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

Midface thread lifting is a minimally invasive procedure that physically pulls up the sagging areas in the middle 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 the layer adjacent to the SMAS to hook and pull the tissue, an immediate lifting effect is visible right after the procedure, and elasticity gradually improves as new collagen is generated over time. The biggest advantages are that it takes 30 to 60 minutes without incisions, is performed under local anesthesia, and allows you to return home on the same day.

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

🔍 Why Does the Midface Collapse First?

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

Therefore, when this area sags, the entire face looks tired and heavy. The area under the cheekbones hollows out, nasolabial folds deepen, and the skin around the mouth feels like it is sliding down. This is why midface lifting is directly linked to a 'youthful appearance'.

📌 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's the Difference?

The most common point of confusion in thread lifting is the type of thread. It is easy to organize if you look at it divided largely into materials and structures.

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

In terms of structure, **Cog Threads** are mainly used for midface lifting as they pull tissue by hooking it with surface barbs, while **Mono Threads** are smooth threads without barbs that focus primarily on collagen stimulation, meaning their pulling force is limited. There are also separate screw and twist types designed for the purpose of filling volume.

For reference, non-absorbable threads like polypropylene have long-lasting effects but are tricky to remove when problems arise, making their nature distinctly different from absorbable threads. Since the choice of material and structure depends on the condition of the face, there is no single 'best thread' answer.

📌 Key Summary: Understanding the distinction between materials (PDO, PLLA, PCL) and structures (cog, mono) makes the criteria for selecting threads clear.

⏱️ When Does the Effect Start, and How Long Does It Last?

Inserting the threads provides an immediate lifting effect that pulls on that very day. In addition, the second improvement in elasticity occurs gradually over 1 to 3 months post-procedure as the neocollagenesis reaction takes place.

The maintenance period ranges from 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. A common misconception is that "once the threads dissolve, the effect also disappears," but even after the threads decompose, the elasticity effect remains for a certain period thanks to the collagen newly generated in their place.

It is recommended to undergo a repeat procedure when about 50% of the effect remains, roughly 1 to 1.5 years after the initial treatment. Doing it at this time rather than waiting for it to completely wear off allows for a much more natural transition.

📌 Key Summary: Dual effect of immediate lifting + collagen improvement, lasts 6 months to 2 years, repeat procedure recommended at the 50% effect point.

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

There are many branches of lifting methods. Since each plays a different role, it is good to compare them.

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

Radiofrequency and ultrasound have almost no downtime, but their physical pulling force is weak. Therefore, a realistic design is to combine thread lifting if pulling is needed, and ultrasound or radiofrequency if the goal is elasticity management. Fillers or fat grafting are also combined in areas with lost volume.

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

🩺 Side Effects and Recovery, Things to Know in Advance

Representative reactions include swelling, bruising, dimpling (skin indentation), asymmetry, and 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 cogs get caught in a shallow layer, which also usually improves naturally within 2 to 4 weeks. Recovery management can be done as follows.

• Avoid facial massages, saunas, strenuous exercise, hard foods, and opening the mouth wide for 2 to 4 weeks post-procedure.

• Apply cold compresses for 2 to 3 days, then switch to warm compresses to alleviate 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 medical staff in advance (do not stop taking them arbitrarily).

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 rules 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 layer, direction, and fixation points. The number of threads used ranges from 2 to 6 on one side, and a total of 4 to 12 on both sides, depending on the facial condition and design.

Onlif pursues a multi-layer lifting perspective that approaches the skin, subcutaneous fat, SMAS, and muscle layer by dividing their characteristics. A customized design that reads the face shape, wrinkles, and volume together—such as organizing wide cheekbones vertically, severe sagging strongly diagonally, and distributing the direction of excess volume—determines the results.

