Ligament injection and thread lifts — hooking and pulling versus supporting and lifting
I do a lot of thread lifts, and a lot of ligament support injections. So I am often asked, “Which is better?” My answer is, “They apply force in different directions.” Once you understand that difference, you can see why some faces look pulled and others look naturally lifted.
The short answer
A thread lift hooks sagging tissue with barbed threads and pulls it upward. Ligament injection places a small support of filler beneath the area near the retaining ligaments so the tissue sits higher on its own. To lift a face whose support has collapsed with threads alone, the threads must be pulled hard, and then the direction of pull can show or the skin can dimple. I prefer to place the support first and pull the threads less. That way the face looks returned to its place rather than pulled. I have not yet found a study comparing the two methods directly in people. Miso Clinic in Daegu (4F Bombom Building, 125 Dongdeok-ro, Jung-gu, +82-53-428-2700) performs both and chooses or combines them to suit the face.
How does the direction of force differ?
Think of a curtain. When a curtain has slipped down, you can grab the hem and haul it up, or you can hang the curtain rod a little higher.
A thread lift is the first. The small barbs on the thread grip the tissue and draw it up in the direction the thread is anchored. You see it rise the moment it is pulled, so it is a satisfying treatment.
Ligament injection is closer to the second. Slipping a support beneath the area near an anchor point lets the tissue resting on it sit a little higher. It is a supporting force rather than a lifting pull, so the change is smaller and quieter than with threads.
| Thread lift | Ligament injection (ligament support) | |
|---|---|---|
| Direction of force | Hooks tissue and pulls | Supports tissue from below and raises it |
| Immediately visible change | Large and immediate | Small and quiet |
| Concerns it suits | Laxity of the jawline · cheeks | A sunken, tired look; mild sagging |
| Amount · material | Several dissolvable threads | Hyaluronic acid filler about 2 cc (about 0.1 cc per point) |
| Common reactions | Swelling · bruising · tightness · skin dimpling | Swelling · bruising · a palpable feeling |
Why can pulling hard with threads alone leave a ‘pulled look’?
With age, tissue does not only move down; the volume that supported it from below also decreases. If you only hook and pull from above on a face whose support has hollowed, it becomes taut instead of lifted. To raise it to the desired height, more thread tension is needed.
Then a few things start to show. A line appears in the direction of pull, the skin dimples where the thread catches, and one side of the face looks stiff when smiling. In an analysis pooling 26 thread-lift studies, skin dimpling was reported in 10% and visible threads in 4%. Most settle with time, but a few weeks can feel long to the person concerned.
My judgement is this: it is not that threads are bad. It happens when one tool, the thread, is asked to solve both ‘support’ and ‘position’. Recovery and complications of thread lifts themselves are covered separately in Thread-lift complications.
What changes when the support goes in first?
A face that has support stays where it is put, even after a small lift. So even when threads are used as well, they need less pull. With less pulling force, I believe lines in the direction of pull and skin dimpling occur less.
The result I want is not “she’s had a lift” but “she looks rested lately”. Not a face drawn upward, but one that has gone back to where it was. I describe this as lifting gracefully.
This is, however, a judgement from my own clinical experience. I have not yet found a human study comparing support-first with threads alone side by side. It is a part I cannot show you in numbers, so I am noting it as such.
So when is a thread lift the right choice?
There are certainly faces that a support cannot help. In these cases I suggest a thread lift first.
- When jowls clearly hang below the jawline — a 2 cc support cannot lift that weight.
- When the cheek tissue itself has slid down a lot — a force that hooks and moves it is needed.
- If you do not want filler remaining in your face — dissolvable threads are absorbed by the body.
Conversely, if the main concern is “looking tired” from a mix of hollowing and mild sagging, the support comes first. When there is both laxity and hollowing, I often place the support first and add threads lightly. The threads we use are dissolvable. Materials are discussed in Thread-lift materials.
If both are done, what order and interval?
There is no set formula. But there are principles I keep.
- I do not calculate the amounts of support and thread separately. I first decide, for both together, “how far the face needs to rise”.
- For people aged 50 and over or with thin skin, I keep the number of threads and the tension conservative.
- Rather than doing everything at once, I think it is safer to look at the face again after the swelling settles and then decide whether to add more.
Which faces suit a thread lift is in Thread lifts in Daegu: which faces do they suit?, and ligament support itself is in Ligament injection in Daegu.
When I do not recommend either first
- Faces with skin loose enough to fold — beyond the range of non-surgical treatment; a surgical consultation may be appropriate.
- When you expect the face shape to change in one go — both are treatments that refine lines.
- Inflammation at the treatment site, pregnancy or breastfeeding — we do not treat that day.
