Introduction The idea of lifting sagged faces noninvasively using medical threads is not novel. Serdev has been using elastic threads made of polycaproamide since 1994, and Sasaki reported using Gore-Tex cable sutures in 2003.1,2 Sulamanidze devised a barbed thread for tightening the facial tissue in 1998 and his product, called Aptos, has since become popular worldwide.3 Sulamanidze also invented a spring-formed thread made of polypropylene, termed Aptos Springs, in 2003.4 Various analogs of Aptos or Aptos Springs threads have been put forward and are currently available.5 The author has also performed minimally invasive face lifts on patients with sagged faces using a kind of Aptos analog, “Xtosis”, which, like Aptos, is made of polypropylene (suture size 0 in USP) with barbs. The name Xtosis originated from its design similar to the letter X. Two threads are crossed at the temple site and the four ends of the two threads are pulled to tighten the tissue. The suture size of Xtosis is larger than that of the original Aptos thread to avoid breakage when it is pulled and tightened firmly. The author has also used one that is nearly identical to Sulamanidze’s Aptos and Aptos Springs analog, which is made of nylon and has a stronger bounce than polypropylene when shaped into a spring.12 Threads used for lifting can be made of insoluble and soluble material. The main advantage of using insoluble threads is their long-lasting effect, although clinical studies on this are scarce. The advantage of using soluble threads made of caprolactone or polydioxanone is that the complications are expected less frequently, especially from the viewpoint of long-term prognosis.6,7 This retrospective study investigated the long-term effects and complications of the thread-lifting technique using insoluble threads in patients with sagging facial tissue.