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. I am delighted to write a commentary on this paper by Park and colleagues. It is a useful contribution to the body of work published about barbed threads in nonsurgical facial rejuvenation, further validating their use as a viable alternative to surgical face-lifting. The authors have presented an elegant technique of thread-lifting that involves first partial dissection in the temporal region and then closed insertion of their modified MIZ threads into the distal part of the face, with the deep temporal fascia providing a stable fixation point for the threads. The results, although subtle, are pleasing and harmonious, with elevation of the cheek/jowl area and volume restoration in the midcheek region. However, the latter may be difficult to assess because nearly 80 % of patients undergoing the MIZ-lift also had autologous fat grafting at the same time. I would have preferred a comparison between a series of patients who had only the thread-lifting procedure and nothing else. I agree with the authors that the ideal material for a thread-lift is a nonabsorbable prolene suture correctly inserted, which elicits a fibrous capsular contraction around the threads that in turn adds to the longevity and stability of the result. With absorbable threads, the holding power is questionable because the barbs are the smallest part of the thread and likely to dissolve first, thus giving very shortterm results. Of course, if the insertion technique is imprecise or performed in the wrong planes or vectors, then it is better that the thread dissolves in time so as not to give any long-lasting complications. The technique described by the authors is not dissimilar in concept to the Woffles Lift [1–3] I pioneered in 2002 or the Isse endo-thread-lift [4] developed by Nicanor Isse in 2004. By way of historical background [5], although barbed sutures were conceptualized years ago by Alcamo [6, 7], Fukuda [8], Ruff [9, 11] and Buncke [10] for knotless wound closure or tendon repair, all credit must go to Sulamanidze [12, 13], who first pioneered the use of bidirectional threads in facial cosmetic applications. His APTOS procedure was novel, unique, and effective, with many surgeons still using it worldwide, including this author. However, I felt that the APTOS procedure, which is essentially a grid of short barbed sutures with no stable fixation point, gave more of a face-firming than a facelifting effect. Therefore, in 2002 I developed my own bidirectional barbed suture slings that were folded on themselves and had a stable fixation point in the deep temporal fascia. This arrangement conferred greater lifting power and a higher pullout tension, which has been verified by independent researchers [14]. I thought that with this stronger version of a long looped barbed suture, it was more logical to suspend the loose facial tissues to the dense and immovable fibrous temporal fascia. I was therefore able to achieve more significant lifting of soft tissues that lasted longer and initially called it the WAPTOS (WofflesAPTOS) procedure in acknowledgement of Sulamanidze’s APTOS procedure.