The classification of nasolabial folds into three types, each with distinct causative factors and mechanisms, is explored. Age-related changes in facial skin and connective tissues are examined in detail, revealing variations across different facial regions due to variances in tissue firmness and thickness. The innovative ‘Reverse Technique,’ involving cog threads to enhance tissue traction and effectiveness in thread-lifting procedures, is introduced. Detailed technical guidelines, anatomical considerations, and safety measures are provided, emphasizing the importance of identifying optimal vectors and fixing points to achieve maximum lifting effects while minimizing potential risks, particularly those associated with vascular structures. Additionally, the ‘Cross Technique using volumizing thread’ is discussed, designed to smooth tissue boundaries and rejuvenate sagging areas. Facial anatomy, including the positioning of arteries and ligaments, is underscored as essential for ensuring the safety and efficacy of procedures. In conclusion, this review stands as a comprehensive guide for practitioners, offering insights into innovative thread-lifting methods and their applications in addressing nasolabial folds. The primary focus is on achieving optimal aesthetic results while prioritizing patient safety.

Thread-lifting traditionally addressed aging-related skin laxity by leveraging precise thread placement and traction. However, recent advancements, notably cog threads, expanded its application to younger patients seeking facial contour refinement. These newer threads effectively lift sagging areas and refine facial contours, broadening the procedure’s appeal. Challenges arise in selecting threads due to variable physician preferences and patient needs. Clear indications for thread efficacy are vital for credibility and tailored selection. Thread choice depends on tissue laxity, necessitating lighter threads for minimal laxity and stronger ones for significant sagging. However, no single thread universally suits all cases. Combining different threads is favored for optimal outcomes and minimizing side effects. Excessive traction post-procedure may lead to prolonged discomfort and skin irregularities. Post-procedural tension adjustments through massage remain debated, potentially conflicting with minimally invasive principles. Understanding thread characteristics guides tailored selection, considering patient conditions and procedural goals. This comprehensive understanding extends beyond specific products, aiming for optimal outcomes in thread-lifting procedures. Key factors influencing outcomes encompass thread materials, thickness, cog shapes, insertion depth, lifting vectors, and absorbable thread expiration dates.

Background: Thread lifting is a minimally invasive technique for addressing facial aging and skin laxity. Despite its popularity, it carries risks of complications ranging from minor bruising to severe structural injuries. Comprehensive understanding of these complications is vital for optimizing outcomes. Aims: To analyze the complications associated with facial thread lifting, provide insights into their underlying mechanisms, and propose effective management strategies to minimize risks. Patients/Methods: A comprehensive review of complications from thread lifting was conducted, focusing on patient outcomes and procedural challenges. Data from clinical studies, case reports, and expert recommendations were analyzed to identify common and severe complications. Advanced techniques, such as ultrasound‐guided procedures, were evaluated for their efficacy in preventing complications. Results: Common complications included bruising, pain, swelling, bleeding, and dimpling, often arising from improper technique or anatomical factors. Severe issues such as infection, granuloma, thread migration, nerve damage, and parotid gland injuries were less frequent but posed significant challenges. Management strategies included massage, saline or filler injections, botulinum toxin, and surgical interventions for persistent or severe cases. Ultrasound‐guided techniques demonstrated efficacy in reducing risks, particularly for glandular and vascular injuries. Conclusions: While thread lifting offers a promising alternative to surgical facelifts, its success depends on precise technique, anatomical knowledge, and effective complication management. Preventive measures, including preoperative planning, proper thread placement, and patient‐specific customization, are crucial. Future advancements in imaging technologies and thread materials will likely enhance safety and efficacy, ensuring better patient satisfaction and outcomes.