Thread Lifts Split the Experts: Barbed vs. Smooth vs. Twisted
Dr. Amy Spizuoco dropped barbed threads after failing to see results, using only smooth and twisted threads. Three doctors break down thread lift types, collagen benefits and real risks.
Updated
The takeaway
- Dr. Amy Spizuoco performs only smooth and twisted threads, abandoning barbed threads after finding them ineffective and uncomfortable for some patients.
- Barbed threads grip tissue for mechanical lifting; smooth and twisted threads deliver subtle tightening and biostimulatory collagen effects, similar in philosophy to Sculptra.
- Dr. Brian Hibler treated patients with lumps, bumps and swelling after multiple procedures abroad, including threads under the eyes, and warns threads are medical procedures with real risks, not viral trends.
Barbed threads, the type designed to mechanically grip and lift tissue, are the very type New York dermatologist Dr. Amy Spizuoco stopped using after finding they didn't work. "I learned on the barbed threads, but I just didn't see the results," she says. Her position cuts to the core of a treatment category that is getting renewed attention as patients shift toward subtle results with less downtime — and that remains divisive among physicians.
Thread lifts place dissolvable threads beneath the skin. Depending on the type, the threads can lift or reposition tissue, add support or encourage collagen production. But doctors warn that "thread lift" is not one uniform procedure, and the differences between thread types matter as much as the decision to treat at all.
Three thread types, three different jobs
Barbed threads are built to grip tissue for lifting. Smooth and twisted threads work differently: they deliver subtle tightening rather than a mechanical lift, and their results should not be grouped under a single promise of a "thread lift."
Dr. Spizuoco, a board-certified dermatologist and dermatopathologist in New York, performs thread treatments regularly but only with smooth and twisted threads. "I only do the smooth and the twisted," she says. She also found barbed threads uncomfortable for some patients.
She uses smooth threads for targeted, modest correction. "I like the smooth ones. I'll do them under the jawline, and it gives a nice little lift and tuck. I also use the smooth ones to improve the lines." For Dr. Spizuoco, matching the thread type to the patient's goal matters more than defaulting to whichever technique promises the biggest lift.
The collagen argument
For Dr. Spizuoco, threads are not primarily about dramatic mechanical lifting. She frames them as part of the broader move toward biostimulatory treatments that encourage collagen production over time.
"It's all biostimulatory. Filler was the thing for a while, along with Botox, but now we're evolving. You can correct something instantly, but now it's more about the longevity of it," she says.
She points to Sculptra as another example of the same collagen-stimulating philosophy. The two treatments work differently — one is a physical filament, the other an injectable — but both aim to stimulate the skin's own collagen production rather than deliver an instant, mechanical change.
Why interest is rising
Beverly Hills, CA facial plastic surgeon Kimberly J. Lee, MD, a board-certified facial plastic surgeon, sees the appeal tied to the demand for natural-looking rejuvenation. "As we turn even more towards looking natural, threadlifting is a minimally invasive procedure to lift sagging skin by using dissolvable threads. It's gaining more popularity because of the ability to provide natural and subtle results, minimal downtime and ease of having it done under local anesthesia," she says.
Even so, threads remain a divisive treatment in aesthetic medicine. Some doctors use them regularly. Others stay cautious about the results, the risks and whether certain patients need them at all.
A cautionary case
The less-invasive nature of a thread lift does not mean it should be treated casually. New York dermatologist Brian Hibler, MD, board-certified, has treated patients who underwent threads and multiple other aesthetic procedures abroad.
"They had threads under their eyes, and they got all this stuff done that I don't think they needed," he says. "They probably need imaging and to see a plastic surgeon." The patients presented with lumps, bumps or swelling after multiple procedures, making it impossible to determine which treatment caused the reaction.
His warning extends beyond threads to aesthetic procedures broadly. "These are medical procedures. There are risks, so it's really important not to do something to your face that you might regret and not to do something just because it's trendy, went viral and you want to be a part of it," he says.
Threads are not a mini-facelift
For patients seeking substantial lifting, a facelift operates in a different category. A facelift repositions deeper facial tissues and can remove excess skin. Threads and facelifts are not interchangeable — one is not simply a lower-downtime substitute for the other.
The practical takeaway for practitioners and patients alike: "thread lift" is not one universal treatment. Patients should ask which kind of thread is being recommended, what it can realistically accomplish and what risks accompany it. Those answers — not the trend cycle — determine whether the treatment makes sense.
Source: NewBeauty
Rebecca Stone
Show full bio
Market editor covering media and advertising at Eurasian Beauty Journal.
