Glycymeris shell beads found in Middle Palaeolithic sites are understood to be artifacts collected by modern humans for symbolic use. In Misliya Cave, Israel, dated to 240-160 ka BP, Glycymeris shells were found that were neither perforated nor manipulated; nevertheless, transportation to the cave is regarded as symbolic. In about 120 ka BP at Qafzeh Cave, Israel, modern humans collected naturally perforated Glycymeris shells also for symbolic use. Use-wear analyses backed by experiments demonstrate that the Qafzeh shells were suspended on string, thus suggesting that the collection of perforated shells was intentional. The older Misliya shells join a similar finding from South Africa, while the later-dated perforated shells from Qafzeh resemble other assemblages from North Africa and the Levant, also dated to about 120 ka BP. We conclude that between 160 ka BP and 120 ka BP there was a shift from collecting complete valves to perforated ones, which reflects both the desire and the technological ability to suspend shell beads on string to be displayed on the human body.