The Silhouette Instalift procedure is a new and exciting minimally invasive procedure designed to lift and re-position drooping cheek skin. In 2004, the FDA approved thread lifting (Contour Lift, Aptos Lift) for mid and lower facial rejuvenation. These sutures were permanent, barbed sutures intended to catch and lift the dermis in one direction, allowing for fixation of the skin and to a lesser extent, the soft tissue in an elevated position. Despite their revolutionary approach, these barbed sutures caused many complications. Patients had severe pain, skin dimpling, and foreign body reactions. Cutting the suture to create the barbs left the overall suture weakened leading to breakage and decreased longevity (3-6 months). Because these sutures were permanent, infection and extrusion were common. Because of the barbed nature, they were difficult to remove. Contour Lift lost FDA approval in 2007 due to these serious complications. More recently, the cosmetic market has been re-introduced to “thread lifting” with absorbable suture suspension using the Silhouette InstaliftTM (Silhouette InstaLift, Sinclair Pharma, Irvine, CA). The Silhouette Soft sutures were first introduced to the European market in 2013. The company then released an upgraded product, the Silhouette Instalift, to the US market, making this suture with knots and cones fully absorbable and fully biodegradeable using polyglycolide/L-lactide (PLGA) and poly-L-lactic acid (PLLA). A fully absorbable product reduces the risk of infection or need for removal. By using biodegradable cones, instead of barbs, the structural integrity of suture was kept intact along with a decreased risk of dimpling, extrusion, and being able to feel the sutures. Another important difference between the Silhouette Instalift and previous barbed lifts is that as the Silhouette sutures break down, they stimulate a collagen response in the skin. Similar to Sculptra®, the sutures stimulate both Type I and Type III collagen as they degrade. It is thought that the collagen growth fixates the sutures for long-lasting results, even when the sutures have reabsorbed. By doing so, the suture adds to the volume loss of the cheek area creating a longer-lasting smooth, contoured appearance. Based on the total collagen production and fat content, along with outcomes of the European data, it is believe that the results begin to peak between 3 and 6 months and may last anywhere from 18 to 36 months.