Overview
The lower eyelid and midface age together, but are often treated separately. The authors describe combining a skin-incision lower blepharoplasty with a midface lift using multi-directional barbed PDO threads through a shared incision below the lash line. This prospective consecutive case series at one clinic, October 2022 to May 2023, used photos before and 4 months after surgery rated by three blinded physicians.
Findings
- 84 patients; Sihler Thread (multi-directional barbed PDO) used for midface suspension.
- Mean perceived age: 57.0 ± 7.5 years before, 50.0 ± 6.6 years at 4 months.
- Mean reduction 7 years (p < 0.001; 95% CI 6.2-7.8).
- Supporting scales: GAIS and the Allergan Infraorbital Hollows Scale.
- The combined approach added about 5-7 minutes and needed no extra incisions.
- No major complications: no hematoma, infection, permanent nerve injury, or thread extrusion or migration.
What it means for a patient
- A thread midface lift can be added to lower eyelid surgery through the same incision, adding only a few minutes.
- At 4 months, blinded doctors judged patients about 7 years younger.
- No major complications occurred in 84 patients.
- Limits: 4-month follow-up, perceived age is subjective, one clinic, and no comparison group. The authors call the results preliminary.
Why this paper matters
It shows that lower blepharoplasty and a thread midface lift can be combined through one incision, and reports early results. The authors call for controlled studies with longer follow-up and objective grading.
Terms
- Lower blepharoplasty: surgery on the lower eyelid to remove or reposition skin, muscle or fat.
- Transcutaneous: through the skin.
- Subciliary incision: a cut just below the lower eyelashes.
- PDO (polydioxanone) threads: dissolvable surgical threads.
- Barbed thread: a thread with small hooks that grip tissue to hold it up.
- Perceived age: how old a person looks to raters.
- GAIS (Global Aesthetic Improvement Scale): a scale for rating how much appearance improved.
- Blinded evaluator: a rater who does not know which photo is before or after, or which treatment was given.