Non-Surgical Facelifting: 8 Common Complications & How to Manage It
- jessilyntanhy9
- 19 minutes ago
- 5 min read
Facial thread lifting has revolutionized non-surgical facial rejuvenation. Offering a minimally invasive alternative to traditional facelift procedures, it allows physicians to lift, contour, and refresh aging facial tissues with minimal downtime. However, despite its growing popularity, thread lifting is not without complications. In a comprehensive 2025 review published in the Journal of Cosmetic Dermatology, Drs. Kyu-Ho Yi and Soo Yeon Park critically examine the anatomical and procedural causes of thread-related complications and provide clear guidelines for their prevention and management.
This blog post summarizes their findings and insights, offering clinicians a practical, evidence-based guide to navigating thread lifting complications safely and confidently.
Why Complications Arise in Thread Lifting
Thread lifting complications often stem from three major factors:
Anatomical Misjudgment: Inaccurate assessment of facial anatomy or depth of insertion can lead to nerve, gland, or vessel injury.
Technical Error: Excessive tension, improper angling, or superficial thread placement increase the risk of migration, dimpling, and irregular contours.
Device or Material Limitations: Defective cannulas or unsuitable thread types may break, migrate, or induce granulomas.
Understanding how each complication occurs is the first step toward effective prevention and resolution.
The 8 Complications & How To Manage Them
1. Dimpling & Skin Irregularities
Why it happens:
Dimpling is one of the most frequent post-procedural complications. It occurs when barbed threads grip too tightly to the fibrotic fat or dermis—often due to shallow placement or excessive tension. This causes a visible indentation in the skin, particularly in the mid-cheek area where soft tissue mobility is high.
How to manage and prevent:
Prevention:
Insert threads at the proper subcutaneous depth—superficial to the SMAS but not dermal.
Avoid overly aggressive lifting or tight anchoring.
Discuss risks and expectations with patients preoperatively.
Management:
Early gentle massage or molding can help release fibrotic tension.
Persistent irregularities may require thread cutting or removal to relieve tissue traction.
Avoid overly superficial placement and consider multidirectional or fixation threads to distribute lift evenly and naturally.
For dimpling caused by reverse vector threads near the temporalis muscle, botulinum toxin (BTX) injections into the temporalis can reduce chewing-induced tissue protrusion.
2. Contour Bulging
Why it happens:
Over-tensioning or poorly planned thread vectors, particularly with bidirectional threads, can cause unnatural bulging—especially in the midface and temples. In Asian patients, this can unintentionally exaggerate cheekbones, disrupting ethnic aesthetic harmony.
How to manage and prevent:
Prevention:
Choose thread vectors that disperse tension naturally.
Use multi-directional or fixation threads instead of over-reliance on bidirectional threads.
Avoid excessive force when anchoring threads near the temples or cheeks.
Management:
Immediate molding with fingers or massage.
Persistent bulging may require thread cutting or removal.
3. Thread Migration and Extrusion
Why it happens:
Threads that are inadequately anchored or placed too superficially may migrate or extrude over time, especially in highly mobile facial areas such as the eyelids, mouth, or chin. This issue often arises from the use of unstable threads or insufficient fixation within fibrous tissue. Migration typically results from unstable anchoring or incorrect insertion depth, causing threads to shift toward the skin or mucosa, which can lead to visible protrusion.
How to manage and prevent:
Prevention:
Secure fixation in dense fascia (e.g., cervical fascia, deep temporal fascia).
Use ultrasound guidance for safer anchoring near critical structures.
Minimize facial movements post-op and consider BTX in dynamic zones.
Management:
Minor migration: Observe or perform guided massage.
Protrusion: Remove via small incision with Castroviejo forceps.
Extrusion: Trim thread at entry point or remove completely under aseptic conditions.
4. Palpable Threads & Residual Cannulas
Why it happens:
Shallow placement, particularly with volumizing threads, can lead to palpable threads or cannula tips beneath the skin. Forcing aluminum cannulas through dense tissue increases the risk of breakage. Such shallow thread placement may not only cause palpability but also promote scar tissue formation. Moreover, breakage of aluminum-integrated cannulas can leave foreign bodies embedded in the tissue, necessitating surgical removal.
