Thread lift gone wrong:
dimpling, visible threads, asymmetry and infection

Why does dimpling happen after a thread lift, and when does it settle?

Dimpling happens when a barb on a cog thread engages the undersurface of the dermis instead of the fat beneath it, or when the thread is drawn toward its anchor under more tension than the tissue can distribute. The skin puckers at that point. A thread lift places barbed, absorbable threads in the subcutaneous fat to carry descended tissue toward an anchor, so some pulling and a few small dimples where cogs have caught are expected in the early period.

Early dimples usually flatten as the swelling resolves and the tissue settles around the thread. A dimple that persists once the swelling has gone is different: it means the barb is holding the dermis, and it can be released with gentle manipulation or by freeing the catch with a fine needle, without removing the thread. Dimpling is more likely in thin skin and over the cheek where the dermis is close to the plane of placement, which is one reason very thin skin is a caution at assessment.

Why can threads be seen or felt, and what can be done?

Threads become visible or palpable when they sit too superficially, when the skin over them is very thin, or when a thread end has not been trimmed flush beneath the surface and sits at or through the entry point. A cog thread placed in the correct plane, in the subcutaneous fat below the dermis, is neither seen nor felt; a thread that shows as a ridge or a hard line under the skin is in the wrong layer or in a face whose skin is too thin to hide it.

An exposed thread end at the entry point, called extrusion, is trimmed back beneath the skin and the point cleaned, because an exposed end is a route for infection. A thread that is palpable but not exposed is assessed: if it is intact and recent, it can sometimes be removed physically through the entry point; if it is settled, it is often left to resorb, with the ridge softening as the polymer hydrolyses. PDO hydrolyses earliest and PCL slowest, so the material placed decides how long that wait is likely to be, and no figure is promised.

“A thread repositions; it does not tighten skin. Laxity needs energy, not string.”

Dr Sin YongOn the Bliss Lift thread lift page

Why does asymmetry occur, and what can be adjusted?

Asymmetry occurs when the two sides of the face have been lifted along different vectors or under different tension, when swelling settles at different rates, or when a thread on one side has slipped, migrated from its planned line or cut through tissue that was heavier than it could hold. Most faces are not symmetrical to begin with, and the assessment maps each side separately for that reason; an asymmetry that is new after treatment still needs to be explained.

The first step is time, because unequal swelling in the first weeks is not the final position. An asymmetry that persists is examined to find its cause. Unequal tension can be adjusted by releasing a catch or adding a vector on the lower side; a thread that has migrated can sometimes be retrieved while it is intact; a thread that has cut through heavy tissue has simply failed to hold, and the honest answer may be a different mechanism rather than more threads. The guide to whether a thread lift is worth it sets out which faces threads tend to disappoint.

How do infection and nodules arise, and how are they treated?

Infection arises when bacteria are carried into the thread track at the entry point or along an exposed thread end, and a thread is a foreign body that bacteria can colonise. The signs are pain that increases rather than settles, redness that spreads beyond the entry point, warmth, swelling that grows and any discharge. These are treated with antibiotics after examination, and a thread that is driving a persistent infection may need to be removed.

Nodules can also appear later without infection, as a granuloma, a foreign-body reaction around the thread. A firm lump along a thread line that appears weeks or months after treatment is examined rather than massaged, and management ranges from observation while the thread resorbs to injected medication or removal. Systematic reviews of thread lift safety describe these as among the recognised complications of the procedure, which is why the entry points, the plane and the thread type are each planned.

What about nerve or duct injury, the plane-related problems?

Nerve and duct injuries are plane-related: they arise when a thread is placed deeper than the subcutaneous fat, into or beneath the SMAS, where branches of the facial nerve and the parotid duct run. A thread that catches a nerve branch can cause weakness of part of the face; a thread that passes through the parotid duct can cause a collection of saliva under the skin or a salivary fistula. Both are described as infrequent in the systematic review of thread lift safety cited below, and both need prompt assessment rather than observation.

The plane is the reason the Bliss Lift places lifting threads in the subcutaneous fat, above the SMAS, from an entry point near the anchor with a blunt cannula or needle chosen for the thread. Respecting that plane keeps the thread superficial to the structures beneath the SMAS. Moving the SMAS itself is a surgical manoeuvre and the line between a thread lift and a facelift; the comparison of thread lift and HIFU explains how the layers differ.

Thread lift problems at a glance: what each one traces to, and what can be done

Each way a thread lift goes wrong traces to plane, vector, tension or thread type. The table sets each problem against its usual cause, what can be corrected, and what is left to resorb, because a settled thread often does less harm than a search for it.

Problem	Usual cause	What can be done	What waits for resorption
Dimpling	A cog catching the dermis instead of the fat	Early dimples settle; a persistent one is released by manipulation or a fine needle	Nothing further once released
Visible or palpable thread	Placement too superficial, or very thin skin	An intact, recent thread can sometimes be removed through its entry point	A settled thread in the correct plane
Extrusion at the entry point	A thread end sitting at or through the skin	Trimmed beneath the surface and the point cleaned	The rest of the thread, if intact
Asymmetry	Unequal vectors or tension, uneven swelling, or a slipped thread	Time first; then release a catch, add a vector on the lower side, or retrieve a migrated thread while intact	Mild asymmetry from heavier tissue on one side
Infection or nodule	Bacteria carried along the thread track, or a foreign-body granuloma around the thread	Antibiotics after examination; a thread driving persistent infection may be removed; a granuloma is observed, injected or removed	A quiet granuloma
Facial weakness or salivary collection	A thread placed deeper than the subcutaneous fat, where nerve branches and the parotid duct run	Prompt assessment, not observation	Nothing: these are reviewed, not waited out

The plane is why the Bliss Lift keeps lifting threads in the subcutaneous fat above the SMAS.

What can be corrected, what waits for resorption, and when should you seek review?

Dimples, exposed thread ends, unequal tension and infection can be corrected or treated. Palpable threads in the right plane, mild asymmetry from heavier tissue on one side and the collagen track along each thread are usually left for resorption, because an intact, settled thread does less harm where it is than a search for it would. A thread cannot be dissolved on demand as hyaluronic acid filler can, which is why vectors are planned on the seated face before anything is placed.

Seek review for pain that increases rather than settles, spreading redness or warmth, a thread end that shows through the skin or can be felt as a hard line, a dimple that does not settle, any change in facial movement, or an asymmetry that persists once the swelling has gone. The complication care page sets out how to reach the clinic and what to do outside clinic hours. If the treatment was done elsewhere, a second opinion starts from examination of how the threads sit now, not from a verdict on the other clinic.