Thread lifteven though I had"Somehowit feels pulled/puckered", or "I actually look older now"— these are concerns we hear often. In fact, there is research suggesting thattheThread liftpulled/puckered lookis related toage-related changes in the skeletal (structural) framework.
This article explains the real reason a pulled/puckered look occurs after Thread lift, published data on how the facial skeleton changes with age, ways of thinking about reducing the risk of a pulled look, and the combination with skeletal correction that may point toward a more natural result.
Many people may be interested in Thread lift but hesitate because they are afraid of ending up with a pulled/puckered look. Choosing with the right knowledge is the surest way to avoid regret. That said, results vary from person to person.
Why does the "pulled/puckered look" from Thread lift happen? An often-overlooked blind spot
For Thread lift,it feels pulled/puckered", the cause is not only the practitioner's skill. According to research, a more fundamental factor — changes in the skeletal structure — may be involved.
In a study by Mendelson and Wong et al. published in an international plastic surgery journal (Aesthetic Plastic Surgery, 2012),the facial skeleton shrinks and recedes at specific sites with age, as shown by 3D CT analysis.
What happens when a Thread lift, which lifts only the skin, is performed even though the underlying skeletal foundation has changed? When the skeleton that should be providing support has receded, lifting the skin alone can producean unnatural pulled/puckered look or irregular contours. This research suggests that such a structural mismatch underlies the "pulled/puckered look."
How the facial skeleton changes with age — 3 key sites of change and warning signs in your 20s
Many people assume that "bone never changes throughout life," but in fact it does. Age-related changes in the skeletal (structural) framework are like changes to the foundation of a house.
In the paper by Mendelson and Wong et al.,bone changes at specific sites were confirmed through long-term follow-up data using 3D CT analysis. According to the published data, characteristic changes occur at the following three sites.
① Shrinkage around the eyes (orbit)
The orbit (the bone surrounding the eye socket) shrinks from the upper-inner and lower-outer regions. This change can make the fat under the eyes appear pushed forward, or shift the position of the eyebrows.
The change in the lower-outer regionhas been observed from the age of 40 onward in the study's subject data,meaning its effects appear relatively early. This is considered a structural background factor for "aged-looking eyes" and "sagging/dark circles under the eyes."
② Recession of the maxilla (upper jaw bone)
As the maxilla recedes with age, support for the base of the nasal wing (ala) and the upper lip weakens. As a result,the nasolabial folds tend to deepen,as shown in clinical research. Behind comments like "my nasolabial folds didn't disappear even with a Thread lift" lies this structural change.
③ Indentation of the bone in front of the chin (pyriform/prejowl area)
When the bone in front of the chin becomes indented, the facial contour tends to break down more easily. Because of this, even when a Thread lift lifts the facial contour,areas with bone indentation cannot be fully compensated for. This is one reason some people feel that "the effect of the Thread lift is hard to notice."
Pre-sagging checklist: has your skeletal change already begun?
- Look in the mirror — do you see dark circles or fat bulges under your eyes? (a sign of orbital shrinkage)
- Are your nasolabial folds deep, and does the base of your nasal wing look flat? (possible maxillary recession)
- Is the area in front of your chin gently indented? (a change in the prejowl bone)
If you notice these signs, even in your 20s or 30s you may already be in the early stages of structural change. We recommend an evaluation by a specialist.
Three ways of thinking about reducing the risk of a pulled/puckered look from Thread lift
Based on findings from published research, here are three approaches worth considering for what may help reducethe risk of a pulled/puckered look from Thread lift.
Point 1: Receive a "structural evaluation" during consultation
What matters most isbeing examined by a doctor who evaluates the condition of your skeletal structure. People who have naturally weak skeletal projection tend to show the effects of bone change earlier and more noticeably. Also, for people in their 20s and 30s, an early approach can be effective as prevention.
Whether Thread lift is suitable for you should be assessed acrossthree layers — skin, fat, and skeleton— and doing so is the first step toward a natural-looking result.
Point 2: Avoid the idea that "Thread lift alone solves everything"
Rather than assuming that "thread lift = universal solution," it is important to determine which layer of your face is actually problematic. On the other hand, thread lifts are most effective in cases where skeletal support is still relatively well maintained and sagging of the skin and fat is the primary cause.
