Loose skin, shifted fat and loosened retaining ligaments can look alike in the mirror. Edition separates them first, because the mix decides whether threads fit and which thread is used.
A thread-lift plan at Edition begins with one question — why is this face descending? — and the answer usually involves one or more of three causes: the skin has lost elasticity, fat has shifted from where it used to sit, or the retaining ligaments that hold soft tissue in place have loosened. Which of these is at work, and in what mix, decides whether threads are used at all, which thread is chosen and in which direction it lifts.
Two faces can look equally “dropped” in the mirror and still need different plans. The same treatment applied to different causes will suit one face far better than the other, which is why the diagnosis comes before the thread.
Sagging describes how a face looks, not why. The consultation at Edition separates reduced skin elasticity, a change in fat position and loosened retaining ligaments, and also checks for volume loss, which resembles sagging but is a different problem. Threads reposition and support tissue; they do not remove surplus skin or replace lost volume. The mix of causes therefore settles whether threads fit, which type is chosen, where they go and whether something else should come first.
What are the three causes of facial sagging?
The first is loss of elasticity in the skin itself. Skin that has lost its spring hangs and folds rather than following the contour beneath it.
The second is a change in the position of fat. The fat of the cheek and mid-face can move downwards, so fullness that once sat high on the cheek ends up nearer the mouth and jowl.
The third is loosening of the retaining ligaments — the fibrous attachments that tether skin and fat to the deeper structures of the face. When they relax, the tissue they held is freer to descend and the face loses definition. In practice the three rarely appear alone, and much of the consultation is spent working out the proportion of each.
Why does the cause matter more than how far the face has dropped?
The degree of sagging tells you how much change is being asked for; the cause tells you which tool can produce it. A thread lift is a mechanical instrument: absorbable threads placed beneath the skin lift descended tissue and hold it in a new position, while also encouraging collagen formation.
That suits tissue that has moved and can be moved back. It suits surplus skin far less, because repositioning tissue does not reduce the amount of skin covering it. Two patients with the same amount of descent can reach opposite conclusions once the cause is known.
What can a thread lift do for each cause?
The table shows how Edition reasons about each source of descent; it is not a verdict on any individual face.
| Cause | What it tends to look like | What threads can do | What else may be considered |
|---|---|---|---|
| Reduced skin elasticity | Skin that hangs rather than following the contour | Support the tissue beneath; they do not reduce excess skin | A facelift where skin sagging is advanced; radiofrequency or skin boosters where lost elasticity accompanies milder descent |
| Change in fat position | Fullness moved from the upper cheek towards the mouth and jowl | Reposition descended tissue; Silhouette Soft is used for volumetric mid-face sagging and the deep cheek | Liposuction or contouring first, where fat volume itself is the main cause |
| Loosened retaining ligaments | Loss of definition along the cheek and jawline | Hold tissue in a planned direction | The amount of surplus skin decides between a thread lift and a surgical lift |
| Volume loss (not sagging) | Hollowing that deepens folds without real descent | Little — lifting cannot fill an emptied space | Volume restoration such as collagen boosters or filler |
What if the sagging is really volume loss?
Volume loss is a common reason a face that “looks saggy” is not a good match for a thread lift alone. Nasolabial folds are the classic example: they are often blamed on sagging, yet in many patients the cause is hollowing, and a thread lift is not the answer to a hollow.
Mixed cases are common too. Where descent and volume loss occur together, Edition may discuss a thread lift alongside a collagen booster or filler. That pairing follows the diagnosis rather than being offered as a default; where sagging is the only problem, a thread lift on its own is often enough.
How is the cause identified in a consultation at Edition?
The consultation usually takes around twenty to thirty minutes, and much of it is spent on this question rather than on the procedure. The face is assessed from the front, at forty-five degrees and in profile, because descent that is obvious from one angle can be hidden from another.
Previous treatments — filler, fat grafting, earlier threads, lasers — are reviewed as well, because they change what lies under the skin. So is the question patients do not always expect: whether a thread lift suits this face at all. A different recommendation is a legitimate outcome of the consultation, not a failure of it.
When does the diagnosis point away from threads?
Edition names two situations. Where skin sagging is advanced, threads move tissue without reducing stretched skin, so a facelift may be more effective. Where fat volume drives the heaviness, liposuction or contouring is reviewed first. A thread lift tends to fit when sagging is early to moderate, there is little surplus skin, and the main concern is the deep cheek or the corners of the mouth; beyond that lie a mini-incision lift in front of the ear, a facelift and, for the forehead, a brow lift.
How does the diagnosis shape the thread and its direction?
Edition uses three families of absorbable thread: PDO threads (Silhouette Fix and Mint), valued for their hold on lines that have collapsed; Silhouette Soft, whose bidirectional cones suit volumetric mid-face descent; and Aptos, used mainly in the mid-face where some improvement in skin quality is also hoped for. A thread is not picked because it lasts longer, but because it matches the kind of descent in front of the surgeon. The choice rests on an analysis of skin elasticity, fat distribution and the cause of sagging, not on a standing preference for one product.
Direction follows the same logic: descended tissue is moved outwards, towards the area behind the hairline, rather than straight up, so the mid-face is not pushed into prominence. The number of threads comes last — around fourteen on average, adjusted to the degree of sagging and the goal.
Frequently asked questions
Can I tell which cause I have by looking in the mirror?
Not reliably. Skin laxity, shifted fat, loosened ligaments and volume loss can look alike from the front. An in-person examination from several angles separates them.
Is a thread lift suitable if my skin is very loose?
Often it is not the first choice. Threads reposition tissue but do not reduce excess skin, so where skin sagging is advanced, a facelift may be more effective.
If my folds come from volume loss, will threads help?
Lifting cannot fill a hollow. Where volume loss is the main cause, volume restoration is usually discussed instead; where it is mixed with sagging, both may be considered.
Does the cause affect which thread is used?
Yes. PDO threads, Silhouette Soft and Aptos behave differently, and the choice follows the type of descent.
Who carries out the diagnosis at Edition?
Thread lifting at Edition is planned and performed by Dr. Dae-hee Han, a board-certified plastic surgeon, who assesses the causes of sagging before any plan is proposed.
About the medical reviewer
Dae-hee Han, MD — Board-Certified Plastic Surgeon (specialist certificate No. 2045, issued 3 March 2014; medical licence 00394, issued 26 February 2009). Master’s degree, Ajou University School of Medicine. Training at the Craniofacial Center, Chang Gung Memorial Hospital, Taiwan (2013), and the IFAAS Mini Fellowship, University of Florida, USA (2016). He carries out consultation, the procedure and follow-up personally; fee guidance is given by the clinic’s consultation manager.
Last reviewed: 2026-09-28
Clinic information
Edition Plastic Surgery Clinic & Dermatology
6F, OPUS 407, 407 Gangnam-daero, Seocho-gu, Seoul 06614, Republic of Korea
One minute on foot from Gangnam Station Exit 10
Tel +82-2-591-0100 · editionprs@gmail.com
Consultation hours: Monday to Friday 10:00–19:00 · Saturday 10:00–17:00 · closed Sundays and public holidays
Disclaimer
Individual results may vary. Bleeding, infection, swelling, asymmetry, and scarring can occur. Please decide after a full consultation with a board-certified specialist.
This page is general medical information. It is not a diagnosis, and it does not promise a particular outcome. Fees are given after an in-person consultation.