Cheek hollows after thread lifts: Why do they occur and how can they be reversed?

If your cheeks look sunken after thread lifting, there is something you should know first. Cheek dimpling is not a single side effect, but a collective term for several phenomena. These include dimpling caused by the thread's cogs pulling on the skin like a dot, puckering where the skin wrinkles and contracts, actual hollow cheeks where the area under the cheekbones becomes wide and sunken, and linear depression that goes in like a line along the thread path. Although they look similar on the outside, the causes and solutions are completely different.

So, you do not have to immediately conclude that a noticeable mark right after the procedure is a failure. It takes several days to 2 weeks just for swelling and bruising to subside, and early dimpling or puckering often resolves naturally within 2 to 6 weeks. However, if it remains the same or gets worse even after 4 to 6 weeks, then you need to look into the cause.

🔍 What exactly is thread lifting cheek dimpling?

Thread lifting is a procedure that inserts absorbable threads under the skin to pull up sagging tissue. The key is that the thread itself does not fill volume, but rather creates a force in the direction of pulling. If the distribution of force is off here, the tissue cannot rise evenly and a specific point becomes depressed.

Cheek dimpling is the general term for that depression. It is easy to understand if you divide it into the following four types.

📌 Key Summary: Cheek dimpling is a complex phenomenon that encompasses dimpling, puckering, hollow cheeks, and linear depression, and the causes and solutions differ for each type.

⚙️ Why do cheeks dimple?

The causes are generally narrowed down to a few. Shallow thread insertion layer, excessive traction tension, inappropriate lifting vector, originally insufficient volume, and adhesion of skin and subcutaneous tissue.

The target insertion layer for thread lifting is the subcutaneous layer or the layer adjacent to the SMAS (Superficial Muscular Aponeurotic System). If this layer is incorrectly targeted and placed too shallow, irregularities occur on the surface. If the lifting vector, that is, the direction in which the thread is pulled, is misaligned, the force is directed to the wrong place, resulting in depression.

To talk a bit more anatomically, if the barb structure of the Cog thread gets caught in the Retaining Ligament, a characteristic cheek dimple can occur below the cheekbones. When the barb gets caught in the ligament that holds the tissue, that spot gets depressed as if pressed.

And just because it is an absorbable thread does not mean the problem disappears immediately. The thread remains in the body for several months until it is completely absorbed, and adhesion and fibrosis reactions can remain along with collagen remodeling during the absorption process.

📌 Key Summary: Shallow insertion layer, excessive tension, incorrect vector, lack of volume, and adhesion are the five axes of cheek dimpling, and the sophistication of the procedure design is decisive.

🧵 Does the type of thread affect cheek dimpling?

Threads differ in absorption period and collagen induction power. We look at three main types.

However, these numbers are not absolute values, but rather a reference range with large variations by product. And to be honest, there is not yet enough comparative data to say definitively "which thread causes less cheek dimpling."

What affects cheek dimpling more directly is the shape of the thread. Cog threads that physically pull tissue are most often pointed out as the cause of dimpling and linear depression. Ultimately, which layer, in which direction, and with how much tension the thread is placed plays a bigger role than which thread is used.

📌 Key Summary: The absorption period is in the order of PDO<PLLA<PCL, but product variations are large, and cheek dimpling depends more on the cog shape and procedure design than the thread type.

😟 Am I in a high-risk group for cheek dimpling?

Thread lifting is a pulling procedure, not a filling procedure. Therefore, a face that originally lacks volume may look even more sunken as it is pulled. This is why pre-procedure evaluation is particularly important.

If you fall into any of the following, it is recommended to approach with caution.

• Faces with little cheek fat and thin skin

• Protruding cheekbones or sunken areas below the cheekbones

• Cases where mid-face fat atrophy has progressed after the 40s

• Past history of liposuction, contouring surgery, or excessive dieting

• History of receiving previous thread lifting

To add one more thing, it is also pointed out that if you excessively overlap procedures of the line that reduces fat, volume may decrease further and cheek hollows may stand out. If you have thin cheeks, you should consult on the combination of procedures itself.

📌 Key Summary: Faces with little cheek fat, thin skin, or sunken areas under the cheekbones are in the high-risk group, and volume-deficient types cannot be solved by pulling procedures alone.

🛠️ How do you correct cheek dimpling?

The first thing I want to emphasize is that unconditionally removing the thread is not the answer. Correction depends on the cause.

• Early dimpling/puckering → Usually observed for 2-6 weeks. Many resolve naturally

• In case of excessive tension → Adjust thread tension or partially remove

• In case of insufficient volume → Supplement the sunken area with hyaluronic acid fillers

• Wide hollow cheeks / loss of mid-face volume → Fundamentally complement with autologous fat graft

• Depression fixed due to skin adhesion → Physically dissect the adhesion with subcision

The principle is simple. If sagging is the problem, lifting; if volume is the problem, filler/fat graft; if both, run them in parallel. Adding more threads will not fill the dimple.

At Onlif Clinic, we also look at this judgment first when dealing with thread lifting. Rather than just pulling threads strongly for those with insufficient volume, we prioritize designing skin procedures such as fillers, skin boosters, ultrasound, or high frequency together to create natural lines. You can understand it as a direction to arrange the natural contours hidden by aging, rather than changing the shape of the eyes, nose, and mouth.