Ultimately, the practitioner's anatomical understanding and expertise are the key variables. Onlif strives to maintain this accuracy through a doctor-specialty system where each doctor takes charge of the procedure they do best in their respective field. It is not about changing the shape of the eyes, nose, and mouth, but rather removing only the signs of aging called sagging to restore the natural balance.

📌 Key Summary: Rather than a competition over quantity, the results are determined by the design of layers, directions, and fixation, along with the practitioner's expertise.

❓ Frequently Asked Questions

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

If the cause of the nasolabial fold is 'sagging', thread lifting comes first; if it is 'loss of volume', fillers or fat grafting are prioritized. If both causes are mixed, a common sequence is to pull with a lifting procedure first and then supplement the remaining depression with fillers. The exact order 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, maintaining the elasticity effect for a certain period. The saying "once the threads dissolve, it goes back to exactly how it was" is a misconception.

When is the best time to get a repeat procedure?

The recommended timing is when about 50% of the effect remains, roughly 1 to 1.5 years after the procedure. Undergoing a repeat procedure at this point rather than waiting for it to completely wear off leads to a natural continuation of the effect.

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

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

Is it effective even if I have a lot of cheek fat and a heavy face?

If the degree of sagging is severe and there is excessive excess skin, there are limits to what thread lifting alone can achieve. In such cases, it is realistic to combine elasticity treatments such as ultrasound and RF, or to consider other methods together.

Can men receive this treatment too?

Yes, they can. However, since men have thicker skin and different supporting tissue characteristics, differences are made in thread selection and insertion design. Individual diagnosis is particularly important.

This article is for general informational purposes, and the appropriate procedure varies depending on individual skin conditions and aging patterns. We recommend confirming through a professional consultation for an accurate diagnosis and procedure design. Gangnam Onlif Clinic provides consultations centered on non-surgical lifting without incisions.

Midface Thread Lifting, Things to Check Before Choosing a Clinic

Even for the same procedure, the results and recovery process vary depending on where, by whom, and how it is performed.

Asking these questions directly during your consultation will help you make a decision.

• Is it a place that performs this procedure frequently? — Every clinic has different procedures they focus on. Check if it is a place that regularly performs midface thread lifting.

• Can I verify the products and equipment used? — Ask during the consultation if you can verify the product name and whether it is genuine (whether it is an imported approved product and if there is an opening verification process).

• Do they explain the breakdown of the cost? — Rather than just hearing the total amount, you need to hear an explanation of what product is used, how much, and in what area to make a proper judgment.

• Do they design by looking at the entire face? — Even for the same procedure, the placement location and amount vary depending on the face shape, skin condition, and left-right asymmetry.

• Do they explain adverse reactions and the recovery process first? — It is better to choose a place that informs you of possible adverse reactions and how to cope with them, rather than a consultation that only talks about the expected positive changes.

• Is there a way to follow up after the procedure? — Check if the timing for progress checks, how to contact them if there is an issue, and the criteria for follow-up visits are established.

This Is How Onlif Clinic Performs Midface Thread Lifting

• We divide responsibilities — Based on the belief that a single doctor should not handle every procedure, Onlif divides doctors by specialty for medical treatments.

• We check products and equipment together during the consultation — We guide you through the products used and the opening verification process during the consultation.

• Costs are guided along with the plan after diagnosis — Since the area, volume, and scope differ for each person, we explain what costs what together.

• We design by looking at the overall facial balance — We view the face through three axes: texture, balance, and youth signals, and make plans to organize the parts that overshadow your natural impression rather than changing its shape.

• We discuss adverse reactions and the recovery process first — Along with the expected changes, we guide you through individual differences, possible adverse reactions, and coping methods before the procedure.

• We review the progress together after the procedure — If verification is needed during the recovery period, we guide you through follow-up visits and contact channels.

If you are considering midface thread lifting, it is best to first check what is possible and what is difficult in your current condition.

An accurate diagnosis and treatment plan can only be determined through an in-person medical examination. Please check through a consultation at Gangnam Onlif Clinic.