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Threadlift Facelift and Necklift Q&A

This FAQ (frequently asked question) section reviews many of the questions and answers regarding the SMART Facelift™, a facelift and necklift procedure performed in just one hour using a customized version of the threadlift technique.  The procedure is performed by Dr. Adam Summers at the Maryland Plastic Surgery Center (just minutes from Annapolis, Baltimore, Columbia and Washington, DC).  The Q&A below are designed to help you decide if the threadlift facelift and necklift procedure is right for you.  Other FAQ’s include:

     FAQ’s – Information about how the Threadlift facelift is performed

     FAQ’s – Post-op recovery issues and concerns


Any licensed medical doctor can perform the procedure. Because the procedure is relatively simple to perform, many physicians (dermatologists, ophthamologists, OB/GYNs, and even internists) are now offering this procedure to their patients. However, there is a significant difference between having the procedure performed by a board certified plastic surgeon who specializes in cosmetic surgery and a physician inexperienced with the threadlift or and who does not specialize in cosmetic surgery.

Additionally, the physician performing the threadlift procedure should be able to offer you ancillary procedures to optimize the results of your threadlift (e.g. FotoFacial, Thermage, Liposuction, Blepharoplasty, Browlift, Necklift, etc.). In general, dermatologists, OB/GYNs and internists simply cannot offer you the full spectrum of treatment options.

Finally, the treating physician should not only have experience with the threadlift procedure, but he/she should also be an experienced facelift surgeon certified by the American Board of Plastic Surgery – this ensures that you will: (1) have a detailed analysis of your face performed; (2) have all of your options presented to you (non-surgical facelift, mini-facelift, S-lift facelift, endoscopic facelift, or full facelift); (3) have the most appropriate procedure recommended; and (4) have the best care provided, including treatment of any complications.

You only have one face – trust an experienced and artistic plastic surgeon to provide you with the best results. After all, you deserve it.


Dr. Summers has been performing suture suspension facelift procedures since 1996. He has authored papers on the procedure, presented techniques at national meetings and performed clinical investigations for 10 years. Dr. Summers has been using the “barbed” polypropylene suture since 2004, shortly after it was granted FDA approval for use in the United States.

Dr. Summers was one of the first surgeons in the country to use the “endo-aptos” technique where the threadlift threads are secured or anchored to the tissues.


If you are beginning to notice a deepening “cheek fold” (nasolabial fold) and/or jowling, you may be a good candidate for a standard threadlift procedure.

The threadlift procedure is appropriate for both men and women of varying ages and socioeconomic classes. With the threadlift procedure the results are immediate, there is little downtime, and the procedure is affordable. I have performed the procedure on homemakers, young professionals, doctors, attorneys, and public figures.


Interestingly, I have found that some of the best candidates for the threadlift procedure are Asian and African-American patients. This is because ethnic skin tends to be slightly thicker and better protected from elastosis (thinning of the skin due to sun exposure).


In patients with very thin skin due to genetics, advancing age or solar elastosis (sun exposure), the threadlift may not be the initial (or primary) treatment for facial rejuvenation. This situation is more commonly noticed in Caucasian patients.

However, I have been able to reverse the effects of solar elastosis and advanced skin aging using a combination of non-surgical modalities.  For example, with a combination of Tehrmage and Photodynamic Therapy (PDT), I have tightened the skin adequately to enable patients to become threadlift patients.  Similarly, with the injection of either Sculptra or autogenous fat, I have created more volume within the soft tissues, enabling these patients to become threadlift patients.


Other surgical treatments (including neck liposuction, eyelid lift and lip enhancement procedures) may be performed at the same time as the threadlift procedure.

Non-surgical treatments such as Thermage and Titan skin tightening procedures should be performed prior to the threadlift or at least one month following the threadlift. FotoFacial and Botox treatments may be performed before or after the threadlift — however, if a brow threadlift is contemplated, Botox should be injected in the glabella one week prior to the threadlift procedure. Injection of fillers (Restylane, Captique, Juvederm, Radiesse) should be performed about one month after the threadlift.


The threadlift procedure will help you look like a more youthful version of yourself. You will not look like a different person.


