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.12springer.com/00266. This is a small study of a minimally invasive facelifting technique with 21 responders, of the short- to mid-term effects after a specially designed facial lifting polypropylene thread called the mesh suspension thread that is inserted into the facial soft tissues via a trocar and cannula, introduced from the temporal area down to the distal face. The cannula is then removed leaving the threads in situ, which are subsequently secured proximally to the deep temporal fascia. This unique thread features a mesh-like configuration at its distal end and some barbs in the proximal end. All subjects were followed up and assessed by the patients themselves as well as an independent rater for between 6 and 24 months using the Global Aesthetic Improvement Scale (GAIS), the Modified Fitzpatrick Wrinkle Scale and the Marionette Lines Grading Scale (MLGS). The authors observed that improved results could be maintained up to one year (in 14 patients) and up to two years (in 8 patients). They also noted that in some cases the independent rater gave a lower score than the patients who gave themselves and who remained satisfied with their own results. Their conclusion was that this novel thread could provide a long-lasting result, up to two years. Three sets of pre-operative and follow-up photographs were used to illustrate this point. They then embark on a discussion based on the literature cited in their references, which examines the merits of traditional facelifting versus the various threadlifting techniques available and the history of barbed threads in our specialty. The study is for the most part neatly conducted and summarised, for which the authors are to be commended. The technique and the mesh thread used are also conceptually interesting as they introduce yet another way to increase the longevity of these types of minimally invasive sutures. The sample size of 21 responders is not insignificant, and some useful information can be gleaned from this. We have, however, some issues with the interpretation of the results, the photographs used and the lack of references cited on the history of barbed threads. Had they been correctly sourced, the narrative of the discussion may have changed. As it is, the discussion is somewhat skewed. First, the photographs are inconsistent in the basics of both lighting and head positioning. Some were taken in shadow, but others not. Furthermore, only three patients (patients 2, 11 and 16) out of 21 responders were shown. It would have been more useful if the authors had illustrated all eight cases they deemed to have good results at 2 years since the long-term results are the thrust of their paper. In evaluating pre- and post-op results in any traditional facelift or threadlift case, it is important to have good oblique views which show clearly the Ogee line of the farside face as well as the jawline and jowls of the near side. It is these two lines or curves that most clearly convey the youthfulness or maturity of the face. The Ogee line allows us to better assess the elevation of the cheeks or jowls and any narrowing of the lower face/jowl area. In this paper,the oblique photographs of patients 2 and 11 are turned away too laterally for this, such that either the nose or the lips obscure full assessment of the Ogee curve.