Suture suspension methods using ordinary sutures weaved in and out of tissues and/or looped around tissue have been around for some time, but have never been proven very practical or effective. Problems with tissue puckering and the sutures eventually cutting through the tissue that was pulled up and suspended seem to doom this type of approach. One version of such lifts, the curl lift, is still being used by some cosmetic practitioners, and one of its strongest proponents, Dr. Pierre Fournier, still promotes it, but in the past couple of years, only its latest version, which can incorporate barbed sutures.

The introduction of cogged sutures, originally with small barbs, to distribute tension and induce tissue fibrosis seemed like a revolutionary concept that might lead to better results. The initial attempts to perform face lifts using sutures with multiple barbs, cogs, or anchors that distribute tension over a greater surface started in Russia with the use of bidirectional polypropylene barbed sutures. The concept was introduced in Russia a decade ago, by Dr. Marlen Sulamanidze, as APTOS threads. It was introduced in the United States in 2000. A U.S. patent for similarly barbed sutures by Duke University plastic surgeon Dr. Gregory Ruff apparently preceded the APTOS thread concept and was the basis for the development of ContourThreads. The original Sulamanidze 2.0 polypropylene self-anchoring APTOS threads had bidirectional small barbs and floated freely in the subdermis.