Thread lift boasts the advantage of minimal invasion for facial rejuvenation and has been increasingly used nowadays. The purpose of this study was to evaluate the outcomes and safety of elastic thread when it was used in the modified minimal access cranial suspension (MACS) lift for rejuvenation of the lower and middle third of the face.Forty-six patients with sagging and laxity of the lower face treated by the elastic thread modified MACS lift from December 2015 and December 2017 were enrolled in this study. A retrospective chart review was conducted. The degree of Wrinkle Severity Rating Scale (WSRS) score and satisfaction score were evaluated immediately, 6 months and 12 months after procedure. Complications during the study were also recorded.All the patients were female, with a mean age of 50.7 ± 6.4 years and a mean follow-up period of 15.4 ± 2.1 months. The mean operation time was 114 ± 13 minutes. For the left face, the mean WSRS score was 4.0 ± 0.8 preoperatively and 3.1 ± 0.8 on the 1-year follow-up; and 4.1 ± 0.9 and 3.1 ± 0.7 on the right face (P < .01). Thirty-nine (84.8%) patients considered the long-term results satisfactory. There were no major complications during the follow-up period.The elastic thread modified MACS lift is a minimally invasive, effective and safe method to improve lagging middle and lower third of the face without significant postoperative morbidity or complications.