When a deeply set nasolabial fold catches your eye in the mirror and the line stays even without smiling, it is rarely just a surface crease. Folds deepen through loss of skin elasticity together with cheek descent, fat migration and reduction, and skeletal change. That is why treatment aims at repositioning descended tissue and restoring three-dimensional balance rather than tightening the skin over the fold — and why thread lifting, which lifts the descended cheek and midface, is considered where descent is part of the problem.
Contents
Why do deep nasolabial folds form?
A fold is not simply skin creasing. With age, elasticity falls and collagen decreases while facial fat and soft tissue migrate downward, making the border between cheek and nose more distinct. Volume loss and skeletal change add to it. When the cheek descends, tissue piles above the fold and it looks deeper still.
The target therefore is not "erasing a wrinkle" but correcting the descent and volume change that create it.
Can deep folds be removed?
Making a deep fold far less noticeable is possible; erasing it completely in one session is a different claim. Where the fold is shallow and elasticity loss dominates, elasticity-focused treatment alone can improve it. Where the cheek beside it has descended, lifting that repositions tissue acts more directly. Where volume deficiency makes the groove look deeper, volume replacement is added.
In short: descent points to lifting, volume loss to volume replacement, elasticity loss to elasticity treatment — often in combination.
How does thread lifting improve the fold?
Medical threads are inserted beneath the skin and their barbs or structure pull and fix descended soft tissue in the intended direction. The important part in fold treatment is lifting the descended cheek above the fold rather than pulling the fold itself: when the cheek has dropped and loaded the fold, moving the cheek up reduces the depth of the line running from nose to mouth.
Thread lifting is therefore better understood as repositioning the tissue that creates the fold, not stitching the crease flat. Thread direction, anchor points and a lifting vector suited to the facial structure drive the result.
Which folds respond best?
Threads earn their place where the fold accompanies cheek descent — cheek fat has moved down and the fold has deepened, or skin beside the mouth has dropped and the lower face looks heavy. Here the descended cheek can be lifted while the fold, marionette line and jawline are tidied together.
Conversely, where there is little descent and the groove itself is deeply set, lifting tissue with threads alone may not be enough, and volume supplementation around the fold is considered. The useful question is not how deep the fold is but how much the cheek has descended with it.
Does more thread mean a better result?
No. What matters is where and in which direction tissue is lifted, and where it is anchored securely. Rather than placing many threads around the fold, the lifting direction should be set from the direction of cheek descent, facial asymmetry and skin thickness.
The fold sits in a region of heavy facial movement, so moving descended tissue while keeping expression natural matters. Pulling too strongly can make expression look odd or the skin uneven. The core is how precisely, in which direction, not how many.
In a meta-analysis of 26 facial thread-lifting studies, the most common complication was swelling (35%), followed by skin dimpling (10%) — which is why accurate plane and direction matter more than thread count.[1]
How do threads and filler differ?
Both improve folds, but differently. Threads move descended tissue upward, directly addressing descent, and can tidy the cheek and jawline as well as the fold. Filler adds volume to the hollowed area, softening the groove — useful where a deep fold coexists with volume deficiency, but not a treatment that lifts the descent causing the fold.
So deep folds can combine both: threads for descent, filler for volume, planned according to whether the fold is descent-dominant or volume-dominant.
When does the fold change, and what remains?
Tissue is pulled from the moment threads are placed, so the facial line and fold can change immediately — though swelling, bruising and tightness in the early period mean the immediate look is not the final one. As swelling resolves and tissue settles, the line tidies naturally.
What threads cannot do is erase a fixed crease already set deep in the skin, or restore elasticity in thin, lax skin. In those cases elasticity treatment or volume replacement is added, since deep folds are made by elasticity, descent, fat distribution and facial structure together.
In a randomised trial of 151 patients with moderate or greater nasolabial folds, the response rate seven months after absorbable thread lifting was 71.6%, with no serious adverse events.[2]
Read alsoBruising care after thread lifting is covered in “How to reduce bruising after thread lifting” (Korean).
