Doctor's Column

Upper blepharoplasty is a completely different procedure from a simple incisional double eyelid surgery. In this article, along with three successful cases, Dr. Sung-hoon Kim shares his know-how on achieving natural double eyelids through detailed surgical design, including differences from incisional double eyelid surgery, anatomical considerations, compensatory eyebrow movement, and strategic approaches based on skin thickness distribution. We provide clear standards and genuine perspectives for those who are considering the procedure.

Dr. Sung-hoon Kim, Facial Designer at SH Plastic Surgery

The condition for success is not missing the details

Facial Designer Sung-hoon Kim

"Doctor... if I get upper blepharoplasty, can it make a big difference?"

It was a female patient in her mid-40s who spoke cautiously from behind her mask. Although she had a bright impression at first glance,

she opened up about her concerns that her eyes kept looking stuffy and heavy due to drooping eyelids.

Prior to the surgery, her biggest worry was "getting unnatural double eyelids."

"Actually, a friend of mine had incisional double eyelid surgery and the swelling didn't go down for over a year... her eyes were open like a doll's... ever since then, I was so scared that I hesitated."

Like this patient, those who have witnessed failed cases around them fear "obvious, unnatural double eyelids" far more than the surgery itself. Of course, I understand that as well.

Even though incisional double eyelid surgery and upper blepharoplasty are completely different procedures, many people confuse them or misunderstand them as being in the "same category."

However, in reality, that is not the case!

While incisional double eyelid surgery is mainly performed on people in their teens to 30s with the primary goal of adjusting the height of the double eyelid for aesthetic purposes,

upper blepharoplasty is a surgery that must simultaneously resolve functional improvements and complex anatomical issues.

In particular, for middle-aged and older adults in their 40s to 60s and beyond, good results can only be achieved by considering eye-opening strength (levator muscle function), skin thickness and elasticity, eyebrow position, fat distribution, and even habits of using forehead muscles.

That day, I slowly and carefully examined the patient's eyes.

Her skin was thin, and the distance between her eyes and eyebrows was above average.

However, the fat in her upper eyelids was slightly sunken, and seeing that fine wrinkles formed on her forehead when she opened her eyes, there was mild compensatory eyebrow movement.

"To get straight to the point, you have suitable conditions for upper blepharoplasty. However, regarding the slightly sunken fat on the upper eyelids, it would look much more natural if we consider fat grafting alongside the surgery."

Only then did the patient's expression seem to relax a bit with relief.

In this way, it is not simply a matter of "the eyes are sagging, so just cut it out." Nor is it a surgery performed in "the same way for everyone."

Today, focusing on cases that achieved satisfying results in my clinic, I would like to explain what factors served as the conditions for success.

Ultimately, details determine the outcome of the surgery.

Starting right now, in earnest!

I will analyze and explain three successful cases of upper blepharoplasty.

Success CASE 1

Thin skin + mild compensatory eyebrow movement

When the skin is thin, there is sufficient distance between the eyes and eyebrows, compensatory eyebrow movement is not severe,

and the upper eyelid is not excessively thick, good results can be expected even with the procedure alone.

For this patient, a small amount of fat grafting was performed concurrently on the sunken upper eyelids.

As a result, it did not look awkward, and we were able to address eyelid sagging while creating very natural and soft double eyelid lines.

Because the skin and fat enveloping the eyelids were organically restructured, it does not look artificial,

and 3 months after surgery, it was a case where those around the patient, rather than the patient themselves, first reacted by saying, "Your eyes have become so clear and defined."

Success CASE 2

When the distance between the eyes and eyebrows is close

For those whose distance between the eyes and eyebrows is inherently short, it is difficult to solve eyelid sagging in a simple manner.

In this patient's case, the procedure was performed alongside a sub-brow lift,

and the position of the eyebrows was also adjusted.

As a result, a much wider field of vision and natural double eyelid lines were secured compared to before,

but the patient mentioned that "a somewhat neutral (androgynous) feel remains."

