This manuscript updates the readership on a noninvasive surgical technique for neck rejuvenation by placing a percutaneous neck suspension suture with the aid of a lightguided tool to more accurately position the suture in the subcutaneous tissues of the upper neck.1 The manuscript reviewed the results of the procedures, which were performed over a 4.5-year period by 5 surgeons in 4 clinical aesthetic surgical centers. In total, 391 patients met the study’s inclusion criteria, which were: mild to moderate neck laxity, prominent anterior platysma bands, and the desire of the patient to improve their neck contour. The clinical outcomes with regard to complications were tabulated, as was the recurrence of platysma bands, skin laxity, and transient marginal mandibular nerve neuropraxia. The mean follow-up time was 240 days. The motivation for less invasive, non-open surgical techniques in facial aesthetic surgery is driven by a number of factors, from both the patient’s and the surgeon’s perspective. These include: less morbidity, less surgical scarring, more rapid recovery time, performance under local anesthesia, the experience of the surgeon, the patient’s expectations, the patient’s premorbid condition, and the patient’s finances. Suture suspension techniques were first proposed by Giampapa and Di Bernardo in 1995 and involved incisions behind the ear and in the submental area with an interlocking permanent smooth suture under the neck affixing to the mastoid process.2 An adjustment of the interlocking suture and fixation to the mastoid fascia produced a sling-like effect under the jaw, improving the cervicomental angle. The problems that were anticipated occurred early and late, which included “cheese-wiring” of the suture and loosening of the result, and possibly loss of the fixation at the mastoid region. Initial satisfaction, however, led to continuing interest and advancement of these techniques. APTOS thread lifts (Tbilisi, Georgia) were introduced by Sulamanidze et al in the late 1990s utilizing barbed sutures.3 Although quite satisfactory in the short term, the results in necks were incomplete. The complications of permanent threads noted with time included palpability, extrusion, and caterpillaring. These threads also interfered with definitive facelifting procedures further down the track when the open neck surgical technique was used.4 Despite these issues, the enthusiasm for suture suspensions has continued and different types of suture materials and techniques are still being developed as evidenced by the authors of this paper.