INTRODUCTION Barbed threads have a structure in which barbs are attached to monofilament suture threads. The barbs are caught by fibers within tissues and thus can immediately attach. Barbed threads were also used for tendon repairs in 1951.1 In 1990, Sulamanidze and Sulamanidze2 first used barbed threads for performing facelifts. In conventional barbed threads, 2 points within tissues are pulled close to each other, whereas inclined barbs are arranged to face each other from each side with the central part of the thread as the center. These barbs are fixed by being hooked to tissues. This produces an antitension effect that prevents tissues from moving apart again. Although the barbs used in the present study may seem to be similar to the existing ones, their inclinations are arranged in opposite directions; thus, the thread axis has the effect of anticompression rather than antitension (Fig. 1). Another difference is that the barbed threads have radially split ends to minimize thread extrusion under pressure (Fig. 2). Herein, the threads were implanted at a location away from the skin by inserting a tube-type injection needle, which contains a barbed thread shorter than the needle inside (Fig. 3), deep into the skin and pushing the thread using a plunger and subsequently pulling out only the needle. Because these threads act as skeletons, areas with an insufficient volume of tissue should be supplemented using a filler injection. We mainly used squeezed fat and fat gel (mechanically micronized fat tissues).3