Background: There are intrinsic difference facial aesthetics between Asian and Caucasian, as well as racial differences in beauty standards. Bi-directional cones threads are effective in mid-face lifting but there was yet no study in Asians.Objective: This study aimed to determine the effects on mid-face laxity the effect size of using bidirectional cone suture for facelifting in Asian patients. Methods:In this prospective study, three pairs of bidirectional cone threads were used for mid-face lifting in 10 healthy volunteers with mild-to-moderate facial laxity. Results:The validated assessment parameters used in the study were the facial laxity rating scale (FLRS) to evaluate the severity of mid-face laxity and the wrinkle severity rating scale (WSRS) to assess the severity of the nasolabial fold (NLF). Overall, there was a substantial improvement in mid-face laxity and the NLF after thread lifting, supported by treatment effect size (Kendall W's value: 0.96 and 0.85, respectively). Significant improvements for both mid-face laxity and NLF were observed in all patients by 3 months (p<0.05), with significant differences in FLRS (p=0.000) and WSRS (p=0.001). At each follow-up, all patients would complete a selfadministered questionnaire that included the subjective satisfaction rating scale. The results showed that patient satisfaction was substantially improved; the differences between baseline and the 6-week and 3-month follow-up were significant (p<0.05), and the treatment effect size was W=0.950 (p<0.05). All subjects tolerated the procedure well with transient and minimal side effects. Conclusion:In Asians with mild-to-moderate laxity, absorbable cones sutures produced considerable improvement in mid-face laxity and NLF within three months. The findings were consistent among the three reviewers and were statistically significant (p<0.05). Patient satisfaction was higher at the 6-week and 3-month follow-up compared to the baseline (p<0.05).

Background: Overlooked compensatory brow ptosis can lead to patients dissatisfaction and poor surgical results. Objective: To evaluate the quantitative changes in periorbital dimensions in 11 patients with mild to moderate brow ptosis after browlift with Poly(Lactic Acid/Caprolactone) (P[LA/CL]) sutures.Method: Retrospective analysis and data collected from reviewing clinical records, 11 patients, with mild to moderate brow ptosis, whom only has P(LA/CL) browlift, fulfilled the criteria and included in the analysis. All patients had 2-dimensional clinical photos and 3-dimensional clinical pictures in 5 standard views at baseline and follow-up. All periorbital measurements determined by the computer and collected for analysis.Results: There was a significant difference in all periorbital measurements at 4 to 6 months' follow-up when compared with baseline (p<0.05). Moderate lifting refers to changes in brow height of at least 2 mm at follow-up. A higher proportion of patients with moderate brow lift were able to achieve moderate lifting compared with mild brow ptosis. Moderate lifting is observed in 30% to 60% medial brow and 45% to 60% lateral brow for patients with moderate brow ptosis compared with 25% in those with mild brow ptosis. Infection, significant bruising, or scarring did not occur. Transient side effects, such as bruising and dimpling, eventually resolved. Conclusion:Preoperative examination is vital to identify pre-existing compensatory brow ptosis. P(LA/CL) thread-lifting for brow augmentation is a simple and effective procedure which can be used as an adjunct to upper eyelid surgery to prevent secondary brow ptosis following eyelid surgery and in turn, improve patients' satisfaction.