In short. Four honest refusals: major descent, volume loss neither route addresses, weight that is still changing, and a decision made to somebody else's deadline.
Key points
- A face whose weight is moving is a moving target.
- Losing weight after an operation changes the face the operation was planned on, and gaining it can reverse the improvement the operation achieved.
- Where weight change is in progress or expected, waiting is not a delay of treatment; it is a condition of planning one properly.
Some faces should not be treated with either route yet, and saying so is part of an assessment rather than a failure of one. Four refusals come up often, and each has a reason worth understanding rather than arguing with.
Descent that has gone past what sutures reach
A face with major descent does not need a stronger version of a thread treatment; it needs an operation, and possibly more of one than expected. Where the neck has separated from the jawline and the tissue has been sitting low for years, a suture has nothing to grip that would change the picture. The refusal here is of the suture route, not of treatment.
Volume loss that neither route addresses
A face whose dominant change is deflation — hollow temples, flattened cheeks, a look that reads as thinner than it was — is not a repositioning problem, and neither route replaces volume. Repositioning a deflated face tightens it, and threading it suspends it; neither makes it full. Treating that face with either route produces a result that is technically what was done and visibly not what was wanted.
Weight that is still changing
A face whose weight is moving is a moving target. Losing weight after an operation changes the face the operation was planned on, and gaining it can reverse the improvement the operation achieved. Where weight change is in progress or expected, waiting is not a delay of treatment; it is a condition of planning one properly. The same applies to any major change in health.
A decision made to a deadline
An event with a date attached — a wedding, a reunion, a photograph — is the commonest reason a patient accepts a plan they would otherwise question. Both routes have a healing period that does not respect a calendar: an operation spends weeks looking like an operation, and sutures leave dimpling and tenderness that can outlast the event. If the deadline is fixed, the honest option is often to do nothing now and decide afterwards, when the date is no longer part of the reasoning.
What declining means
Declining now is not closing the door. Tissue that is not operated on and not threaded remains available for either route later, and an untreated face is the easiest one to plan for. Waiting costs the ageing that would have happened anyway, and it buys a decision made on the merits rather than on a date.
Signals that the answer should be no for now
- The plan was proposed before anyone examined how much of the change is descent and how much is volume.
- The timing is being driven by an event, a discount, or someone else’s opinion rather than by your face.
- Weight, health or medication is in flux, and nobody has suggested waiting until it settles.
An assessment that ends with no treatment is a legitimate outcome, and it should include a plan for what to watch and when to come back. If nothing is offered on that front, the appointment has not finished its job.
Frequently asked questions
What if my weight is still changing when I decide?
Then waiting is not a delay of treatment, it is a condition of planning one properly. Losing weight after an operation changes the face the operation was planned on, and gaining it can reverse the improvement the operation achieved. The same reasoning applies to any major change in health or medication. Settle first, then plan.
Is volume loss a reason to decline both routes?
It is a reason to decline both routes as the answer to that problem. Hollow temples, flattened cheeks and a face that reads as thinner than it was are a loss of volume rather than of position. Repositioning a deflated face tightens it and threading it suspends it, and neither makes it full. Volume is a separate problem with separate treatments.
Does declining now close the door on treatment later?
No, and it usually leaves the better starting position. Tissue that has not been operated on and not threaded remains available for either route, and an untreated face is the easiest one to plan for. Waiting costs the ageing that would have happened anyway, and it buys a decision made on the merits rather than on a date.
Risks & Limitations
- A facelift cannot be undone, and revision is a harder operation than the first.
- Scars are permanent. They mature and soften over 6–12 months but do not disappear.
- Suspension sutures are absorbed, so their support is temporary and varies between people.
- Dimpling, tenderness and palpable sutures are common after a thread treatment.
- Nerve injury and bleeding are the main operative risks; either route can complicate later surgery.
When to Seek Care
- Difficulty breathing or chest pain — seek emergency care immediately.
- Fever with spreading redness, warmth or discharge from a wound or an entry point.
- Bleeding that does not stop with gentle pressure, or a wound that opens.
- A suture that becomes visible through the skin, or pain and swelling that increase.
- Marked asymmetry, or a result that changes suddenly rather than gradually.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
- Chongqing West District Hospital — departmental clinical standards
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.