Korean Face Slimming Without Surgery: When Threads Are Enough

I'm Dr. Jong Hoon Lee, a doctor at Gangnam HERA in Seoul. I have been in practice for more than 25 years, I co-wrote the textbook LIFTINGOLOGY: Science and Clinical Practice in Aesthetic Medicine, and I have taught more than 20 hands-on thread-lifting seminars and live demonstrations for other physicians. In this episode of our talk series with my colleague Dr. Jong Seon Kim, he asked me the questions patients ask most about getting a slimmer face, and I answered them using real before-and-after photos.

My short answer: many people who search for face slimming surgery do not need surgery. If the face looks wide because tissue has dropped, a thread lift can give a slimmer, more oval line — but if laxity is severe, surgery is the honest answer.

Why do so many people come to Korea for a no-surgery V-line?

Because word has spread that threads can sharpen the lower face without an operation, and patients arrive already well informed. Our domestic patients ask for it, and so do patients from Japan, China, Southeast Asia and further afield. Most of them have researched before they come.

The wish behind the search is almost always the same, at any age: a face that looks a little smaller, a little firmer, a little more oval. There is a ladder of ways to approach that, from simple injections, to energy devices such as Ultherapy, Titanium and Thermage, to thread lifting, and finally to facelift surgery. A large share of the people who ask me about threads have already had a device lift and felt "it wasn't very dramatic." They want more than a device can give, but surgery feels frightening. Threads sit exactly in that gap.

Why are people in their twenties getting thread lifts?

Because a thread lift is not only for sagging — it can refine the jawline and turn a square-looking face into a softer oval. We usually picture sagging as a problem of the forties and fifties, but in recent years the number of patients in their twenties asking for threads has grown a lot.

They do not have heavy jowls. What they want is proportion: an inverted-triangle face, a cleaner jawline, a V-line. When threads lift the lower face slightly, an angular face looks narrower and the outline becomes neater. For these younger faces the plan is lighter, because we are refining a line rather than holding up heavy tissue. If your lower face looks wide mainly because of fat rather than position, a fat-reducing injection may do more than threads — which V-lift method suits which face compares the two.

What is a thread lift, and how does a thread hold the face up?

A thread lift places fine medical threads under the skin to pull sagging tissue back up and hold it there. There are many kinds of thread, made from different materials, in different shapes and sizes, and each is chosen for a purpose: some mainly lift, some add firmness, and some are said to add a little volume.

To understand why it works, think about how the face ages. The face is held in place by retaining ligaments. With time they stretch, gravity wins, and the outline of the face shifts from an inverted triangle toward a triangle or a square. You can see this yourself: lying down, most faces look noticeably more V-shaped; sitting or standing, the tissue drops and the face looks heavier. Once threads are in, they help the face keep something close to its lying-down shape when you are upright.

Are dissolving threads better than permanent ones?

For most patients, yes — today well over 95% of the threads I see used are absorbable, and that is for good reasons. Thread lifting began in the 1990s with a Russian physician. The first lifting threads, the early Aptos threads, were cut by hand to create small barbs, and they did not dissolve; the idea was that a permanent thread would give a permanent result.

Permanent threads do last somewhat longer. But by around two years their effect has also dropped considerably, and then you face placing new threads on top of many old ones that are still there. That is why dissolving threads became the standard. Today's Aptos threads, for example, are absorbable P(LA/CL) threads — you can read how they work on our Aptos Thread Lift page.

Absorbable threads have their own limit. PDO, one of the most widely used materials, has many advantages, but it breaks down in about six months. So manufacturers have developed threads that last longer, and in practice I often combine a basic thread with a longer-lasting one.

Who is a good candidate for a thread lift?

People whose main problem is tissue that has dropped: loose jowls, deepening smile lines, and marionette lines below the corners of the mouth. Because the core idea of threads is to lift what has slid downward, these are the classic indications.

• Jowls and lower-face sagging — the most common reason patients come.
• Nasolabial folds that have deepened as the cheek drops.
• Marionette lines — the creases running down from the mouth.
• Drooping brows — threads in the forehead can lift a brow that has dropped onto the eyelid, or that sits very close to the eye, without a large operation.
• A square or wide-looking lower face in younger patients who want a softer oval.

Threads do have side effects and limits — temporary swelling, tightness, small bruises and, occasionally, dimpling or a visible thread — which are covered in our thread lift patient guide.

Thread lift or facelift: how do I know which one I need?

It is a matter of degree: the more laxity, the more volume and the longer the result you want, the more the answer moves from threads toward surgery. In the video I walked through three real faces to show where that line falls.

A woman in her thirties: threads alone

Her face was already fairly oval, but after threads it became a clearer inverted triangle, a sharper V-line, and her smile lines softened as well. This is the kind of face where a modest number of threads makes a visible difference.

A woman in her early fifties: threads plus a little filler

She was bothered by her nasolabial folds, by the groove that runs down across the front of the cheek, and by marionette lines. She needed more threads than the first patient, and I placed extra threads along the lifting vectors that pull the marionette area up. Where a groove remained after lifting, I added a small amount of filler. Lifting and filling solve different problems — lifting repositions, filler replaces lost volume — and many faces need a little of both.

A woman in her late sixties: surgery was the right choice

The third photo showed a much older face with a lot of facial fat, heavy laxity, marked neck lines and deep folds. Simply pulling sagging tissue upward in a face like this gives a short-lived result. If a younger patient might have six to eight threads on each side, the same number in this face gives less effect and does not last. For her, facelift surgery — together with reducing the fat in the cheeks and under the chin — was the appropriate plan.

So my rule is simple. If the sagging is severe, if there is a lot of volume to lift, or if you want the result to last much longer, surgery is the better fit. The lifting treatments on HERA's treatment pages are non-surgical, so if your face is in that third group, I will tell you plainly rather than sell you threads that will not hold. Four checks for jowls, laxity and downtime goes into that decision in more detail.

Why does the doctor matter more than the thread?

Because with the same thread and the same number of threads, results can differ enormously depending on who places them and how. Of all the injection and device treatments for a younger-looking face, thread lifting is the one where technique shows most: the direction of each vector, the depth, the anchoring, and knowing where not to place a thread.

The trend I see is clear. Patients increasingly avoid anything painful, with long swelling or a long recovery, and prefer a procedure with less discomfort and a visible result. That is a reasonable choice for the right face. If you choose threads, choose someone who has placed a great many of them. The complete thread lift guide covers recovery and planning a trip around treatment.

The honest limits

A thread lift is not surgery, and it is not permanent. It repositions tissue and supports it while the threads are in place and the collagen around them forms; it does not remove excess skin, and it does not reduce bone or large amounts of fat. Swelling, tightness and some discomfort when opening the mouth wide are common for the first days. How much lift you get, and how long it holds, varies from person to person, and we confirm the plan — which threads, how many and where — at your consultation. International patients pay the same as local patients, and an English interpreter is with you throughout.

If your face is in the large middle group — not severe enough for surgery, not satisfied with devices alone — threads are often the most efficient step. You can see real HERA results in our before-and-after gallery.