This was a limitation where it could look less feminine due to the characteristics of the distance between the eyebrows and eyes,

and if desired, brighter and larger double eyelids can be created later through a forehead lift.

Success CASE 3

When eyebrow compensatory movement is severe

The last case was a patient with severe eyebrow compensatory movement, who heavily used the forehead muscles when opening their eyes.

It was a typical presentation with many forehead wrinkles, which made the eyelids appear thick.

In cases like this, if performed alone,

there was a high risk that the eyebrows would drop downward after surgery, making the distance between the eyes and eyebrows excessively narrow, and due to the thick upper eyelids,

an awkward double eyelid would be formed.

Therefore, an endoscopic forehead lift + upper blepharoplasty + upper eyelid fat grafting were performed together,

and after surgery, the position of the eyebrows remained stable, forehead wrinkles decreased, and the double eyelid line turned out clear and distinct.

Conclusion

If middle-aged individuals are considering this, they must be diagnosed regarding the following factors:

Skin thickness and elasticity

Eye-opening strength (levator muscle function)

Presence of eyebrow compensatory movement

Distribution of upper eyelid fat

Distance between the eyes and eyebrows

Distribution of eyelid wrinkles

Especially if eyelid sagging is severe, you should not try to solve it with upper blepharoplasty alone,

and you must consider a forehead lift or sub-brow lift together to create natural and well-defined double eyelids.

Reflections of Face Designer Kim Sung-hoon

For double eyelids to look beautiful, simply "making good incisions" is never enough.

The technique of merely cutting away skin and setting a good line alone cannot transform a person's impression.

The distance between the eyes and eyebrows, the strength of the eyelid-opening muscles, the distribution of fat in the eyelids, the direction of wrinkles,

and even the compensatory movement of the forehead that moves the eyebrows...

Only when all these elements interlock with one another can a natural and harmonious result be achieved.

A much more sophisticated and three-dimensional plan is required.

Skin thickness and elasticity, fat distribution, eye size and eyebrow position, and even the way one opens their eyes...

Only when everything can be read during the preoperative evaluation phase can the most suitable line be created for that person.

Double eyelid design is not simply the act of drawing a line.

It must be a "three-dimensional design" that calculates the person's facial bone structure, pupil position, facial expression when smiling,

and even the movement when opening the eyes.

In the end, success depends on the details.

Looking a little deeper, judging a little more carefully, and adjusting a little more meticulously

is the key to transforming a person's overall facial impression beyond just double eyelids.

FAQ

Q1. Will there be scars left?

A. Incisions are made along the creases and texture of the eyelid, and most are hidden under the eyebrow hairs, becoming blurred.

Over time, they become almost invisible.

Q2. Does recovery take longer than an incisional double eyelid surgery?

A. Because the incision range is larger and it deals with complex anatomical structures, the recovery period can be relatively longer.

However, a well-designed surgery is actually more natural, and recovery proceeds smoothly.

Q3. What should I do if my forehead wrinkles are severe?

A. Forehead wrinkles can be the result of compensatory eyebrow movements.

If performed alone, the eyebrows may lower and look even more heavy or stifling, so it is recommended to perform a forehead lift in combination.

Q4. Exactly how do upper blepharoplasty and incisional double eyelid surgery differ?

A. The former is a cosmetic procedure for younger people that only adjusts the double eyelid line.

On the other hand, the latter is a surgery for middle-aged and older individuals that comprehensively addresses eyelid drooping, muscles, and fat after evaluation.

Q5. Can double eyelids remain asymmetrical even after surgery?

A. Differences can occur depending on the anatomical asymmetry of the eyes themselves or muscle-use habits, so

Pre-operative evaluation and fine-tuning are very important.

Q6. Can the eyes look smaller after surgery?

A. If the thickness of the eyelid or the position of the eyebrows is miscalculated, the eyes may actually look smaller and heavy.

This also requires harmony with procedures such as a forehead lift.

※ This post reveals actual before and after photos of the surgery to provide accurate information.

Please note that these photos were posted with the patient's consent, and bruising and swelling may vary and differ from person to person.