1 | INTRODUCTION Facial aging is a dynamic process involving dramatic changes in different structures of the face,1,2 including skin, soft tissues, and facial skeleton.3,4 In the last decade, there has been a significant paradigm shift in the field of rejuvenation surgery with the spreading of minimally invasive techniques for facial rejuvenation instead of more invasive surgically oriented modalities.5 More and more patients ask for procedures with a short recovery time to get rapidly back to work. The growing trend nowadays is to seek high-quality results with the least invasive treatment possible and with less risk and downtime. In many situations, patients prefer minimally invasive procedures and are willing to trade a more modest degree of esthetic improvement in exchange for decreased morbidity.6 A large variety of injectable fillers and structural fat grafts may be combined with neurotoxins to resolve superficial wrinkles and restore facial volumes.7 Indeed, rejuvenation with soft tissue fillers, while providing the opportunity for volumetric restoration to the aging face, often fails to provide adequate soft tissue repositioning and, in certain situations, may result in puffiness with unnatural facial appearance. In recent years, thread lifts are becoming popular since they enable the correction and repositioning of soft tissue laxity and ptosis, ensuring short recovery time, fewer complications, limited scarring, and lower costs.8-10 These minimally invasive procedures may be performed separately or in combination with other facial surgical interventions. However, there is a lively debate about efficacy, long-term outcomes, and morbidity of suture suspension techniques, and only a few reliable studies have analyzed its use in large cohorts.11,12 In the present study, we used the suspension thread technique with DefinisseTM free floating threads for facial rejuvenation. DefinisseTM free floating threads are monofilament, absorbable skin support of synthetic origin, belonging to Class III of medical devices according to Rule 8 of Annex IX of the Legislative Decree n.46/1997, as amended, which is the Italian transposition of the Medical Device Directive 93/42 EEC as amended.13 DefinisseTM free floating threads are characterized by a special kind of barbs, created by a unique technology that does not reduce thread gauge.11 The presence of these barbs and their tri-dimensional geometry (length, number per unit of length, angulation, and spatial distribution) are essential for the interaction of the sutures with the surrounding tissue; in fact, their tri-dimensional geometry is specifically developed to obtain an intense mechanical stimulation of fibroblasts.14 The interaction of the DefinisseTM free floating threads with the surrounding tissue provides a dual effect. Through a mechanical effect, this interaction gives support and allows the repositioning of tissues, inducing a lifting action, while the barbs and the molecules poly-L-lactic acid and caprolactone stimulate the synthesis of collagen, hyaluronic acid, and elastin inducing a revitalizing action.11 Furthermore, the fibrous capsule formed around the inserted thread prolongs the lifting effect and maintains the skin traction.14 In addition, it also protects the thread from hydrolysis, extending its permanence in the tissue. This translates into a simultaneous mechanical and histological lifting effect.11 The goal of this study is to report treatment outcomes and patient satisfaction following mid-face reshaping with DefinisseTM free floating threads.