At Medisha Clinic a non-surgical facelift is a planned combination of two treatments. Structural dermal filler and a PDO thread lift — done in one visit or staged a few weeks apart depending on the patient, to correct the two separate processes that age a face. Faces deflate: the cheek fat pads, chin and jaw lose volume, and the skin above them drops. Faces also descend: tissue slides downward into jowls, folds and a heavy lower face. Filler restores the volume, placed on bone to rebuild the scaffold. Threads physically reposition the descended tissue and hold it, stimulating collagen as they dissolve. Neither can do the other’s job. Filler into a sagging face adds weight, threads over an empty face look tight. Done in the right order, the result is a lifted midface and jaw, softened folds and a redefined jaw-neck line, visible the day the threads go in, at its best at 12 weeks and lasting 12–18 months, with no surgery, scarring or general anaesthetic. Both halves are performed by Dr Nish Shah MD using The Medisha Method.

At Medisha Clinic it is itemised: structural filler is £350 per ml. A PDO thread lift is £750 per area (4–6 threads, both sides), £1,500 for two areas and £1,995 for the full face and neck (14–18 threads). A typical programme — 1ml of filler plus one thread area, usually the lower face — is therefore from £1,100; the complete non-surgical facelift of 2ml filler plus full face and neck threads is £2,595. An optional skin-quality phase with Profhilo or Sunekos Performa is from £350. A 4-week review follows each session. Consultation with Dr Nish is £50, fully redeemable against treatment, and at consultation he will tell you which components your face needs and which it does not. The clinic is at 58 South Molton Street, Mayfair, London W1K 5SL, three minutes from Bond Street station.

Because they solve different problems, and most faces over 40 have both. Filler replaces volume: it is the treatment for cheeks, a chin and a jaw that have emptied and flattened. Threads reposition tissue: they are the treatment for jowls and a midface that have slid downward. Filler used to lift a sagging face adds bulk in the wrong place. The route to ‘pillow face’. Threads used to lift an empty face pull skin over a hollow and look tight rather than young. The lift test at consultation shows which you need: if pushing your cheek upward restores you, threads. If it leaves you hollow, filler. If both, the sequenced facelift. The combination also means fewer threads are usually needed, because the restored structure does some of the lifting.

Either, and which is right for you is decided at consultation, because it depends on the person. What never changes is the order: filler is placed before threads, so that the thread directions are planned against the restored structure rather than the deflated one. Whether the threads follow in the same visit or two to four weeks later depends on how much volume is being restored (larger corrections settle better before threads are set), the quality and thickness of your skin, how much swelling you are likely to have, and practical factors such as an event or travel. Many patients have both in a single visit of about an hour. Others are better served by two shorter visits with a review in between. Dr Nish assesses this with you at consultation and explains why he is recommending one or the other. Both routes reach the same result and both include the complimentary 4-week review.

Threads: 720 Dimension COG threads — barbed polydioxanone threads with a 720-degree, multi-directional barb architecture that provides around four times the lift force of older 360-degree helical threads, anchoring tissue from every angle. They dissolve over 6–9 months while stimulating collagen. Filler: a firm, cohesive structural hyaluronic acid placed on bone, fully reversible with hyaluronidase which is on site at every appointment. Dr Nish is Brand Ambassador and Key Opinion Leader for the global manufacturer of both, and trains other doctors internationally in their use.

Twelve to eighteen months for the combined result, and the two components support each other. The threads themselves dissolve over 6–9 months, but the collagen they stimulate, and the repositioning of tissue while it forms — persists well beyond that. Structural filler on bone lasts 12–18 months and often longer on repeat. Patients who maintain the skin-quality phase and repeat the programme at 12–18 months see cumulative improvement, because each round builds on structure and collagen already laid down. A surgical facelift lasts longer — seven to ten years. But at ten to twenty times the cost, with weeks of downtime, scarring and a permanent result that cannot be adjusted.

