{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T03:14:53Z","timestamp":1777950893998,"version":"3.51.4"},"reference-count":16,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Lower eyelid malposition is a recognized complication following eyelid tumor excision, trauma, or degenerative changes, and is frequently associated with laxity or disruption of the canthal ligaments. Conventional reconstruction techniques using autologous grafts such as fascia lata or auricular cartilage are effective but are associated with donor-site morbidity and increased surgical complexity. This study aimed to evaluate the feasibility and early outcomes of a novel technique for reconstruction and reinforcement of the lower eyelid canthal ligaments using a barbed suture system. Methods: A single-institution retrospective case series was conducted, including consecutive patients who required lower eyelid canthal ligament reconstruction or horizontal support reinforcement from April 2025 to November 2025. Margin reflex distance 2 (MRD-2) was measured from standardized photographs preoperatively and at final follow-up. Munk scale scores, surgically induced astigmatism (SIA), and postoperative complications were recorded. Results: Seven patients (median age 72 years; range 38\u201386) underwent the procedure. Indications included post-oncological eyelid reconstruction (n = 2), cicatricial ectropion (n = 2), paralytic ectropion (n = 1), involutional ectropion (n = 1), and cicatricial entropion (n = 1). The median follow-up was 189 days (range 105\u2013280). MRD-2 at final follow-up was 5.4 mm in Case 1 (preoperative: 5.7 mm) and 4.1 mm in Case 2 (preoperative: 4.2 mm), indicating maintained eyelid position. Munk scale scores improved in four of five evaluated patients. No recurrence of ectropion or entropion was observed during follow-up. Transient linear skin indentation along the suture pathway was observed in all cases and resolved spontaneously in all patients by 3 months postoperatively. One patient experienced transient postoperative diplopia that resolved with conservative management. Conclusions: This study demonstrates the feasibility of lower eyelid canthal ligament reconstruction using a barbed suture system in a heterogeneous cohort of seven patients. Short-term results are encouraging, with maintained eyelid position and no recurrence of malposition observed during the follow-up period. These preliminary findings warrant further evaluation in larger, prospective, controlled studies with longer follow-up.<\/jats:p>","DOI":"10.3390\/jcm15093510","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T08:29:34Z","timestamp":1777883374000},"page":"3510","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Technique for Reconstruction of the Canthal Ligaments of the Lower Eyelid Using Barbed Sutures"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1326-1605","authenticated-orcid":false,"given":"Yutaro","family":"Araki","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hospital, Tokyo 160-0023, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuki","family":"Shimada","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hospital, Tokyo 160-0023, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6327-5886","authenticated-orcid":false,"given":"Miki","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hospital, Tokyo 160-0023, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takako","family":"Komiya","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hospital, Tokyo 160-0023, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8788-7684","authenticated-orcid":false,"given":"Hajime","family":"Matsumura","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hospital, Tokyo 160-0023, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1007\/s40123-022-00533-8","article-title":"Surgical strategies for eyelid defect reconstruction: A review on principles and techniques","volume":"11","author":"Yan","year":"2022","journal-title":"Ophthalmol. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kopeck\u00fd, A., Hlinomazov\u00e1, Z., Synek, S., and Vlkov\u00e1, E. (2022). The role of the lateral tarsal strip procedure in modern ophthalmic plastic surgery\u2014A review. Front. Ophthalmol., 2.","DOI":"10.3389\/fopht.2022.871964"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1097\/SCS.0000000000005639","article-title":"Oncoplastic lower eyelid reconstruction analysis","volume":"30","author":"Orgun","year":"2019","journal-title":"J. Craniofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2192","DOI":"10.1001\/archopht.1979.01020020510021","article-title":"The tarsal strip procedure","volume":"97","author":"Anderson","year":"1979","journal-title":"Arch. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100004","DOI":"10.1016\/j.aopr.2021.100004","article-title":"Lateral tarsal strip procedure for involutional ectropion: A retrospective analysis of 85 cases and a comprehensive literature review","volume":"1","author":"Hou","year":"2021","journal-title":"Adv. Ophthalmol. Pract. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1097\/00006534-199905000-00011","article-title":"Lower eyelid reconstruction with a cheek flap supported by fascia lata","volume":"103","author":"Matsumoto","year":"1999","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_7","first-page":"313","article-title":"Lower eyelid retraction repair using autologous auricular scapha cartilage","volume":"44","author":"Aakalu","year":"2024","journal-title":"Orbit"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1055\/a-2621-7781","article-title":"Reconstruction of the posterior lamella of the lower eyelid using a long L-shaped periosteal flap: Technical Modification and Literature Review","volume":"52","author":"Kono","year":"2025","journal-title":"Arch. Plast. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nambi Gowri, K., and King, M.W. (2023). A review of barbed sutures\u2014Evolution, applications and clinical significance. Bioengineering, 10.","DOI":"10.3390\/bioengineering10040419"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2305856","DOI":"10.1080\/01443615.2024.2370973","article-title":"Tissue damage between barbed suture and conventional sutures in animal laboratory model using scanning electron microscopy","volume":"44","author":"Shiga","year":"2024","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e79","DOI":"10.1097\/IOP.0b013e3181eea51d","article-title":"Barbed suture suspension technique for prevention of lower eyelid ectropion after Mohs micrographic surgery","volume":"27","author":"Kim","year":"2011","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1148\/radiology.177.3.2243969","article-title":"Epiphora: Treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus","volume":"177","author":"Munk","year":"1990","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.cps.2011.06.002","article-title":"Lifting and wound closure with barbed sutures","volume":"38","author":"Mulholland","year":"2011","journal-title":"Clin. Plast. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Heidari, M., Haydar, A.A., Rajabi, M.T., and Rafizadeh, S.M. (2023). Corneal biophysical changes after upper eyelid blepharoplasty and ptosis surgery: A review. BMC Ophthalmol., 23.","DOI":"10.1186\/s12886-023-03010-3"},{"key":"ref_15","unstructured":"Cho, H., Lee, J.H., and Kim, J.Y. (2020). Analysis of corneal real astigmatism and high order aberration changes after lower eyelid epiblepharon repair surgery. PLoS ONE, 15."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"NP41","DOI":"10.1093\/asj\/sjab359","article-title":"Barbed polydioxanone sutures for face recontouring: Six-month safety and effectiveness data Supported by Objective Markerless Tracking Analysis","volume":"42","author":"Preibisz","year":"2022","journal-title":"Aesthetic Surg. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3510\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T08:31:39Z","timestamp":1777883499000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3510"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":16,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093510"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093510","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]}}}