T hread lifting” is a minimally invasive outpatient procedure that is becoming increasingly popular internationally [1-3]. Threads are surgical sutures that can be utilised for facial and body contouring and rejuvenation. These sutures can be used for skin rejuvenation as bio-stimulators for “lifting” / repositioning and realignment of the soft tissues. Regardless of the aims and objectives, these treatments are known as “thread lifting” by professionals and the public. There are many thread materials available in the market with various shapes and surface characteristics (Table 1, Figure 1). Thread technology, techniques and procedure are all evolving. Improved experience and an increase in the number of peer-reviewed publications contribute to the body of evidence and help to improve safety and efficacy. Patient selection is of utmost importance and equally, patient communication and understanding of the procedure, before and aftercare, and management of patient expectations determine the fine line between patient satisfaction and dissatisfaction. Patients should undergo a comprehensive consultation and be given complete information regarding the pre-operative care, the procedure itself and what to expect, what to anticipate afterwards, the necessity of the pre-and post-treatment care, recovery time and possible need for multidisciplinary treatment. It is important to underline to the patients that this procedure is not the same as a surgical facelift and unlike the public perception not to anticipate a quick “lift” with no downtime. Thread-lifting can be provided as the sole treatment or in combination with other procedures such as facial fillers, neuromodulators, devices or surgery [3]. Threads work by re-positioning and realignment of the ptotic soft tissues and/or through bio-stimulation. The use of suspension threads in the subcutaneous layer allows the sagging tissues to be elevated in a non-surgical/ minimally invasive manner [4]. Facial tissue suspension by means of threads is reported to be safe and effective with tissue repositioning which lasts up to 12 months or in some cases longer for the correction of mild to moderate ptosis of the midface and lower face [5,6]. Safe and effective use of threads for rejuvenation and recontouring requires an in-depth understanding of anatomy, thread characteristics, aseptic technique and appropriate techniques. It is important to avoid damaging the facial vasculature and nerves during facial thread lifting. In the absence of caution, the superficial temporal vein, superficial temporal artery, facial artery, and facial nerve branches are susceptible to injury. In addition, injury to the parotid gland, the duct of the parotid gland, or the muscles should be avoided by using the correct technique and thread placement [7]. Patients should be informed that the thread-lifting procedure is not a replacement for a surgical facelift and that optimal rejuvenation and recontouring require multimodal treatment over a few sessions with their respective risks and benefits and downtime. Patients should be informed that thread placement will require pre-and aftercare. Patients usually experience localised pain, bruising and swelling post procedure and hence need to be informed and consented regarding these issues. Some downtime should be expected. Unrealistic expectations should be managed prior to the treatment and aftercare instructions need to be adhered to. The outcome is heavily influenced by choosing the right patient and the correct indication for thread lifting treatment. Individual assessment and treatment planning should be carried out to attain the intended goal. Thread lifting procedures can be carried out for patients in good overall health with realistic expectations of the procedure, post-procedure care, and the outcome. The initial appointment should include a mental health screening, including psychiatric history, body dysmorphic disorder screening, and present mental state. This is for the patient’s and the practitioner’s benefit.