The perky brow, the lifted cheek: has she or hasn't she? The latest aesthetic-medicine trend explained.

By Alexandra Marshall
Jan 13, 2021 @ 8:45 am
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Threading
Credit: Marcus Ohlsson/Trunk Archive

Perhaps you've heard of threading? Not the thing a stern lady does to painfully shape your brows with what feels like coarse dental floss, but the medical-aesthetic procedure in which tiny filaments made out of the same sugar-based material used for self-dissolving stitches are inserted under your skin. It's said to give you exceptionally lifted brows, raise up other sagging areas of the face, and improve your skin's overall firmness. If you've spent any time looking at red carpets in the past few years, you've seen these results.

"A lot of models come in before fashion week to do threads, and so do actresses before the Cannes Film Festival," says Antoni Calmon, a general practitioner in Paris. For the brows and upper face, threads are "like taping but under the skin," he explains, referring to the Hollywood technique perfected by actress Marlene Dietrich, who applied sticky tape to her hairline. "There are so many women who still do tape; it's insane," he says. Threading is considered a much cleaner, more durable option to compete with injectable fillers, whose signs of overuse — chipmunk cheeks, duck lips, and a Neanderthal brow — we all know too well.

Thread lifting uses a cannula, or a hollow needle, to inject a hair-size thread, usually with barbed edges on both ends, below the dermis. Like a cantilever, the barbs anchor into subcutaneous fat and tighten, pulling skin and facial fat upward and outward. How lifted, plumped, or firmed the skin appears depends on the angle, placement, and number of threads, which can be anywhere from three to a dozen per area. After a few weeks to a month for the brows and longer elsewhere, the thread slowly loses elasticity and then gradually dissolves in place. The skin reacts by building up collagen around it, which, for a few months more, continues to lift and plump. Just the action of the foreign object dissolving — and the healing that occurs along with it — is reason enough for the treatment, which is why doctors like Calmon are also injecting barbless threads in a mesh pattern under the skin to give other areas a boost.

Threading
Credit: Marcus Ohlsson/Trunk Archive

The cost goes up depending on how many threads are needed, and usually the most dramatic changes last the least amount of time. "Brow threads look amazing for about a month," Dr. Calmon says. Then, because of facial mobility and gravity, the threads stretch out like elastic, reducing what was once a 5-millimeter brow lift to 2 to 3 millimeters. Still, because there are no stitches, there is only minor swelling and bruising. Anyone who places a high premium on looking very alert for an awards show or runway season is likely considering the treatment.

Vanessa Lee, the registered nurse behind the Things We Do, a downtown L.A. practice known for injectables, was an early adopter and now says threading accounts for half her practice. "Six or seven years ago, one of my patients came back from Thailand and asked me if I did thread lifts. It kind of piqued my interest," she says. Lee does research and training trips to Asia regularly, especially South Korea, where "they do all the cool things first," and discovered more development of the all-important threads themselves. Rather than barbed threads made by cutting away from the body of the filament, like those commonly found in Europe and North America, "South Korean threads are made for more heavy-duty lifting, molded with extra branches that are much stronger," she explains. Dr. Calmon has patients who have come back from the Middle East with permanent, non-dissolvable threads implanted. But for now, he's wary of the technique until he determines whether they're easy to remove in case of infection and won't be rejected by the body and be pushed back out of the skin, which has been known to happen.

Aesthetic medicine evolves at a rapid pace — unsurprising, given the massive amount of money and the incentives at play. "A lot of plastic surgeons fought threading at first," says Lisa Goodman, founder of GoodSkin anti-aging clinics in L.A. and N.Y.C., which have a thriving threading practice. "And now they're all doing it."

Placement is key. Lee likes them in the mid-face, to pull up sagging cheek pads without too much puffing out, and even around the jowls and lower face, which other practitioners might avoid because the mobility of the face causes standard jagged threads to unhook more easily. (It sounds awful, though the effect isn't harmful because the thread is dissolvable. Instead, thread slippage, like a hem coming out of a dress, just renders the whole procedure moot.) Goodman agrees that pulling up drooping cheeks offers the best bang for the buck, with effects that can last four to nine months. But "if the problem is simply a lack of cheekbone, filler is still a better option," she says. "And if someone needs a facelift, they need a face-lift."

Indeed, threads are not a substitute for the gravity-defying and more dramatically tuned-up effects of a classic surgical tightening. Threads tend to work better on women in their 30s and 40s, who have ample natural collagen reserves and enough subcutaneous facial fat to grab onto. The procedure can also pose problems for any future trips under the knife, because of the scar tissue they cause under the dermis. "Over time, too much can cause circulation issues," warns Vanessa Coppola, nurse practitioner and founder of Bare Aesthetic med spa and wellness clinic in New Jersey. "And it can complicate surgical intervention down the line. I would not repeat the procedure more than once or twice a year, maximum."

Threading
The Results: A patient of Vanessa Lee’s, the registered nurse who runs the L.A. practice the Things We Do.
| Credit: courtesy The Things We Do

You'd think that under confinement, when red carpets and fashion shows were all but canceled, the interest in threading might have slackened, as it were. Au contraire. Specialists have never been busier. "It's definitely the Zoom effect," says Lee, who closed for four months in 2020 but had almost made up the drop-off by the end of the year. "I remember also back in 2009, when the economy was really bad and the same thing happened. I was interning for someone, and it was so busy. Patients were telling me: 'I'm getting a divorce. We're losing our business. I've lost everything.' And I'd be like, 'Why are you here? Save your money!' But one patient told me, 'Honey, if my life is going to shit, I'm going to look good.' When people experience a loss of control, they want to feel good about themselves." If the events of 2020 have added 10 years to our lives, you'd never know it to look at some of us.

For more stories like this, pick up the February 2021 issue of InStyle, available on newsstands, on Amazon, and for digital download Jan. 15.