7.

Combination procedures performed with thread lifts. ECM, extracellular matrix.

DISCUSSION

Our study findings indicate that thread lifting procedures are frequently used as part of comprehensive facial rejuvenation strategies in combination with other aesthetic treatments. The increase in the number of procedures and in patient age suggests that thread lifting is being progressively adopted for patients in older age groups, likely owing to advancements in thread materials, techniques, and safety. Moreover, the increased use of nonabsorbable threads may reflect a growing demand for longer lasting results, which absorbable threads may not fully achieve.

Although women constituted the majority of patients, which is consistent with previous trends in aesthetic medicine, almost 9% of the patients were men, indicating a growing acceptance of thread lifting among both sexes. Occupational data indicated a strong demand among company employees and healthcare professionals for whom social engagement and interpersonal communication form essential aspects of their work. This finding highlights the importance of psychosocial motivations, including the effect of appearance, on enhancing perceived professional confidence and success.

Significant differences were observed in age distribution according to thread type. Older adults more frequently selected nonabsorbable threads (polypropylene), which is consistent with previous literature reporting superior long-term mechanical support provided by such materials.⁷ In the future, personalized thread selection strategies based not only on age and skin characteristics but also on lifestyle and downtime tolerance may become more important.

Thread lifting was found to be often performed in combination with treatments such as hyaluronic acid fillers, botulinum toxin, and fat removal, emphasizing its role as a foundational method for structural support and contour enhancement. Our findings showed high combination rates of more than 30% with filler and botulinum toxin, suggesting that thread lifting plays a critical role in achieving a harmonious aesthetic balance that cannot otherwise be attained with thread lifting alone. These combination strategies are appealing because they address multiple signs of aging simultaneously and have promoted thread lifting as a key component of holistic cosmetic treatment. One study that evaluated the long-term effects of thread lifting alone and in combination with other procedures showed that thread lifting alone had poor durability of effect and that better results were obtained in combination with other procedures.⁸

A multicenter study in India reported aesthetic improvement in more than 96% of cases, as assessed by both physicians and patients, supporting the effectiveness of thread lifting.⁹ One meta-analysis reported mild complications such as dimpling and asymmetry in approximately 7% of cases. Absorbable threads have been associated with lower risks of sensory disturbance and extrusion than nonabsorbable threads.¹⁰ This finding aligns with our findings, in which older patients showed increased use of nonabsorbable threads, highlighting their need for more refined techniques and appropriate risk management.² In a small observational study of thread lift complications in our group, “skin dimpling” was reported in 40 (11.7%) patients, “thread palpation” in 8 (2.3%) patients, and “transient asymmetry” in 3 (0.9%) patients, out of a total of 342 patients. No serious complications such as infection or nerve damage were observed.

Patients aged older than 50 years are at increased risk of complications and decreased long-term satisfaction.¹¹ Considering the trend toward increased use of thread lifting in older populations and greater reliance on nonabsorbable materials, careful patient selection remains essential. Future developments might include validated preprocedural screening tools or risk stratification models to optimize both safety and satisfaction in thread lifting practices.

This study had some limitations. The data were derived from a single corporate group, which may limit generalizability. Although the sample size was large, detailed clinical variables such as satisfaction scores or objective outcome measures were unavailable. The anonymized and aggregated nature of the dataset precluded the assessment of complications or long-term outcomes. The average longevity of the thread lift effect in our practice is approximately 6–12 months, depending on the thread material and anatomical area treated. PDO threads tend to degrade within 6–8 months, whereas PCL threads may persist slightly longer, up to 12 months. Finally, selection bias may exist, as the population receiving thread lifting may differ from the general cosmetic patient population.

CONCLUSIONS

This is the first nationwide, large-scale study to report trends in facial thread lifting, showing rising procedure volumes, increasing patient age, variations in thread selection, and frequent combinations with other aesthetic treatments. These findings reflect the evolution of thread lifting from a standalone rejuvenation tool to a strategic component of personalized multimodal aesthetic treatment. These insights may serve as a foundation for future research and the development of evidence-based protocols for thread lifting.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

ACKNOWLEDGMENTS

The authors express their sincere gratitude to the clinical staff and data management teams across the Tokyo Chuo Cosmetic Surgery Group for their invaluable contributions to the collection and organization of patient records. They also thank their academic advisors for their critical feedback during the manuscript development process.