We had a cold in the house and were in need of a soft tissue. We had never purchased Puffs before but decided to give it a try. The tissue is quite strong and soft. The "Plus" stands for the lotion that is added to the tissue to help protect the skin. The product has worked fine and is better than many products available on the market. As such I am rating this product a 4. That said, I do believe the comparable Tissue from Kleenex is even softer. Again the Puff's product is quite good, just not quite as good as another product I have used.