Combined Lower Blepharoplasty and PDO Thread Lift Shows Early Promise in Case Series
Key Takeaways
- A preliminary prospective case series found that combining transcutaneous lower blepharoplasty with a multi-directional PDO thread midface lift produced a mean 7-year reduction in perceived age at 4 months.
- The combined procedure added only 5 to 7 minutes of operative time, required no additional incisions, and no major complications were reported in the 84-patient cohort.
- The authors emphasize that findings are preliminary because of the subjective primary endpoint, lack of a control group, and short follow-up, underscoring the need for comparative studies with longer-term outcomes.
A combined transcutaneous lower blepharoplasty and multi-directional polydioxanone (PDO) thread midface lift performed through a shared subciliary incision demonstrated favorable early aesthetic outcomes with no reported major complications in a prospective consecutive case series published in JPRAS Open.
Combined Periorbital and Midface Approach Demonstrates Early Results
The study was conducted at a single plastic surgery clinic between October 2022 and May 2023 and enrolled 84 consecutive patients undergoing lower blepharoplasty with simultaneous midface suspension using multi-directional barbed PDO Sihler Thread®. The investigators sought to address the periorbital region and midface as a continuous anatomic unit rather than treating each region independently.
Standardized preoperative and 4-month postoperative photographs were independently assessed by three blinded physician evaluators. The primary aesthetic outcome was perceived age, with secondary outcomes assessed using the Global Aesthetic Improvement Scale (GAIS) and the Allergan Infraorbital Hollows Scale (AIHS).
Mean perceived age declined from 57.0 ± 7.5 years before surgery to 50.0 ± 6.6 years at 4 months, representing a mean reduction of 7 years (95% CI, 6.2-7.8; P < .001). According to the authors, incorporating the thread lift increased operative time by approximately 5 to 7 minutes and did not require additional incisions.
No major complications—including hematoma, infection, permanent nerve injury, or thread extrusion or migration—were reported during the study period.
The authors noted several limitations, including the absence of a control group, reliance on perceived age as a subjective outcome measure, and the relatively short 4-month follow-up.
"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," the authors wrote. "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."
Source
Kim J, et al. Synergistic lower blepharoplasty and midface lift: The role of multi-directional thread fixation. JPRAS Open. 2026;50:555-564. doi:10.1016/j.jpra.2026.05.006