Doctor's Column

If your double eyelid line repeatedly collapses and your eyes look heavy and hooded, the cause might not be the eyelids themselves, but rather sagging of the forehead and upper face. Based on a real case of a female patient in her 50s, this content uses anatomical evidence and academic literature to explain why the decision of "forehead lift first" was made after a revision double eyelid surgery consultation. It presents an approach that simultaneously improves the structure of the eyebrows, forehead, and upper face through an endoscopic Endotine forehead lift, clearly pointing out re-sagging after sub-brow excision, the limitations of revision double eyelid surgery, and the precise indications for a forehead lift.

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

"I went for a double eyelid consultation,

and was told, 'It's not an eyelid problem, it's a forehead problem.'"

These were the words spoken by a 54-year-old female patient during her first visit.

While consulting for revision double eyelid surgery at another clinic,

she was told that the root cause of the drooping eyes lay in the forehead and upper face.

Searching for a hospital specializing in forehead lifts, she ultimately visited SH Plastic Surgery.

Before & After Comparison Photos

CASE _ Why Wasn't Revision Double Eyelid Surgery the Priority?

<Pre-surgery>

Limitations of Sub-Brow Lift – Skin was reduced, but the weight remains

A sub-brow lift is a surgery focused primarily on skin excision.

In the short term, the eyelids may appear lighter,

but over time, the weight of the forehead muscles and upper soft tissue exerts downward force once again.

Especially in cases where more than 5 years have passed,

Gravitational sagging from the forehead to the upper cheek often covers the eyelids again,

causing the double eyelid line to blur or disappear.

▶ Related Research

Knize DM. Limited incision forehead lift. Plast Reconstr Surg.

→ Explains that the primary cause of upper facial sagging is the descent of muscle and soft tissue, not simply excess skin

The Risks of Revision Double Eyelid Surgery

When the upper face is already heavy,

raising the double eyelid line again can lead to the following problems:

The line appears thick and "sausage-like"

The facial impression becomes harsh and unnatural

It will likely sag again over time, potentially leading to yet another revision surgery

In other words, it becomes a procedure that only touches the surface without addressing the root cause.

Direction of the Solution: Cases Where a Forehead Lift is Needed First

<Post-surgery>

By first lifting the upper facial structure through a forehead lift:

Reduction in eyelid weight

Expanded field of vision

Brighter impression

Existing double eyelid line naturally restored and stabilized

In this case,

Forehead lifting was the top-priority solution for improvement.

Why Endotine Endoscopic Forehead Lift?

The Endotine endoscopic forehead lift

Full dissection of the temple and forehead

Resection of retaining ligaments that pull the eyebrows down

Maintaining a stable position with an Endotine fixation device

is a method that reduces the possibility of sagging again.

▶ Evidence from academic papers

Nahai F et al. Endoscopic brow lift with Endotine fixation.

→ Pointing out that fixation failure is the main cause of forehead lift failure, emphasizing the stability of Endotine fixation

Facial Proportion Analysis – Why the Forehead Lift Looks Natural

This patient

has a relatively long face

Relatively long philtrum

Nose length is not excessively long

In other words, it was a structure where the facial proportions would not be compromised even if the forehead was slightly elevated.

Rather, when the forehead is lifted,

it was a type where the balance among the eyes, philtrum, and nose centered properly and improved.

Reflections by Facial Designer Dr. Kim Seong-hoon

“When the double eyelid line keeps collapsing,

the problem is often the forehead, not the eyes.

A forehead lift is not a surgery to make the eyes bigger,

but a surgery to keep the eyes from being covered.

Like this case,

For those who need structural improvement before double eyelid revision surgery,

The Endotine endoscopic forehead lift

it can be the most natural and long-lasting choice.”

FAQ

Q1. Do I have to redo my double eyelids if I get a forehead lift?

→ No. Once the structure is lifted, the existing line is often revived.

Q2. Can I get a forehead lift even if I have had a sub-brow lift?

→ Yes. The surgical scope and purpose are different.

Q3. Is Endotine fixation permanent?

→ It is an absorbable material that induces tissue adhesion during the fixation period.

Q4. Doesn't the face look short?

→ It is performed only when the facial proportions are analyzed and the indications are appropriate.

(197) Endotine vs. Bone Tunneling Forehead Lift: What are the differences in fixation methods? - YouTube

SH Plastic Surgery Clinic