Mid-face thread lift: How to reverse smile lines and sagging cheeks

Midface thread lifting is a minimally invasive procedure that physically lifts the sagging central area of the face—extending from under the eyes to the cheekbones, front cheeks, and upper nasolabial folds—using absorbable medical threads with cogs (barbs). When threads are inserted into the subcutaneous fat layer or adjacent SMAS layer to hook and pull the tissue, an immediate lifting effect appears right after the procedure, and elasticity gradually improves thereafter as new collagen is produced. The biggest advantages are that it takes only 30 to 60 minutes without incision, is performed under local anesthesia, and allows you to return home on the same day.

However, thread lifting is not the answer to all sagging. If the nasolabial folds are due to "sagging," it is a good fit, but if they are wrinkles caused by "loss of volume," fillers or fat grafting are more appropriate. That is why everything always starts with a diagnosis. We must first analyze why your midface is collapsing to ensure an accurate procedure.

🔍 Why Does the Midface Collapse First?

If you divide the face into three sections, the area between below the eyebrows and the tip of the nose is the midface. Encompassing the area under the eyes, the cheekbones, the front cheeks, and the upper nasolabial folds, this region is where age-related changes—such as fat descending, volume loss, and skin sagging—all concentrate at once.

As a result, when this area sags, the entire face looks tired and heavy. The hollows under the cheekbones, deepening nasolabial folds, and the sensation of flesh sagging down toward the mouth—this is why midface lifting is directly connected to a "youthful look."

📌 Key Summary: The midface is a concentrated zone of aging where fat descent, volume loss, and skin sagging occur simultaneously.

🧵 From Thread Materials to Structure, What Are the Differences?

The most common confusion in thread lifting is the type of threads. It is easier to organize if you look at it divided into material and structure.

First, there are three main types of absorbable thread materials.

In terms of structure, **Cog Threads** are mainly used for midface lifting because they hook and pull tissue using surface barbs, while **Mono Threads** are smooth threads without barbs that focus primarily on collagen stimulation, offering limited lifting strength. There are also separate screw or twist-type threads designed for volume enhancement.

For reference, non-absorbable threads like polypropylene have a long duration, but they are difficult to remove if problems arise, making them distinctly different from absorbable threads. Since the choice of material and structure depends on the condition of your face, there is no single "best thread" answer.

📌 Key Summary: Understanding materials (PDO, PLLA, PCL) and structures (Cog, Mono) separately makes the criteria for thread selection clear.

⏱️ When Do the Effects Start, and How Long Do They Last?

Once the threads are inserted, there is an immediate pulling effect on that very day. In addition, the elasticity is enhanced for a second time as the collagen regeneration reaction gradually appears over 1 to 3 months after the procedure.

The maintenance period is **an average of 6 months to 2 years (with some reports up to 3 years)**, depending on the type of thread, individual skin, and lifestyle habits. One common misconception is that "when the threads dissolve, the effect disappears," but even after the threads decompose, the elasticity effect remains for a certain period thanks to the collagen produced in their place.

It is recommended to schedule a touch-up procedure when about 50% of the effect remains, which is approximately 1 to 1.5 years after the initial procedure. Performing it during this period allows for a much more natural transition than waiting until it has completely worn off.

📌 Key Summary: Double effect of immediate lifting + collagen enhancement, lasting 6 months to 2 years, touch-up recommended when 50% of the effect remains.

⚖️ How Does It Differ from Facelift Surgery, Fillers, and Ultrasound?

Lifting methods come in many forms. Since each has a different role, it is helpful to compare them.

A facelift surgery offers long-lasting results, but it is a surgical procedure that involves incisions and long recovery periods. It is true that surgery may be more appropriate for severe sagging and excessive skin laxity. However, Onlif prioritizes a non-surgical approach that restores the skin's natural texture and elasticity without incisions.

Radiofrequency and ultrasound devices have almost no downtime, but their physical lifting power is weaker. Therefore, combining thread lifting when pulling is needed and ultrasound/RF treatments when elasticity management is the goal is a practical approach. Fillers or fat grafting are also combined for areas that have lost volume.