For reference, facelift surgery accompanied by incision is sometimes mentioned for moderate or higher sagging. However, this is a separate area with vastly different recovery periods and burdens, and Onlif does not deal with plastic surgery that uses a knife. The approach recommended by Onlif is strictly a non-surgical procedure from a dermatological perspective.

📌 Key Summary: Correction is divided into observation, tension adjustment, filler, fat graft, and subcision depending on the cause, and unconditional thread removal is not always the correct answer.

⏱️ How long should I wait, and when should I go to the clinic?

I will summarize the time criteria for you. The immediate result after the procedure is not the final result. It takes 2 to 4 weeks after the swelling goes down to evaluate the actual appearance.

• Swelling/Bruising: Usually several days to 2 weeks

• Natural resolution of early dimpling/puckering: Usually 2 to 6 weeks

• Requires medical attention if it persists or worsens for more than 4-6 weeks

However, you must go to the clinic immediately regardless of time if you experience the following signals: when accompanied by skin color change, heat sensation, pus, or fever. It may be related to blood circulation or infection, so you should not delay.

Recovery care also affects the outcome. It is generally recommended to avoid opening your mouth wide, hard foods, strong massage/acupressure, sauna, and strenuous exercise for about 1 to 2 weeks after the procedure.

📌 Key Summary: 2-4 weeks is the waiting period before outcome evaluation, medical attention is required if it persists for more than 4-6 weeks, and color change, heat, and pus are signals for an immediate visit.

❓ Frequently Asked Questions

My cheeks are sunken after thread lifting. Will it get better if I wait, or should I go to the clinic?

Early dimpling or puckering often resolves naturally within 2 to 6 weeks. However, if it remains the same or worsens even after 4 to 6 weeks, medical attention is needed, and if there is color change, heat, or pus, you should visit immediately regardless of time.

Are dimpling and cheek dimpling where the entire cheek is sunken the same thing?

They are different. Dimpling is a localized depression caused by the thread's cog pulling on one spot like a dot, while hollow cheeks are a volume issue where the area under the cheekbones or around the mouth is widely sunken. Because the causes are different, the correction methods also differ.

I have a thin face with little cheek fat. Can I get thread lifting?

If you have little cheek fat and thin skin, you are in the high-risk group for cheek dimpling. Since pulling force alone can make it look even more sunken, it is recommended to sufficiently consult before the procedure on whether to design volume supplementation or skin procedures together.

Will getting fillers solve cheek dimpling?

Volume-deficient cheek dimpling can be improved by supplementing the sunken area with hyaluronic acid fillers. However, since the approach differs depending on whether it is the area where the thread entered and whether there is adhesion, a decision must be made after diagnosing the cause.

Will my cheeks go back to normal if I remove the threads?

Dimpling caused by excessive tension can be improved by thread adjustment or removal, but if adhesion or fibrosis has already remained, it may not completely return to normal just by removal. Subcision or volume supplementation may be needed together.

Why did cheek dimpling occur only on one side?

Subtle differences in left and right facial structures, differences in thread insertion depth and tension, and differences in habits of using facial expression muscles can be the causes. For asymmetrical depression, the exact correction direction can only be determined after directly checking the status.

Can cheek dimpling remain even if absorbable threads are used?

Yes. Absorbable threads also remain for several months until they are completely absorbed, and adhesion and fibrosis reactions can remain along with collagen remodeling during the absorption process. Just because it is absorbed does not mean the possibility of side effects disappears.

What to check before choosing a clinic for thread lifting cheek dimpling

Even for the same procedure, the results and recovery process vary depending on where, by whom, and how it is performed. Asking these items directly during counseling will help you make a judgment.

• Is it a place that performs that procedure frequently? — Each clinic has different main procedures they deal with. Check if it is a place that regularly handles thread lifting cheek dimpling.

• Can I check the products and equipment used? — Ask if you can check the product name and genuineness (whether it is an import-approved product and if there is an unboxing verification process) during counseling.

• Do they explain the breakdown of the cost? — Rather than just hearing the total amount, you can make a judgment only after hearing explanations of what products are used, how much, and in which areas.

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

• Do they explain adverse reactions and recovery processes first? — Rather than counseling that only talks about expected changes, it is better to judge a place that also informs you of possible adverse reactions and how to deal with them.

• Is there a way to follow up after the procedure? — Check if the timing for checking progress, how to contact if there is an anomaly, and standards for revisit are set.

Onlif Clinic does thread lifting cheek dimpling like this

• We divide responsibilities — With the thought that a single doctor cannot deal with all procedures, Onlif divides medical treatments with responsible doctors by field.

• We verify products and equipment together during counseling — We guide you through the products used and the unboxing verification process during the counseling process.

• Costs are guided along with the structure after diagnosis — Since the part, volume, and range differ for each person, we explain together what costs how much.

• We design by looking at the overall facial balance — We look at the face with three axes: texture, balance, and youth signals, and make plans in a direction to arrange parts that hide the natural impression rather than changing the shape.

• We tell you about adverse reactions and recovery processes first — Along with the expected changes, we guide you through individual differences, possible adverse reactions, and management before the procedure.

• We look at the progress after the procedure together — If verification is needed during the recovery period, we guide you through revisits and contact channels.

If you are concerned about thread lifting cheek dimpling, it is recommended to first check what is possible and what is difficult in your current state. Accurate diagnosis and procedure plans can only be determined through face-to-face medical treatment. Check through counseling at Gangnam Onlif Clinic.