Facelift vs Thread Lift: What's the Difference, and How Long Does a Facelift Last?

Hello, I'm Dr. Yoosuk Chung, Director of TheLINE Plastic Surgery.

When people come in for sagging, the first thing most of them ask is, "Will a thread lift be enough, or do I need a facelift?" Those who have had several thread lifts ask, "Threads don't seem to work for me anymore. Is it still okay to have a facelift?"

I have regularly presented at academic meetings on facelift surgery and facial anatomy. In 2024, I presented "Understanding Facelift Surgery: General Principles and Surgical Techniques" at the Fall Conference of the Korean Academy of Obesity & Aesthetic Treatment. In 2025, I presented "Facial Anatomical Considerations and Their Relevance to Facial Procedures" at the academy's Spring Conference and "Essential Anatomy for Facelift and Understanding Its Dynamic Changes" at the Asia Forum for Aesthetic Surgery and Medicine (AFAS). Today, from the perspective of a surgeon who performs facelifts, I'd like to explain how the two differ, how long a facelift lasts, and what changes when a facelift is done after repeated thread lifts.

What Is the Difference Between a Facelift and a Thread Lift?

A facelift and a thread lift share the same goal: lifting sagging facial tissue back up. The difference lies in the approach. A thread lift inserts threads through needle punctures to hook and pull the tissue, and how it pulls depends on the type of thread and the layer it is placed in. A facelift is surgery in which the skin is incised and the SMAS, the firm fascial layer beneath the skin, is directly dissected, repositioned and lifted, after which the excess is trimmed and secured. This difference is what changes the size of the result, how long it lasts and how long recovery takes.

The deep-plane facelift, which is widely discussed these days, is an approach that focuses especially on the retaining ligaments. Retaining ligaments are pillar-like structures that connect bone, skin and muscle and hold facial tissue in place against gravity. The difference between the two methods comes down to whether these ligaments can be released directly so the tissue can be repositioned. A thread lift can also hook threads around the retaining ligaments and pull the tissue. However, it differs from a facelift, in which the retaining ligaments are directly dissected and released to reposition the tissue.

At What Age Do People Move from Thread Lifts to a Facelift?

In general, we distinguish by age group. Thread lifts are usually done in the 30s and 40s, and facelifts with incisions are most often done from the late 40s to the 60s.

That said, age alone doesn't decide it. Even a younger person may choose a facelift if they want a definite lift, and someone in middle age or older may choose a thread lift if they want only a modest improvement without a dramatic change. Occasionally people in their early to mid-30s have a facelift. Some people whose square jaw isn't large still look angular around the jaw, often because the soft tissue has descended. If it has descended moderately, the jawline can be refined with facial liposuction; if there is a lot of descended tissue, some choose a facelift. In these cases, the result can be quite good, almost like facial contouring surgery.

How Long Does a Facelift Last?

In my experience, the results of a surgical facelift last about 5 to 10 years, and at least 5 years.

But those 5 to 10 years are the time it takes for the face that was lifted to begin looking older again, not the time it takes to return to how it was before surgery. Aging continues after surgery, but it starts again from a younger point than before. If two people with the same degree of sagging at age 50 had different choices, one having a facelift and the other not, I believe the difference between them never closes for the rest of their lives. That is why I describe the effect of a facelift as semi-permanent. It doesn't mean the result stays fixed; it means the time you have turned back stays with you.

Research shows similar results. A 2012 study in Plastic and Reconstructive Surgery re-evaluated 50 facelift patients with standardized photographs an average of 5.5 years after surgery and found that 76% still looked younger than before surgery[1]. By area, the jawline (jowls) lost only about 20% of its initial improvement, whereas the neck relapsed the most, losing about 69% of the improvement in the angle between the chin and neck[1]. This is why, when planning a facelift, we decide in advance whether to include the neck.

How Long Does a Thread Lift Last, and What Are Its Limits?

A thread lift has many advantages. It needs only needle punctures with no large incision, so it feels similar to getting fillers. There is some swelling, but after about 3 days it's at the level where friends might ask, "Why does your face look a bit puffy?" It barely interferes with daily life, and there is no worry about scars. Non-absorbable threads were used in the past, but today we mainly use absorbable threads that are strong yet dissolve over the long term.

The early effect of a thread lift is very good. Take a photo right after the threads go in, and the face is clearly lifted. Over time, however, it gradually comes down, and when done well, the good condition lasts about 2 years. Combining it with treatments such as HIFU or jawline liposuction can enhance the effect. Also, going up and then gradually coming down is different from only ever going down. For as long as the face takes to come back down from where it was lifted, the visible aging of the face has effectively been slowed.

Major problems such as heavy bleeding, hematoma or tissue necrosis, which can occur with a facelift, are rare with thread lifts, but thread lifts do have minor complications. A 2021 meta-analysis in Aesthetic Plastic Surgery that pooled 26 studies found swelling to be the most common at 35%, followed by skin dimpling at 10%, altered sensation at 6%, visible or palpable threads at 4%, and infection and thread extrusion at 2% each[2]. Absorbable threads had lower rates of altered sensation (3.1% vs 11.7%) and thread extrusion (1.6% vs 7.6%) than non-absorbable threads, and satisfaction fell from 98% right after the procedure to 88% at 6 months[2]. The effect is smaller than a facelift, but the advantage of a thread lift is that it can be repeated with little burden.

