Problems after a Thread Lift: Dimpling, Palpable Threads, Asymmetry and Infection — What Can Be Done?

What is normal after a thread lift?

In a thread lift, medical threads, either smooth or carrying small gripping projections (barbs), are placed under the skin. This is why swelling, bruising, tightness and a pulling sensation that increases especially when opening the mouth, chewing or smiling are expected in the first days. Small crusts and redness may also appear at the thread entry points.

Mild dimpling and a slight difference between the two sides of the face are also common in the early period and usually decrease as the swelling goes down. For the general features of the procedure, see our article “Thread Lift (Non-Surgical Facial Lifting Threads)”, and for details about bruising and swelling, our article “Bruising and Swelling”.

Why does dimpling occur after a thread lift, and will it go away?

Dimpling is a small indentation or fold in the skin that forms when the gripping barbs of the thread pull the tissue too much at one point, or when the thread is placed too close to the skin. It is one of the most frequently reported unwanted effects of thread lifts. A published meta-analysis reported that dimpling is more common at an older age.

Mild dimpling that appears early usually decreases within days to weeks as the swelling goes down and the tissue settles. If dimpling does not go away, the physician may assess the area and consider options such as a gentle correction, monitoring or, if necessary, loosening or removing part of the thread. Pressing on or massaging the area yourself may move the thread out of place.

A thread that can be felt, seen or pokes out

A thread can be felt with the finger, may look like a line in certain light or may move over time, especially when placed in thin skin or close to the surface. Sometimes the end of the thread pokes out through the entry point or the skin surface and causes a pricking sensation. Because this can also increase the risk of infection, it should be shown to a physician.

Do not try to pull out or cut a protruding thread yourself. If the thread has gripping barbs, pulling it can tear the tissue or leave part of the thread inside. The physician will decide whether the thread should be trimmed or removed appropriately.

How long do asymmetry and pain last?

In the first days, the two sides of the face looking different is usually due to swelling and bruising not being evenly distributed, and it decreases within weeks. Assessing the final appearance usually requires waiting a few weeks. If marked asymmetry continues after the swelling has gone down, the physician will assess whether further intervention is needed.

Tightness and mild pain that increase with facial movements are expected in the first days. Pain that increases rather than decreases as the days pass, is throbbing or is concentrated at one point, however, may suggest a problem such as an infection, a collection of blood, or the thread pressing on a nerve or another structure.

How can infection after a thread lift be recognised?

Infection can appear in the first days after the procedure or weeks to months later. The main signs are increasing redness, warmth, swelling, pain, pus-like discharge from the thread line or an entry point, fever and chills. Sometimes the body’s inflammatory tissue reaction to the thread material (a granuloma) can appear months later as persistent lumps that can be felt.

If infection is suspected, the physician will assess the area, take a sample if necessary and start appropriate treatment. In some cases the thread may need to be removed. Do not use leftover antibiotics you have at home on your own. For general information, see our article “Infection after Aesthetic Treatments”.

Can a nerve or salivary gland be injured?

Rarely, a thread can damage the branches of the nerve that moves the face or the salivary gland in front of the ear (the parotid gland). When a nerve is affected, loss of movement in part of the face or drooping at the corner of the mouth may occur. When the salivary gland is affected, there may be swelling in front of the ear that increases especially when eating, or clear fluid coming from an entry point.

Effects on the sensory nerves are more common and appear as numbness or tingling in the area; these symptoms usually subside over time. Loss of movement or swelling in front of the ear, however, needs to be assessed by a physician without waiting. Such serious problems can be reduced considerably by choosing an experienced physician with a good knowledge of facial anatomy.

Can a thread be removed?

Yes, in some cases a thread can be removed by a physician; however, this is not always easy. Because barbed threads grip the tissue and connective tissue forms around them over time, removing the whole thread can become more difficult the more time has passed since the procedure. Sometimes only part of the thread can be removed.

Removing a thread is a minor procedure carried out under sterile conditions with the area numbed, and it may itself carry a risk of a new scar or dimpling. For this reason, the decision is made together with the physician after assessing the type of problem and the position of the thread.

What should you do at home if there is a problem after a thread lift?

1. Note your symptoms and when they started; if possible, take photos at regular intervals in the same light.
2. If you have any of the warning signs, call the physician who performed the procedure the same day. If you know which type of thread was used, when and in which area, tell them.
3. If you cannot reach your physician and you have a fever, rapidly increasing swelling or loss of movement in the face, go to the emergency department and say that you have had threads placed in your face.
4. In the first days, follow the written instructions you were given: for example, not opening your mouth very wide, limiting hard foods and not sleeping face down.
5. Keep the entry points clean as your physician recommends.

What should you not do?

• Do not pull, cut or poke with a needle at a thread that is protruding or can be felt.
• Do not massage the area or try to correct it by pressing unless your physician recommends it.
• Do not apply heat unless your physician recommends it; do not start using saunas or Turkish baths (hammams) or doing strenuous exercise before the recommended time has passed.
• Do not use leftover antibiotics or prescription medicines on your own.
• Do not have filler, threads or a device treatment on the same area somewhere else to correct the problem.
• Do not wait for days thinking it will go away on its own; early assessment is important, especially with signs of infection or loss of movement.

What are the treatment options? What can a physician do?

The physician first assesses whether the problem is part of the expected healing or is related to the position of the thread, an infection or another structure being affected. If necessary, imaging methods such as ultrasound may be used. For mild dimpling and asymmetry, monitoring and gentle corrections by the physician are often enough.

If a thread can be felt or protrudes, or with persistent dimpling, infection or a tissue reaction, trimming or removing the thread may be considered. For infection, appropriate medication can be planned, and for nerve or salivary gland problems, follow-up together with the relevant specialties. For the general process, see our article “What Should You Do If a Complication Occurs after an Aesthetic Treatment”.

What can be done to reduce the risk?

• Have the procedure done by a physician who has a good knowledge of facial anatomy and has been trained in this technique, in a licensed healthcare facility where sterile conditions are ensured.
• Make sure the thread to be used is licensed as a medical device and genuine, and see its packaging opened in front of you; ask for the product information in writing.
• Mention any previous fillers, threads and operations, the medicines you take, and any tendency to bleed or to scarring.
• Keep in mind that with marked sagging a thread lift may offer limited benefit, and that some problems have been reported more often at an older age.
• Do not plan the procedure just before an important event.
• When choosing a physician and clinic, make use of our article “A 10-Point Safety Checklist for Choosing a Clinic and Physician for Medical Aesthetics”.

Limits of the evidence: how often problems occur after a thread lift varies greatly depending on the type of thread, the material, the technique and the operator. Most published studies are small and have short follow-up; in meta-analyses, the differences between studies are large. For this reason, you cannot be given a personal risk figure. This page is for general information and does not replace an examination.