Factors That Determine Thread Count
The number of threads used in a thread lift cannot be calculated by a single formula. All of the following factors are evaluated before a decision is made:
- Degree of sagging: Grade 1 sagging requires fewer threads, while Grade 3 pronounced sagging requires more threads and stronger anchoring.
- Skin thickness: Thicker skin means threads have greater difficulty gripping; more threads may be needed.
- Amount of fatty tissue: Excess fatty tissue in the lower face reduces thread resistance, so more threads or supporting lipolysis may be required.
- Size of the target area: A larger facial surface area requires more threads. Localized brow lifting needs fewer threads.
- Thread type: PDO monofilament and PLLA COG threads are not used in the same quantities. PLLA provides a stronger and longer-lasting effect, so fewer threads are generally needed.
Average Thread Count by Area
| Area | PDO COG (threads) | PLLA COG (threads) | Note |
|---|---|---|---|
| Cheeks (mid-face lift) | 4–8 | 4–6 | For both sides |
| Jawline | 4–6 | 2–4 | Increases with jowl sagging |
| Brow lift | 2–4 | 2 | Unilateral or bilateral |
| Forehead | 4–6 | 2–4 | COG threads can be used alongside mono threads |
| Neck (turkey neck) | 6–12 | 4–8 | Additional threads may be needed for platysmal bands |
| Nose (non-surgical rhinoplasty) | 1–2 | 1–2 | Nasal tip lift only |
| Full face V-line package | 12–20 | 8–14 | All areas combined |
Important Note: The values in the table are general references. The exact thread count cannot be determined without an individual examination.
PDO vs PLLA: Why Is There a Difference in Thread Count?
PDO (polydioxanone) and PLLA (polylactic acid) threads have different biological action profiles:
- PDO threads: Absorbed by the body within 4–6 months. Collagen stimulation is moderate. Therefore, more threads may be needed to cover the area.
- PLLA threads: Absorbed much more slowly (12–18 months). Collagen stimulation is 3–4 times stronger than PDO. Fewer threads, longer duration, and a more pronounced collagen cage effect.
For this reason, experienced physicians may prefer PLLA COG threads — especially for advanced sagging or thick skin structures — and achieve more effective results with fewer threads.
Risk of Insufficient Effect with Too Few Threads
Using fewer threads than necessary to cut costs can render the treatment ineffective. Possible outcomes include:
- Asymmetric lifting (one side lifts more than the other).
- Early relapse — when the thread count is insufficient, tissue weight displaces the threads more quickly.
- Early "thread sensation" — a smaller number of threads may be more perceptible under the skin.
Risk of Complications with Too Many Threads
Conversely, applying more threads than necessary can also cause problems:
- More injection points = increased risk of infection and bruising.
- As thread density within the tissue increases, the risk of dimpling and irregularity rises.
- The procedure takes longer and patient comfort decreases.
The optimal thread count is determined by the principle of "minimum threads for sufficient effect."
Relationship Between Result Stability and Thread Count
Research shows that beyond a certain threshold, the marginal improvement per additional thread diminishes. For a more stable and long-lasting result:
- Selecting an adequate number of COG threads (distribution according to barb pattern)
- Planning the thread layout to match the anatomy of the area
- Combined approaches (threads + Botox + filler) provide a stronger and longer-lasting effect
Can Threads Be Added in a Repeat Session?
Yes. Especially when PDO threads begin to lose their effect after 9–12 months, a new session can be planned. In this session, new threads can be added over the previous threads or in different planes. With PLLA threads, re-evaluation is generally done after 18 months. Each new session provides fresh collagen stimulation.
Thread Count Planning Process at Virtuana Clinic
Virtuana Clinic (Izmit/Kocaeli) creates each patient's thread lift plan not according to a standard protocol, but through individual facial analysis. During the consultation phase, the degree of sagging, skin thickness, fat distribution, and the patient's expectations are assessed to determine the thread count and type for each area. Please contact us for pricing information.
This article is for informational purposes only. Please consult a qualified physician for treatment decisions.