- When you do not know what filler or threads were used before — we first check what remains.
Frequently asked questions about ligament injection and thread lifts
What is the difference between ligament injection and a thread lift?
A thread lift hooks tissue with barbed threads and pulls it up; ligament injection places a small support of filler beneath the area near the retaining ligaments so tissue sits higher. The direction of force differs: pulling versus supporting.
Why can a thread lift alone look pulled?
Lifting a face that has lost its support from above needs more thread tension to reach the desired height, which can create lines in the direction of pull or skin dimpling. An analysis of 26 thread-lift studies reported skin dimpling in 10%.
Can ligament injection and a thread lift be done together?
Yes. When there is both laxity and hollowing, I often place the support first and add threads lightly. I believe that with a support in place, threads need less pull. However, I have not yet found a human study comparing the two methods directly.
Which faces need a thread lift first?
Faces with clearly hanging jowls or cheek tissue that has slid down a lot. A small support cannot lift that weight, so a force that hooks and moves the tissue is needed.
Is ligament injection more natural than a thread lift?
The change is small and quiet, so there tends to be less of a ‘pulled’ feeling. But by the same token it has less power to lift a very lax face. Whether a result looks natural depends less on the treatment than on whether the method chosen fits that face.
Where can I get a ligament injection consultation in Daegu?
Miso Clinic is at 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, in front of Exit 1 of Kyungpook National University Hospital Station. +82-53-428-2700. Weekdays 11:00–19:00, Saturday 10:00–16:00, closed Sundays and public holidays.
Read next
- Ligament injection in Daegu — it does not make ligaments ‘stronger’, it places a support beneath them
- Where ligament injection came from — de Maio’s MD Codes and Restylane’s HIT
- Ligament injection: what to watch even in small doses
- Thread lifting in Daegu: which faces does it suit? — How it differs from devices and fillers
- Thread lift complications: the risks in numbers — what raises the risk and how to lower it
- Jawline sagging in Daegu — the order for choosing lifting devices and boosters
Product pages
Related reading: Thread-lift materials · How long thread lifts last
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Meta-analysis of thread-lift complications — Niu Z et al., Aesthetic Plast Surg 2021, PMID 33821308. 26 studies: swelling 35% · skin dimpling 10% · altered sensation 6% · visible thread 4% · infection 2% · extrusion 2%; satisfaction 98% right after treatment → 88% at follow-up.
- Systematic review of thread-lift complications — Ojha et al., Dermatol Surg 2025, PMID 39442180. 19 studies, 1,406 people: bruising 19.49% · swelling 16.79% · tenderness 9.96% · infection 2.49%. Risk was higher with barbed threads and in the midface.
- Randomised trial, ligament technique vs conventional technique — Feng G et al., Aesthetic Plast Surg 2023;47(4):1550–1559, PMID 36810835, DOI 10.1007/s00266-023-03278-2, ChiCTR2100041702. 2 centres in China, 40 people with moderate to severe nasolabial folds, split-face randomised and double-blind. Blinded WSRS improvement at 24 weeks: ligament technique 0.73 ± 0.61 vs conventional 0.89 ± 0.61 (p>0.05); GAIS 1.32 vs 1.41 (p>0.05). The authors concluded “similar efficacy, better improvement of midface deficiency and fewer adverse events”, but I could not confirm those figures in the abstract. Funded by the product company.
- Split-face study injecting outside the ligament line first — Casabona G et al., J Cosmet Dermatol 2019;18(5):1237–1243, PMID 31402563, DOI 10.1111/jocd.13089. 12 people. The side where points outside the ligament line were injected first used less total volume, 1.26 ± 0.64 cc vs 1.88 ± 0.57 cc (p=.02), with no left-right difference in assessment scores (p=1.00).
- Limits of ligament-targeted approaches (perspective paper) — Kwon BS, Hong GW, Lim Y, Clin Cosmet Investig Dermatol 2026;19, PMID 42472085, DOI 10.2147/CCID.S616026. The authors, who are themselves developing the technique, write that the results are observational data from few cases and a single operator, that quantitative analysis of ligament tension is lacking, and that ordinary volume support may have contributed to the lifting observed.
- Korean Medical Service Act — Article 56(2) prohibits treatment-experience testimonials, comparisons with other clinics and superlatives in medical advertising. This is why the column carries no reviews, before-and-after photos or prices.
- Miso Clinic treatment criteria — Support injections at ligament points use small divided doses: about 2 cc in total for the whole face and about 0.1 cc per point (confirmed by the director); thread lifts use dissolvable threads only, planned conservatively for people aged 50 and over; for hollow cheeks, dissolvable hyaluronic acid filler comes first. Source of the sentences written as “I” or “we”.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.