Filler session: topical anaesthetic and lidocaine within the filler. Mild swelling for 2–5 days. Back at work the same day. Thread session: local anaesthetic at the entry points and along the thread paths, so you feel pressure and tugging rather than pain. Afterwards, swelling, tenderness and some bruising at the entry points for 3–7 days and a tight, pulling sensation for 1–2 weeks that is normal and fades as tissue settles. Most patients are back to normal life within 48 hours, sleeping on their back for 1–2 weeks after threads and avoiding facials, massage, wide yawning, saunas and strenuous exercise for two weeks.

A surgical facelift lifts more, lasts 7–10 years, and is the right choice for severe sagging. But it needs a general anaesthetic, 2–4 weeks of visible downtime, scars around the ears and hairline, a result that settles over 6–12 months and cannot be adjusted, and costs £12,000–£30,000 in London. The sequenced non-surgical facelift delivers most of the visible change for mild to moderate descent. The 40s and 50s. With local anaesthetic, 48 hours’ downtime, no scarring, an immediate result that improves for 12 weeks, a reversible filler component, and a cost from £1,100. It can also be repeated as the face continues to age, where surgery is a single irreversible event. Dr Nish will tell you at consultation if your sagging is beyond what threads and filler can properly correct.

The combined programme suits faces that have started to both deflate and descend. Typically from the early 40s to the early 60s. Under 40, most faces have volume loss without real descent, and filler alone (or skin-quality treatment) is usually enough. Threads at that age add little. Over 65 with advanced sagging, threads can lift but cannot hold very lax tissue for long, and surgery gives a better and longer result — Dr Nish refers these patients on. The deciding factor is not age but the lift test and skin quality at consultation.

It is itself a combination, and it has a natural third phase. Once filler and threads have restored structure and lift, Profhilo or Sunekos Performa four weeks later improves the quality of the skin over them — firmer, more luminous skin makes the lift look better and last longer. Anti-wrinkle injections for the forehead, frown and crow’s feet can be added at any point and are often done on the same day. Under-eye filler or polynucleotides complete the midface. Non-surgical rhinoplasty or chin filler as profile balancing fits within the filler session. Dr Nish designs the full sequence at consultation.

Filler risks: swelling, bruising and tenderness for a few days. Uncommonly asymmetry, lumps or migration (avoided by structural product and on-bone placement, and dissolvable). Rarely a blocked blood vessel, minimised by checking for blood vessels, small deposits, reversible HA and hyaluronidase on site. Thread risks: swelling, bruising and a pulling sensation for 1–2 weeks. Occasionally dimpling or a visible thread end at the surface (correctable at review, usually settling on its own). Uncommonly infection at an entry point (sterile technique), asymmetry (adjustable), or a thread that migrates or extrudes (rare with COG threads placed by an experienced practitioner). All are discussed at consultation, both sessions are performed by a medically trained doctor who teaches complication management, and Dr Nish provides his direct number for the first 48 hours after each visit.

Because a combined facelift only works when one specialist plans and performs both halves, and Dr Nish Shah MD is that specialist. He is a medically trained doctor, one of the UK’s most experienced PDO thread practitioners, Brand Ambassador and Key Opinion Leader for the global manufacturer of both the 720 Dimension COG threads and the structural fillers used at Medisha. Senior International Clinical Trainer at Derma Medical, where he teaches doctors how to sequence the two. Every filler and every thread is his, using The Medisha Method: what has deflated and what has descended mapped first. Filler on bone to rebuild the scaffold; 720 Dimension COG threads along directions planned against the restored face, in the same visit or staged as your face requires. Tension set live. Reversible filler with hyaluronidase on site. A review after each visit. From £1,100; complete facelift £2,595; £50 consultation redeemable. 58 South Molton Street, Mayfair, London W1K 5SL, three minutes from Bond Street. Also Marylebone.