Anatomical Considerations in Lateral Canthal Ptosis and Temporal Hairline Lifting with Sihler Threads

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Background: The temporal region stabilizes the lateral canthus and brow. Age-related weakening of the superficial temporal fascia and galeal continuity contributes to temporal hooding and lateral canthal ptosis, but outcome data for 2-plane temporal thread lifting are limited. Methods: Retrospective review of 22 Asian women treated with an I-type multidirectional barbed thread technique. A blunt cannula was advanced in the sub- superficial temporal fascia areolar plane and the barbed segment anchored beyond the superior temporal line in the subgaleal aponeurosis. Standardized photographs assessed lateral canthal tilt, lateral canthus vertical displacement, brow tail height, temporal hooding severity, global aesthetic improvement scale, and satisfaction at 6 and 12 months. Results: Lateral canthal tilt increased from 2.1 ± 1.4 degrees to 4.3 ± 1.6 degrees at 6 months and 3.6 ± 1.5 degrees at 12 months. Lateral canthus vertical displacement improved by +1.8 ± 0.7 and +1.2 ± 0.6 mm; brow tail height by +2.4 ± 1.0 and +1.8 ± 0.9 mm. Temporal hooding improved from 2.6 ± 0.5 to 1.4 ± 0.5 and 1.6 ± 0.6. Global aesthetic improvement scale was "improved" or better in 90.9% at 6 months and 77.8% at 12 months, with high satisfaction. Adverse events were minor and transient. Conclusions: In this retrospective uncontrolled cohort (evidence level V), subgaleal anchoring after subsuperficial temporal fascia passage was associated with measurable improvement maintained at 12 months. Prospective comparative studies are needed to define durability and generalizability.

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