ArticleJPRAS open2026
Synergistic lower blepharoplasty and midface lift: The role of multi-directional thread fixation.
Article in JPRAS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
2 authors.
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Abstract
Background: The periorbital region and midface age as a continuous anatomic unit. Standard approaches addressing these regions separately may overlook their functional linkage. We describe a combined transcutaneous lower blepharoplasty and midface lift using multi-directional barbed polydioxanone (PDO) threads via a shared subciliary incision. Methods: This preliminary prospective consecutive case series was conducted at a single plastic surgery clinic between October 2022 and May 2023 to evaluate the early clinical outcomes and safety of combined transcutaneous lower blepharoplasty with multi-directional PDO thread midface lift. The study included 84 patients undergoing combined lower blepharoplasty and midface suspension using Sihler Thread® (multi-directional barbed PDO). Standardized pre- and postoperative photographs (4 months) were evaluated by three blinded physician evaluators. Outcomes included perceived age (pragmatic early aesthetic endpoint) and supportive validated/commonly used scales (Global Aesthetic Improvement Scale [GAIS] and a standardized infraorbital/tear-trough grading tool (Allergan Infraorbital Hollows Scale [AIHS]). Results: Mean perceived age decreased from 57.0 ± 7.5 years preoperatively to 50.0 ± 6.6 years at 4 months (mean reduction 7 years; Conclusions: Combined transcutaneous lower blepharoplasty with multi-directional PDO thread midface lift via a shared incision is technically feasible and associated with early (4-month) improvement. Because perceived age is subjective and follow-up is short, results should be interpreted as preliminary; controlled comparative studies with longer follow-up and objective grading are warranted.
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