The Thread Dilemma: How to Choose What’s Right
You walk into a conference now, and it’s a world away from what it was just five years ago. Back then, you’d see maybe one or two thread vendors in the whole country. Today, you’re looking at eight, ten, sometimes a dozen booths, each one promising you the perfect lift. And then there’s your inbox—every morning, another email from a company in some distant country, offering threads at prices that make you pause. Molded threads, barbed threads, hurricane threads, smooth threads—the names blur together. How on earth do you decide?
It’s a question I hear every day: Which threads do you use? How should I choose? And I want to take you through this not as a sales pitch, but as a conversation between two people who care deeply about getting this right. Because the truth is, the thread itself is only a small part of the story.
Why Cost Is the Wrong Place to Start
Let’s tackle the elephant in the room first: cost. It’s tempting to let price drive your decision, especially when you’re building a practice. But here’s the thing—your outcome depends almost entirely on the person doing the work. It’s about the vectors you pick, the depth you place the thread, the balance between barbed, molded, and smooth threads, and the way you combine them with other treatments. The price of the thread matters, but it should be a small factor.
What really matters is safety. Safety first, always. Because side effects like puckering, thread visibility, or a lift that doesn’t last are far more costly than the thread itself. A cheap thread that gives you a bad result isn’t a bargain—it’s a liability. Your patient isn’t going to blame the thread; they’re going to blame the hands that put it in.
Five Pillars for Choosing Your Thread Company
So, if not cost, what should you look for? Here are five factors I’ve come to rely on, and I believe they’ll serve you well, too.
1. How long has the company been around?
New thread companies pop up like mushrooms after a rain. They offer training for their threads, but then they vanish. You need a partner, not a temporary supplier. A company with a long track record has a consistent avenue for feedback, for thread development, and for training that evolves with experience. Choose a company that’s been in the game for years, not months.
2. Look for FDA clearance.
This isn’t just a checkbox. FDA clearance brings a layer of reassurance—both for you and for your patients. It tells you the device has met rigorous standards. When a patient asks, “Are these safe?” you want to be able to point to that clearance without hesitation. It’s a mark of trust.
3. An indicator on the thread—bevel up or bevel down.
This is crucial, especially for barbed and molded threads. Molded threads need to be placed at a precise depth, slightly deeper than barbed threads. With barbed threads, you can get away with a more superficial placement. But knowing where the bevel is—whether it’s facing up or down—makes a world of difference in your outcomes. In the trainings I’ve done on these molded threads, that single piece of knowledge has unlocked a whole other level of results. You can feel it in the lift you achieve.
4. Made in the United States.
I’m not saying threads from elsewhere are bad—far from it. But there’s reassurance in knowing exactly where your threads are made. Consistency matters. Some batches from certain sources are perfect; the next batch can be wildly different. You’re the one holding the thread. Your patient’s outcome is your responsibility. Knowing the manufacturing process, the sterility, the quality control—it gives you peace of mind. And your patients feel it too.
5. The range of threads available.
I use a lot more smooth threads than barbed, but I love having options. A 21 gauge, an 18 gauge, and the newer molded threads—like the molded infinities—they’re absolutely amazing. The results are better: more lift, longer duration. They’re a little more particular to place, but that gives me the flexibility to adapt. For a patient who’s had a facelift or fillers, I can use a smaller thread. For someone who wants a more aggressive lift, I reach for something larger. And for body work, having a nice 2.5-inch smooth twist thread is a game-changer—you don’t want to be placing dozens of tiny threads when one longer one will do the job beautifully.
The Art of the Lift
Remember, this is an art, not a recipe. When you’re doing threads, you’re watching the results unfold in real time. Unlike a surgical procedure where the result is fixed once you close, here you have the freedom to adapt. You place a barbed thread, you see a great lift—maybe you add one more, or maybe you stop. If you don’t get the lift you want, you shift. You think, “I’ll go up and use an infinity molded thread for more lift.” It’s a continuum, a dance between you and the tissue.
So, as you stand in front of those vendor tables, remember: the thread is a tool, but you are the artist. Choose wisely, choose safely, and let your hands tell the story.