When is a thread lift used for nasolabial folds?

A thread lift is usually considered for nasolabial folds when the cheek has slid down and inward and now rests on top of the fold. If the fold has deepened because the front of the cheek has hollowed, lifting alone may not be enough, so your doctor will also talk with you about restoring volume. Many people have a mix of both, so the first step is an in-person assessment of which one plays the bigger role.

Two reasons nasolabial folds deepen

The fat under your facial skin isn't one solid layer. It's divided into separate compartments, and there's a distinct one sitting just above the fold beside your nose. These compartments don't change at the same rate as you age, so some descend while others shrink.

(Evidence: US cadaver anatomy study of 30 hemifaces, 2007)

The first reason is sagging. When the cheek below your cheekbone drops and rests on the fold, it's the full tissue above it, more than the crease itself, that makes the fold look deep.

The second reason is hollowing. As the deep inner cheek fat shrinks and the upper jawbone gradually resorbs, the front of the cheek loses support. Rather than tissue moving down, the foundation underneath has sunk.

(Evidence: anatomy study, 2008; literature review, 2012)

Signs that point to sagging

These are things you can gauge in a mirror. They aren't a diagnosis, just a useful starting point for your consultation.

• When you lie down and look in a mirror, the fold fades noticeably.
• Gently lifting the cheek below your cheekbone up toward your ear with your fingertips almost smooths the fold out.
• The cheek just above the fold looks full, as if it's resting on it.
• Compared with older photos, the highest point of your cheek has moved lower.
• Your jawline and the area beside the corners of your mouth look like they're sagging too.

Signs that point to hollowing

• Even when you lift your cheek, the fold stays like a groove.
• The front of your face, from under the eyes down into the cheek, looks flat or shadowed.
• The fold has looked deeper since you lost weight.
• The spot where the fold starts beside your nose looks sunken even when your face is relaxed.

If you recognize yourself in both lists, you likely have a mix. In that case, your doctor will work out where to lift, where to add volume, and what to do first.

When a thread lift is considered

Threads lift descended cheek tissue up and outward and hold it in place. They don't fill the groove directly; they take weight off the fold. So the clearer the signs of sagging, the more a thread lift is worth considering.

• The fold smooths out a lot when you lift your cheek
• You have both cheek sagging and jawline sagging
• You'd rather return tissue to where it used to sit than dramatically change your facial contours

How much change you see and how long it lasts vary from person to person. A review pooling multiple studies also concluded that evidence for long-lasting results is still limited, so it's a good idea to set follow-up check-ins from the start.

(Evidence: systematic review of 12 studies, 2018)

When other options are discussed too

• If the signs of hollowing are strong, your doctor will also discuss ways to restore volume in the front of the cheek.
• If your skin has thinned and has lots of fine lines, options for skin firmness are considered separately.
• If you have a mix, the plan is staged instead of relying on one treatment to do everything.

It's less about which method is better and more about matching what's actually creating the fold in your face right now.

If you choose a thread lift, it helps to know what recovery looks like ahead of time.

• Swelling, bruising and a tight feeling can last a few days.
• Rarely, small skin dimples or a difference between the two sides can appear.
• Threads that can be felt or seen under the skin have also been reported.

Most of these reactions are managed as you heal, but contact the clinic right away if anything feels wrong.

(Evidence: comprehensive US review of thread-lift literature, 2019)