Since the earliest reports of surgical facial rejuvenation by Miller and Kolle,1,2 physicians have searched for more durable and less invasive means of facial rejuvenation. An improved understanding of changes to the facial soft tissues that contribute to an aged appearance has enabled the development of new techniques to address the specific anatomy of the aging face. Among these techniques, resuspension to counteract the descent of the face may be performed with prosthetic materials, including sutures, polytetrafluoroethylene (Gore-Tex; W. L. Gore and Associates, Flagstaff, Ariz.) slings, mesh, or autologous tissue, including tendon and fascia. Suture suspension of the face, although not a new idea,3–5 has gained prominence with the advent of the so-called lunch-time face lift. This procedure entails the passage of sutures under the skin of the face and neck to counteract the descent and laxity of the tissues, avoiding large incisions, significant undermining, or substantial recovery time following surgery. In the past decade, the load-bearing ability of facial suspension sutures has increased with the addition of barbs to polypropylene suture. These sutures are described in the indexed literature as Aptos Threads (Aptos, Moscow, Russia), Isse Endo Progressive Face Lift Sutures, and Contour Threads (Surgical Specialties Corp., Reading, Pa.). Although there has been substantial mention in the popular press, little information exists in the plastic surgical or dermatologic literature regarding the safety, efficacy, longevity, or complications of these suspension procedures. We review the literature to evaluate several clinical parameters pertaining to thread suspensions: (1) the clinical efficacy of various types of polypropylene barbed suture; (2) the longevity of effect of a midface suspension with barbed suture; (3) the in vivo safety of permanently implanted barbed suture; and (4) the risk of serious adverse events, including injury to the facial nerve, associated with such sutures.