How to manage and prevent:
Prevention:
Use threads suitable for soft or thick tissues.
Inspect cannulas for defects prior to insertion.
Avoid excessive pressure in fibrotic or scarred areas.
Management:
Make a small incision proximal to the thread end.
For thin threads (e.g., size 3-0), gently tug on the middle section with fine forceps in a tug-of-war fashion to remove as much thread as possible without breakage.
5. Infection & Granuloma Formation
Why it happens:
Superficial thread placement or poor sterility introduces foreign particles or bacteria, which may result in localized infections or granulomas.
How to manage and prevent:
Prevention:
Ensure thorough disinfection with povidone-iodine.
Avoid inserting threads through compromised skin or inflamed areas.
Use prophylactic antibiotics for 3–5 days post-procedure.
Management:
Infections: Oral antibiotics, drainage if abscessed.
Granulomas: Steroid or 5-FU injections; thread removal if persistent.
6. Nerve Injury
Why it happens:
Incorrect depth or angulation may damage the facial nerve branches or greater auricular nerve (GAN). The GAN is particularly vulnerable due to its superficial course behind the platysma in the neck.
How to manage and prevent:
Prevention:
Use blunt cannulas.
Avoid areas near Pitanguy’s line or SMAS danger zones.
Insert threads above the facial nerve trajectory (above SMAS).
Management:
Most neurapraxias resolve spontaneously.
Persistent sensory loss may require surgical decompression.
BTX may assist in relieving associated muscle tension.
7. Parotid Gland Injury
Why it happens:
Accidental penetration of the parotid gland or duct—especially when patients clench or move—can result in pain, swelling, and salivary leakage.
How to manage and prevent:
Prevention:
Use ultrasound guidance in high-risk zones.
Avoid crossing the Stensen duct.
Keep the patient still during cannula manipulation.
Management:
Facial pressure band, antibiotics, and anti-cholinergic medication.
BTX injection to reduce gland activity.
Ultrasound monitoring for resolution.
8. Hematoma Formation
Why it happens:
Puncturing arteries (e.g., superficial temporal, zygomatico-orbital, or facial artery) due to sharp needle insertion or incorrect vectoring can lead to large hematomas.
How to manage and prevent:
Prevention:
Use epinephrine-based local anesthetic; wait 10–15 minutes for vasoconstriction.
Employ cannulas over needles.
Avoid threading along major vascular routes.
Management:
Immediate compression.
If unresolved, ultrasound-guided drainage.
Monitor for vascular compromise or secondary infection.
Strategies for Safer and More Effective Thread Lifting
Yi and Park emphasize the importance of:
Preoperative Planning: Thorough anatomical knowledge, Doppler ultrasound mapping, and patient-specific customization.
Technique: Proper thread depth, gentle handling, and appropriate tension.
Postoperative Care: Early follow-up to catch complications as swelling subsides, along with clear patient education.
Embracing Imaging & Future Protocols
The use of ultrasound-guided thread lifting is one of the most effective ways to avoid deep structure injuries, particularly in the parotid and vascular regions. Pre-procedure Doppler scanning can help map vessels and glands, guiding safer and more predictable thread insertion.
Emerging technologies, including real-time 3D imaging and high-resolution facial mapping, will continue to improve thread lifting precision, making it not only safer but more customized.
Conclusion
Thread lifting is a powerful technique, but only when practiced with anatomical respect, technical precision, and continuous learning. As highlighted by Yi and Park’s 2025 review, success lies not only in lifting tissues—but in lifting our understanding of the face, its complexities, and its tolerances.
By prioritizing prevention, maintaining vigilant follow-up, and embracing new technologies, clinicians can minimize risks, manage complications effectively, and deliver consistent, high-satisfaction outcomes.
Reference:
Yi, K.-H. and Park, S.Y. (2025), Facial Thread Lifting Complications. J Cosmet Dermatol, 24: e16745. https://doi.org/10.1111/jocd.16745
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