Abstract Facial soft tissue lifting with subdermal sutures has a significant attraction for physician and patient alike. The case report describes a 48 year old woman who presented with pain and discomfort over the left cheek after a thread-lift procedure with anti-ptosis (APTOS) sutures performed 13 months previously. The clinical examination showed extrusion of the APTOS thread (Aptos, Moscow, Russia) accompanied by slight soft tissue tightness and tenderness along its course to the temporal area, indicating complete removal of the thread. A simple minimal access cranial suspension lift was performed with the patient under local anesthesia to remove the subdermal sutures together with autologous fat grafting to enhance the aesthetic result. At the 1 year follow-up visit, no complications were reported, and the patient was entirely satisfied with the final result. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords APTOS Autologous fat grafting Facial soft tissue lifting MACS lift Subdermal sutures Thread-lift procedure Numerous attempts have been made over the past decade to improve the appearance of a ptotic face without incisional surgery. The use of barbed suture for facial soft tissue lifting is becoming increasingly popular and attractive for physician and patient alike. The thread lift promised to correct facial aging with limited scarring, rapid recovery, minimal complications, and lower cost compared with the standard rhytidectomy. The polypropylene anti-ptosis (APTOS) threads were first described by Sulamanidze et al. [1] in 2002. These 2-0 polypropylene sutures had bidirectional barbs and anchored to the dermis to improve the facial contour lifting of various ptotic areas of the face [2]. After 350 APTOS procedures, Lycka et al. [3] reported completely satisfactory results with no major complications and suggested that the subdermal suspension thread technique provides an effective and much safer alternative to rhytidectomy. Nevertheless, complications have been reported with the thread-lift procedure including facial asymmetry, ecchymosis, hematoma, recurrence, expulsion and extrusion, formation of inclusion cysts, and more severe complications such as nerve damage and significant scarring [4, 5]. All these complications require additional procedures such as simple thread removal (with subsequent loss of lifting effect) or a more invasive procedure (e.g., rhytidectomy). However, the removal of barbed sutures could be quite challenging due to the inherent structure of the sutures. The case report describes successful removal of extrusion APTOS thread with the patient under local anesthesia using a simple minimal access cranial suspension (MACS) lift and autologous fat grafting. The authors believe this is the first case reported in the literature with use of the MACS lift not only to remove the sutures but also to maintain the lift and enhance the facial contour.