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The authors of this paper, Bertossi et al,1 are to be congratulated for a timely review of barbed suture facelifts utilizing dissolvable threads (polydioxanone [PDO]) in 160 patients, with the appropriate conclusion that all initial improvements of facial lifting or contouring were absent at 1 year. This reflects what many of us who are actively involved in threadlifts have believed: that dissolvable threads do not last and as they dissolve, all benefits are lost, which has been clearly shown through this study. As the authors and others have demonstrated, it is indisputable that threadlifts, whether dissolvable or permanent, can create a lifting and shaping of the facial soft tissues.2-6 It is only the duration of the effect or the longevity of the result that is constantly called into question (Figure 1). In their retrospective analysis of 160 threadlift patients, Bertossi et al have carefully documented the type of threads utilized in their cohort of patients, the method of insertion, whether there was any intraoperative discomfort or pain, any postoperative sequelae, and the results, which were evaluated at 1, 6, and 12 months. The quality of the photographs, which appear standardized for size, lighting, and head position, are superb and makes it easy to compare the preoperative and postoperative appearances. Bertossi et al have determined that the average expenditure of their patients for each threadlift was approximately 40% of the surgeon’s fee for a traditional facelift, which enables us to put into perspective whether the cost justifies the short duration of action. The authors have also included a useful discussion of the different kinds of threads currently available and how they are inserted and deployed. Unfortunately, they were unable to evaluate the efficacy of the Woffles threads, because these threads are presently not commercially available. The Woffles thread is the thread utilized in the Woffles lift, which is the method that the author of this commentary has employed for the last 16 years. The statistic in this paper that concerned me most was the complication rate, which occurred in 55 of 160 patients (34%) and included superficial displacement of the threads (11.2%), self-resolving erythema (9.4%), skin dimpling (6.2%), infection that necessitated suture removal (6.2%), and facial stiffness that ultimately resolved (2 patients). I would no longer include erythema, dimpling, or facial stiffness to be complications, because they occur routinely in threadlifting and eventually resolve spontaneously. A more accurate complication rate would therefore be 17.4%, which is still high but was possibly related to technical issues during the insertion of the threads or sterility. With time and experience, however, this statistic should decrease significantly. If it does not, then that particular type of thread utilized in this study and/or its application may be problematic. © 2019 The American Society for Aesthetic Plastic Surgery, Inc. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/ by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] Aesthetic Surgery Journal 2019, Vol 39(3) 248–253 applyparastyle "fig//caption/p[1]" parastyle "FigCapt" applyparastyle "fig" parastyle "Figure"