Thread lifting: common myths and facts
| You may think… | In practice |
|---|---|
| "More threads flatten the fold more." | Direction of descent and anchor position decide the result. |
| "Threads erase deep folds completely." | With deep hollowing or creasing, filler or other methods are added. |
| "Threads and filler do the same thing." | Threads lift descended tissue; filler fills hollows. |
In fold consultations I first look at how much the fold fades when you lie down. If it fades a lot, descended cheek is the cause and lifting tends to fit well.
A deep nasolabial fold is a three-dimensional change built from cheek descent, elasticity loss and volume shift, so thread lifting works by lifting the descended cheek rather than pulling the crease — with direction and anchors, not thread count, deciding the outcome. A meta-analysis of 26 studies found swelling (35%) and dimpling (10%) the common complications, and a randomised trial of 151 patients reported a 71.6% response at seven months with no serious adverse events. Where hollowing or a fixed crease dominates, filler or elasticity treatment is added; where descent is severe, more direct correction may be needed.
🔬 The research behind this article
These are the international journal papers that support the content above. Select a title to open the abstract on PubMed.
- Aesthetic Plastic Surgery 2021 — meta-analysis of 26 facial thread-lifting studiesNiu Z, Zhang K, Yao W, et al. A Meta-Analysis and Systematic Review of the Incidences of Complications Following Facial Thread-Lifting. Aesthetic Plast Surg. 2021;45(5):2148-2158.Key: swelling 35%, skin dimpling 10%Text [1] · PMID 33821308 · DOI
- Aesthetic Plastic Surgery 2026 — multicentre randomised trial, 151 patients, absorbable threads for nasolabial foldsJia D, Song K, Ting W, et al. Absorbable Micro-Aesthetic Lifting Thread for Nasolabial Fold Correction: A Multicenter, Randomized, Evaluator-Blinded, Parallel-Controlled Clinical Trial. Aesthetic Plast Surg. 2026;50(17):6838-6849.Key: 71.6% response at 7 months, no serious adverse eventsText [2] · PMID 42380313 · DOI
🎬 Watch: Dr. Park Seong-Soo on video
Korean-language videos from BongBong Plastic Surgery's official channel and Dr. Park's channel, “Seongsu-ro Doctor”. Titles are translated for reference; selecting one opens YouTube.
- Only thread lifts you can have done and still go to workSeongsu-ro Doctor · 2022.10.11
- Every question about thread lifting, from Korea's first plastic surgery podcastSeongsu-ro Doctor · 2018.05.14
Frequently asked questions
Can deep nasolabial folds be removed with thread lifting?
A. Thread lifting reduces fold depth and improves surrounding cheek descent. A fixed crease set deep in the skin is difficult to erase completely, so the plan should match the cause and depth.
Are threads placed directly into the fold?
A. Lifting the descended cheek above the fold is more effective than pulling the fold itself, and thread direction and anchor position must be designed accordingly.
For deep folds, should I choose filler or threads?
A. Threads suit folds caused by cheek descent; filler suits hollowing and volume deficiency. Where both are present, the two can be combined.
Does thread lifting raise the cheek as well as the fold?
A. Yes. Because it moves descended cheek tissue upward, it can improve the fold together with cheek descent and a blurred jawline.
📖 References
Select a [number] in the text to jump to the source, and ↩ to return. Only papers whose title, journal and year were verified on PubMed are included.
- Niu Z, Zhang K, Yao W, et al. A Meta-Analysis and Systematic Review of the Incidences of Complications Following Facial Thread-Lifting. Aesthetic Plast Surg. 2021;45(5):2148-2158. — Aesthetic Plastic Surgery 2021 — meta-analysis of 26 facial thread-lifting studies. ↩
- Jia D, Song K, Ting W, et al. Absorbable Micro-Aesthetic Lifting Thread for Nasolabial Fold Correction: A Multicenter, Randomized, Evaluator-Blinded, Parallel-Controlled Clinical Trial. Aesthetic Plast Surg. 2026;50(17):6838-6849. — Aesthetic Plastic Surgery 2026 — multicentre randomised trial, 151 patients, absorbable threads for nasolabial folds. ↩
BongBong Plastic Surgery · Dr. Park Seong-Soo, Medical Director
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