So many people maintain their results with repeated thread lifts until, at some point, threads can no longer solve the problem and they move on to a facelift.

Why Does a Facelift Become Harder After Repeated Thread Lifts?

If thread lifts have been repeated in anatomically correct positions, a later facelift may be a little harder, but not dramatically so. The problem arises when threads were not placed in the layer where they belong. If threads go in too shallow or too deep, they leave severe adhesions along the path the surgeon must take during a facelift.

Separating these adhesions is very difficult. And, unfortunately, adhesions tend to form exactly where the facial nerve runs. In a facelift, the nerve must be carefully separated from the SMAS above it, and when adhesions are severe in that area, the risk of tearing the SMAS or injuring the nerve during separation increases. In my own facelifts, patients whose threads were in the correct layer are not that difficult, but for those whose threads were in the wrong layer, this separation takes far more time and care.

A Korean study reported the same problem. A 2021 study in the Journal of Cosmetic Medicine analyzed 39 patients who had a facelift after deformities developed following at least one facial liposuction and at least one thread lift. Chronic granulomatous scarring had formed as the threads dissolved, obliterating the spaces inside the face; in all 39 patients, dissecting the skin and SMAS was difficult, and most facial nerve branches were buried in scar tissue[3]. There were 2 nerve injuries, both recovering, and the author concluded that such patients carry a high risk of difficult scar separation and nerve injury[3]. Because the study looked at patients who had already developed deformities after these procedures, it does not mean that everyone who has had a thread lift will find a later facelift difficult.

The same is true of liposuction. If only the correct layer is suctioned, adhesions are not severe when more suction or a revision is needed later; but if the whole fat layer is disrupted, adhesions form in every layer and the next surgery becomes difficult. A thread lift itself is a good method. But the threads need to be in the correct layer so that, when a facelift is needed later, it can be done without added burden. If you have had several thread lifts, telling us when, how many times and with what type of threads during your facelift consultation helps with surgical planning.

What Are Facelift Recovery and Scarring Like?

A facelift requires a clear surgical view, and even if you only want to lift a specific area, an incision just for that area won't work. If you pull your face up with your hand, you'll see that skin in unrelated areas bunches up. That is why the incision inevitably ends up longer than people would like. Instead, we place it where the scar will be as inconspicuous as possible, along the hairline and the natural creases around the ear. The scar becomes hard to notice after about 3 months for those who heal quickly, and about 6 months for those who take longer.

What concerns people more than the scar is the swelling and bruising. It usually takes about 2 weeks before things settle enough to see people socially. How swelling and bruising resolve is covered in detail in "Swelling and Bruising After a Facelift: When Can You See People Again?" In exchange for that recovery period, a surgical facelift is a procedure from which you can expect a dramatic change that makes you look 5 or 10 years younger.

Individual Differences and Precautions

• Whether a facelift or a thread lift is right for you is judged by examining the degree of sagging and the condition of your skin and tissue, rather than by age.
• How long a facelift lasts varies from person to person depending on skin elasticity, weight changes and lifestyle.
• If you have had thread lifts before, please tell us when, how many times and what type of threads were used at your consultation.
• If one side suddenly swells a lot or pain worsens after a facelift, contact us right away regardless of the schedule.

Three Key Takeaways

1. A facelift and a thread lift share the goal of lifting sagging tissue, but a facelift directly dissects and repositions the SMAS and can release the retaining ligaments, so its effect is greater and lasts longer.
2. In my experience, a facelift lasts about 5 to 10 years; aging continues after surgery, but it resumes from a younger starting point than before. A study found that 76% of patients still looked younger than before surgery 5.5 years later[1].
3. Repeated thread lifts with threads placed in the wrong layer can leave adhesions around the nerves and make a later facelift more difficult[3].

Whether a thread lift is still enough for your face or it is time for a facelift should be judged by examining the degree of sagging and your previous treatment history in person. Please visit us for a consultation for an accurate assessment.

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By Dr. Yoosuk Chung (Board-Certified Plastic Surgeon)

--- Sources

1. Jones BM, Lo SJ. How long does a face lift last? Objective and subjective measurements over a 5-year period. Plast Reconstr Surg. 2012;130(6):1317–1327. PubMed 23190814

2. Niu Z, Zhang K, Yao W, 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. PubMed 33821308

3. Bai C. Difficulties of facelift in patients with scar after treatment of facial liposuction or thread lift sutures. J Cosmet Med. 2021;5(2):57–66. DOI 10.25056/JCM.2021.5.2.57

This article summarizes common questions about facelifts and thread lifts, based on Dr. Yoosuk Chung's clinical experience and papers published in academic journals. Please confirm your own condition through an examination by a specialist.