📌 Key Summary: Thread lifting is for 'pulling,' ultrasound and RF are for 'elasticity,' and fillers are for 'volume.' They are combined according to the cause.

🩺 Side Effects and Recovery, What to Know in Advance

Common reactions include swelling, bruising, dimpling (skin indentation), asymmetry, and a foreign body sensation. Most of these are temporary. Swelling and bruising subside within 3 days to 2 weeks, and it takes about 2 to 4 weeks for the tissues to fully settle.

Dimpling occurs when thread barbs catch on a shallow layer, which also typically improves naturally within 2 to 4 weeks. Recovery care can be managed as follows.

• For 2 to 4 weeks post-procedure, avoid facial massages, saunas, strenuous exercise, hard foods, and opening your mouth too wide.

• Apply cold compresses for 2 to 3 days, then switch to warm compresses to help ease swelling and bruising.

• Aspirin, anticoagulants, omega-3, and high-dose vitamin E can increase the risk of bleeding and bruising, so be sure to consult with your medical staff in advance (do not stop taking them on your own).

In the midface, where blood vessels and nerves are complex, using a blunt-tipped cannula is preferred to reduce the risk of damage.

📌 Key Summary: Swelling, bruising, and dimpling usually improve within 2 to 4 weeks; switching from cold to warm compresses and following the 4-week lifestyle guidelines are key to recovery.

🎯 Design Over Quantity, Onlif's Perspective

"The more threads inserted, the better" is a common misconception. What really matters is not the number of threads, but the design of the insertion layers, directions, and anchor points. The number of threads used varies from 2 to 6 per side, totaling 4 to 12 for both sides, depending on facial conditions and design.

Onlif aims for a multi-layer lifting perspective, approaching the skin, subcutaneous fat, SMAS, and muscle layers by dividing their unique characteristics. Whether it is lifting wide cheekbones vertically, pulling severe sagging strongly at an angle, or redistributing excessive volume by adjusting directions, customized designs that read facial shape, wrinkles, and volume together determine the outcome.

Ultimately, the practitioner's anatomical understanding and skill level are the key variables. Onlif strives to maintain this precision through a system where doctors specialize in the procedures they perform best. Instead of changing the shape of the eyes, nose, or mouth, the focus is on restoring natural balance by simply lifting away the signs of aging.

📌 Key Summary: It is not a competition of quantity; the results are shaped by layer, direction, and anchor design, as well as the practitioner's expertise.

❓ Frequently Asked Questions

Between midface thread lifting and nasolabial fold fillers, which should I get first?

If the cause of the nasolabial folds is "sagging," thread lifting comes first; if it is "loss of volume," fillers or fat grafting are prioritized. If both causes are present, a common sequence is to pull the skin with a lift first and then complement any remaining hollowness with fillers. The exact sequence is determined after diagnosis.

Does the effect remain even after the threads have completely dissolved?

Yes. Although the threads themselves decompose, the collagen stimulated during the procedure remains, allowing the elasticity effect to persist for a certain period. Saying "it reverts back once the threads dissolve" is a misconception.

When is the best time to get a touch-up treatment?

The recommended timing is when about 50% of the effect remains, which is roughly 1 to 1.5 years after the procedure. Undergoing a touch-up at this stage ensures a natural continuation of the effects compared to waiting until they have completely faded.

I have dimpling (skin indentation). Is this okay?

This phenomenon occurs when thread barbs catch shallowly, and most cases improve naturally within 2 to 4 weeks. If it persists for a long time or causes severe pain, please contact the clinic where you received the procedure.

Is it effective for those with a lot of facial fat and heaviness?

If sagging is severe and skin laxity is excessive, there are limits to what thread lifting alone can achieve. In such cases, it is practical to combine it with elasticity treatments like ultrasound or RF, or to consider other methods together.

Can men receive this procedure?

Yes, they can. However, because men have thicker skin and different structural characteristics in their supporting tissues, differences are made in thread selection and insertion design. Individualized diagnosis is particularly important.

This article is intended to provide general information, and the appropriate procedure varies depending on individual skin conditions and aging patterns. We recommend consulting with a professional to confirm an accurate diagnosis and treatment plan. Gangnam Onlif Clinic provides consultations focusing on non-surgical, incision-free lifting.