Why Thread Lifting Is Often Combined With Filler
Filler and thread lifting serve two distinct functions. Filler restores volume in areas that have become hollow or deflated, while thread lifting pulls sagging structures back into a more youthful position. Combining the two addresses both "shape" and "positioning" of facial structure.
Today, Dr. Pun wants to walk through two recent studies on safe, ethnically-appropriate thread lifting techniques — essential groundwork before considering combination treatment with filler.
Safety of Temporal Thread Anchoring: The Most Critical Risk Zone
A study by Yi and Oh (2024), published in Skin Research and Technology, examined 12 cadavers (24 specimens) using high-resolution micro-CT imaging to identify the safest anchoring point for lateral thread lifting in the temporal region.
The study found that the superficial temporal artery branches into two main divisions: the parietal branch, located posteriorly at a mean of approximately 13 mm from the vertical line crossing the tragus, and the temporal branch, located anteriorly at a mean of approximately 44 mm from the same reference line.
Based on these findings, the researchers concluded that the safest anchoring zone is the deep temporal fascia, between the superior temporal line and the inferior temporal line — specifically along a vertical line crossing the tragus, extending 1–3 cm anteriorly. This is the tautest fascial layer in the temporal region, providing a stronger anchor point than anchoring in subcutaneous fat or superficial temporal fascia.
"I think this research is genuinely important, because most thread lifting is performed blindly, without direct visualization of the artery. Without knowing its exact position, there's real risk of injuring the superficial temporal artery, which sits close to the surface and can be easily palpated. Having a clear anatomical map like this allows for far more precise, safer anchoring planning."
Vertical Lifting Technique: An Option Specifically Suited to Asian Facial Structure
Another notable study by Kang and colleagues (2017), published in Dermatologic Surgery, highlights a key difference between Western and Asian beauty standards.
Traditional thread lifting techniques typically pull threads obliquely toward the temple, which causes the thread to traverse the malar eminence (cheekbone), accentuating it. This may be acceptable in Western populations, but for Asian patients, a prominent cheekbone is generally not preferred — a rounder, softer "apple cheek" appearance is typically favored instead.
The research team therefore developed the Vertical Lifting technique, using short (6 cm), bidirectional wedge-shaped PDO threads pulled straight downward in the anterior malar and submalar areas, specifically avoiding the malar eminence.
Results in 39 Korean patients showed:
- 89.7% of patients were satisfied with the results
- Physicians rated 87.2% of outcomes as improved to very much improved
- Complication rates were low (15.4%) and minor, including dimpling and bruising
- The risk of cheekbone widening was notably lower than with traditional techniques
"This technique really addresses Asian patients' needs well — it doesn't just lift and tighten, it also preserves the facial shape that Asian patients tend to prefer."
When Thread Lift Works Together With Filler
Understanding the anatomy behind both studies makes clear that thread lifting works by "pulling and repositioning" structure using strong fascial anchor points, while filler works by "restoring volume" where it's been lost. The two mechanisms can complement each other based on these general principles:
- Filler first, thread later: In some cases, restoring volume at the cheek or temple first can create a better foundation for the thread to lift effectively.
- Thread first, filler later: In cases of significant structural laxity, lifting the position first with thread, then adding filler only where volume is still lacking, may reduce the total filler volume needed.
- Choosing anchor points that don't conflict with existing filler: Since threads anchor in the deep fascial layer while most filler sits more superficially, the physician needs to assess existing filler placement before planning thread anchoring, to avoid interference between the two.
"I think combining the two really requires understanding both anatomical maps at once — the vascular anatomy relevant to thread placement, and the existing filler placement. Good planning is what makes the result look natural and stay safe."
Summary
Safe thread lifting requires a clear understanding of key vascular anatomy, particularly the superficial temporal artery in the temple region. At the same time, technique should be adapted to each ethnicity's facial structure — as seen in the Vertical Lifting technique designed to preserve features Asian patients tend to prefer. When combined thoughtfully with filler, the result can achieve both lifted structure and natural-looking volume.
At Drema Clinic, we offer personalized consultations tailored to you. If you're interested in Thread Lift combined with filler and would like a treatment plan designed specifically around your facial structure, feel free to reach out for a chat.