Abstract The APTOS threading procedure is a relatively new method in antifacial ptosis surgery. The reported cases present a small percentage of minor complications. A 57- year-old woman experienced scarring after APTOS threading. Scar biopsy showed an epidermoid inclusion cyst. Epidermoid inclusion cysts are a potential complication of APTOS threading. Proper surgical technique may reduce their likelihood. Keywords APTOS Complications Epidermoid Facial ptosis Inclusion cyst Facioplasty using the recently described subdermal APTOS thread, Kolster Methods, Inc., Hayward, CA, USA (RF patent number 2139734, international priority PST/RU 99/ 00263 [Aptos threads facial tissue, TOTAl Charm, Moscow, Russia]) insertion is an emerging technique increasing in popularity for clinical use. The method, described initially by Sulamanidze et al. [1] in 2002, entails injectionneedle introduction of 2-0 polypropylene lines with slanted, sharp indentations. These indentations anchor the filament in the surrounding tissues, providing support for the uplifted tissue while maintaining the adjusted contour [2]. Minor complications described include mild facial asymmetry, ecchymosis, erythema, hematoma, swelling, discomfort, thread migration, and expulsion with exit-site scar formation [3,4]. More severe complications reported are Stensen duct rupture and insertion-site infection with associated scarring [5].