Abstract
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Introduction: Facial aging manifests through bone resorption, fat atrophy, skin laxity, and gravitational descent of soft tissues. While multiple non-invasive treatments claim lifting effects, only thread lifting and surgery directly reposition ptotic tissues. This review assesses whether non-thread, non-surgical treatments can provide a measurable lifting effect.
Objective: To compare the lifting effects of botulinum toxin, fillers, energy-based devices, biostimulators, threads, and surgical facelifts based on existing clinical evidence.
Methods: A literature review was conducted, evaluating studies measuring objective lifting outcomes in millimeters (mm) across various treatments. Data were extracted from clinical trials assessing botulinum toxin, radiofrequency (RF), high-intensity focused electrical stimulation (HIFES), dermal fillers, biostimulators, thread lifts, and surgical facelifts.
Results: Threads and surgical facelifts were the only treatments providing true lifting by physically repositioning tissues. Non-thread, non-surgical methods primarily created volume or skin tightening effects rather than true suspension of ptotic tissue.
Conclusion: Non-invasive treatments such as botulinum toxin, fillers, and energy-based devices offer temporary enhancements but do not achieve significant lifting. Threads provide an intermediate option between injectables and surgery, offering a measurable lifting effect with collagen stimulation. Facelift surgery remains the gold standard for long-term and significant lifting. These findings highlight the importance of managing patient expectations regarding lifting outcomes in aesthetic medicine.
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