Related article:How to avoid regret with rhinoplasty: key points for finding a skilled surgeon and everything you need to know to prevent failure
Point 3: Consider combining with structural correction
When bone recession is confirmed, combining structural correction with hyaluronic acid or PCL-based fillers, fat grafting, and similar treatments can lead toa more natural-looking result. This study suggests that possibility.
Performing a thread lift after first correcting the underlying structural "foundation" tends to produce a more natural-looking skin-lifting effect.
"Facelift alone has its limits" — what the literature says about the importance of combination treatment
According to the published data,faceliftand treatments that lift the skin and soft tissue, such as thread lifts, alonecannot fully address the root cause, which is skeletal change, the research suggests. On the other hand, treatments that combine skeletal correction with lifting show potential for improvement.
Hyaluronic acid injections rebuild skeletal support by restoring the volume lost from bone recession, and can be expected to produce natural-looking rejuvenation. Fat grafting (autologous fat grafting) has also drawn attention as a method of restoring lost volume using the patient's own tissue (Strong et al., Plastic & Reconstructive Surgery, 2024).
For treatment options, please refer to theTreatments list. Also, regarding the concept of "skin lifting," which is similar to thread lifts, please see[With progress photos] How many days does rhinoplasty swelling (downtime) take to subside?for reference on how to spend your downtime.
Frequently Asked Questions
Q. Do hyaluronic acid injections also help with skeletal aging?
By using hyaluronic acid to restore the volume lost from bone recession, structural support can be rebuilt, and natural-looking rejuvenation can be expected.
Q. I've heard that facelifts and thread lifts alone have their limits. Why is that?
If the underlying issue of skeletal change is left unaddressed, lifting the skin alone tends to result in an unnatural-looking outcome. For this reason, a combined approach that evaluates both skin and skeletal structure is recommended.
Q. Are deep nasolabial folds caused by the skeleton?
Research suggests that recession of the maxilla is one contributing factor. At the same time, skin sagging and fat displacement are also involved. For this reason, it is important to evaluate both.
Q. Around what age does skeletal aging begin?
According to the paper by Mendelson and Wong, changes in the lower lateral orbital region have been observed in subjects in their 40s, while other areas generally become noticeable from the 60s onward. That said, depending on one's inherent skeletal structure, effects may appear earlier in some cases.
Q. What treatments address skeletal aging?
Representative options include structural correction with hyaluronic acid or PCL-based fillers, and fat grafting. It is important to choose the appropriate method through a consultation with your physician.
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Summary
The underlying cause of pulling/tightness after a thread liftis the root cause of age-related skeletal change
In specific areas such as the orbit, maxilla, and anterior chinbone can shrink and recedeas research has shown
For a natural-looking result,it is important to choose a treatment method after evaluating the condition of the skeletal structureThis is essential
By combining with skeletal correction,the possibility of improvement is suggested
Whether a thread lift is suitable should bethree layers — skin, fat, and skeletoncarefully evaluated based on this
If you are concerned about facial sagging, nasolabial folds, or changes in your facial contour, why not start with a consultation that "reconsiders things from the structure up"? At Zetith Beauty Clinic, we incorporate a perspective on age-related structural change to propose a rejuvenation plan tailored to each individual. If you have any concerns, please feel free to make use of ourfree consultation.
Written by
Hiromitsu NakamuraPhysician
Zetith Beauty Clinic Ginza / Osaka / Fukuoka
He has presented research at academic conferences both in Japan and internationally, and is also involved in technical guidance and training across Zetith Beauty Clinic. He specializes in precision rhinoplasty based on anatomical evidence, pursuing natural-looking results tailored to each individual's skeletal structure and tissue.
References
Mendelson B, Wong C. Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation. Aesthetic Plastic Surgery. 2012 (DOI)Strong A, Rohrich R, Tonnard P, et al. Technical Precision with Autologous Fat Grafting for Facial Rejuvenation: A Review of the Evolving Science. Plastic & Reconstructive Surgery. 2024 (DOI)