The expansion of aesthetic plastic surgery in the last 2 decades has been a combination of invasive and noninvasive procedures. In the past 10 years, invasive procedures have grown approximately 100%, whereas noninvasive procedures have grown almost 1000%.1 Although consumers of cosmetic plastic surgery seek to look and feel their best, most potential patients also generally desire procedures that are affordable and have minimal pain, recovery, and downtime. The mobilization and repositioning of soft tissue, whether of the brow, midface, neck, breast, or body contouring, is often a significant and important goal in an aesthetic plastic surgery procedure. The use of sutures to suspend soft tissues is not new. Suture suspension techniques have been used in medicine to treat several functional and aesthetic problems including congenital ptosis, sleep apnea, and bladder suspension for urinary incontinence.2–5 In aesthetic plastic surgery, nonbarb suture suspension techniques have been used alone or in combination with other surgical maneuvers to elevate soft tissue of the midface, brow, and cervical mental angle.6–10 The reported problems with simple 2-point suture fixation techniques are principally the phenomenon of cheese wiring of either end of the suture fixation and/or stress relaxation of the skin under tension, both of which compromise the suture suspended elevation and repositioning.11,12 Cheese wiring occurs when suspended tissues are under tension and, with constant movement, the sutures migrate through the soft tissue fixation points, even if fascial tissue sutures are deployed, resulting in the loss of part, or all, of the elevation or repositioning.11 The stress relaxation occurs when soft tissue, particularly skin, is held under tension in 2 points, and the tensile relaxation properties of the dermis reorganize the collagen, elastin, and ground substances to lengthen the distance between the fixation points. Like tissue expansion, the body’s ability to recruit tissue to reduce tension loading compromises the elevation when the repositioning is supported in only 2 points. Multiple-point fixation techniques and technologies, like the Endotine device or barbed sutures, can minimize stress relaxation and cheese wiring (Coapt Systems, Inc., Palo Alto, CA, USA). Without multiple fixation points, there is often limited long-term efficacy of pure suture suspension techniques.