The threadlift procedure is most commonly performed to raise the cheeks and jowls.  Improvements in the nasolabial fold, meliolabial fold, jowling, nasojugal trough (tear trough) and infraorbital hollow are seen with the typical threadlift.  Also, tightening of the neck occurs simultaneously.

In selected individuals, the threadlift procedure can be used to lift the eyebrows, turn up the corners of the eyes, raise the corners of the mouth, and lift loose neck skin.


The threads are made of polypropylene – this has been used as a surgical suture material for about 30 years. It is a permanent suture material and, to the best of my knowledge, there has never been a report of an allergic reaction to the material.


The results of a threadlift procedure are immediate and substantial. No other minimally invasive procedure can provide the significant and long-lasting results as those obtained by the threadlift procedure.


There are many different versions of the threadlift technique – each variation involves a change in either the materials used or the method of placement. Dr. Summers performs the endo-aptos threadlift technique, which he helped to pioneer. The threads are anchored with surgical knots to a deep layer of tissue called “fascia”. This tissue is very strong and does not sag or loose its strength over time.

One of the most important differences among threadlift procedures is the variability in placement of the threads.  To ensure optimal results, Dr. Summers customizes the location and placement of the threads based on each patients’ individual anatomic requirements.


First, the threads are inserted into the tissue under the skin (not in the skin itself). Next, hundreds of tiny barbs engage and distribute the weight of the tissue and the overlying skin as the threads are pulled tight. Finally, the threads are secured.


Although I have never had a patient reporting dissatisfaction with the procedure, the threadlift is the only facelift procedure which can either be easily tightened or removed completely. In the unlikely event the threads are removed, your face will return to its pre-op appearance.


Well placed threads should never be visible through the skin.

In the hands of an inexperienced surgeon, superficial thread placement can result in threads which are able to be seen beneath the skin. Also, improperly placed threads can result in dimpling of the overlying skin. In the hands of an experienced surgeon, the incidence of this should be zero.

In some individuals with thin skin, a “buckling” of the end of the thread can occasionally be seen when the patient smiles. In most cases, this resolves spontaneously after a couple of months. If the “buckling” persists or is problematic, the offending thread can be removed or replaced. The overall incidence of this is less than 5%.


There is a difference between short-term and long-term palpability (ability to feel the threads).

Immediately following the procedure, there is some swelling around the threads. This swelling is not visible, but it does make the thread feel “thicker”. Therefore, you may be able to temporarily “feel” some of the threads. After one month, the swelling should be completely resolved. Additionally, after 4-6 weeks, your body forms a sheet of collagen fibers around the thread, essentially incorporating the thread into your tissues. At this point, 95% of the threads inserted are not be palpable.

However, about 5% of threads are able to be palpated distally (close to the nasolabial fold) after complete healing has occurred. This appears to be due to distal thread migration. Sometimes patients notice this as a “pimple-like” sensation under the skin. In many cases, this can be resolved with appropriate soft-tissue massage.

Note: In the hands of an inexperienced surgeon, superficial thread placement can result in threads which are able to be easily felt (and potentially seen) along their entire course beneath the skin. The appropriate treatment for this is removal of the offending thread.


Absolutely. The threadlift procedure works well with other procedures and will not prevent you from having any future procedure.


The Lifestyle Lift® facelift is a variation of a mini-facelift marketed by Lifestyle Lift Holding, Inc. for their franchised physicians.  Physicians offering the Lifestyle Lift® facelift frequently do not perform any other type of facelift procedure.  The Lifestyle Lift® facelift involves an incision around the ear, removal of skin, displacement of the hair line, and a permanent scar around the ear.  (Note: Neither Dr. Summers nor Maryland Plastic Surgery are affiliated with Lifestyle Lift Holding, Inc.)

In contrast, Dr. Summers, who is certified by the American Board of Plastic Surgery, Inc. and who is a clinical assistant professor of plastic surgery, has developed the Multiplanar One-hour Suspension Threadlift (MOST™)facelift and necklift.  With the MOST™ facelift, there are no incisions around the ear (so there are no visible scars in front of or behind the ear), there is no displacement of the hairline (so the beard is not positioned behind the earlobe), and the results have been proven to last many years.