Threads, Skin Boosters, and the Newer Stuff

This is the chapter where I get to be the most honest with you about what the industry is selling versus what the evidence supports.

The procedures I'm going to discuss in this chapter sit in a different category than Botox and traditional filler. Some of them have solid science behind them and just haven't reached the same level of household awareness. Others have aggressive marketing budgets and weaker evidence. A few have so much hype around them right now that you'd think they were revolutionary, when really we're still figuring out what they do and how well.

I'm going to walk through each one and give you my actual clinical perspective. Not the marketing copy. Not the influencer talking points. What I'd tell my sister if she asked me whether she should try it.

PDO Threads

Threads have been around for decades in their original surgical form. The modern aesthetic version uses dissolvable threads made of polydioxanone (PDO), polylactic acid (PLA), or polycaprolactone (PCL). Different materials have different properties and dissolution timelines.

There are two general categories:

Smooth or mono threads. Thin threads placed in a mesh-like pattern under the skin. They don't lift. They stimulate collagen production over time as the body responds to the threads being there. Sometimes called "skin quality threads."

Barbed or lifting threads. Threads with small barbs along their length that grab onto tissue. These are placed in specific patterns to physically lift sagging skin, particularly in the cheeks, jawline, neck, and brow areas. They provide an immediate lift effect that softens as the threads dissolve, while leaving behind some collagen stimulation as a longer-term benefit.

What threads can do:

For barbed lifting threads, provide a real but modest lift to mildly sagging tissue. Particularly useful for early jowls, mild brow descent, mid-face laxity, and neck softening in patients who aren't ready for surgery but want more than skincare and Botox can offer.

For smooth threads, contribute to skin quality and collagen support in treated areas over months.

What threads can't do:

Substitute for a facelift. Patients with significant skin laxity won't get the lift they need from threads. The most common reason patients are disappointed in threads is unrealistic expectations.

Last as long as the marketing suggests. The lift effect from barbed threads typically lasts six to twelve months, sometimes longer with newer-generation threads. The collagen-stimulating effect can persist beyond that, but the dramatic lift itself fades.

What good thread work looks like:

A subtle improvement in the position and crispness of facial contours. The cheek sits slightly higher. The jawline looks cleaner. The neck is a bit more defined. The patient looks like a refreshed version of themselves, not a lifted version of someone else.

What bad thread work looks like:

Pulling or pinching at the entry points where threads were placed. Visible thread shadows under the skin if placed too superficially. Asymmetric lift if one side was treated differently than the other. In rare cases, palpable or even visible threads that didn't fully dissolve or weren't properly placed.

Risks:

Bruising and swelling. Common, usually resolves in a week or two.

Pinching or tightness sensations at entry points. Usually settles over weeks.

Visible threads or dimpling. Sometimes resolves on its own, sometimes requires manipulation or removal.

Infection. Rare with sterile technique.

Granuloma formation. Rare delayed inflammatory reaction.

My honest take on threads:

They're real procedures with real effects, but the marketing has consistently overpromised what they can do. The "non-surgical facelift" branding is misleading. Threads are not a facelift. They're a moderate intervention that fits between non-invasive treatments and surgery.

Good candidates are patients with mild to moderate skin laxity, who understand the temporary nature of the lift, who have realistic expectations, and who are using threads as part of a broader strategy rather than as a standalone solution.