Doctor's Column

An impression where the distance between the eyebrows and eyes looks narrow is often not simply a problem with the double eyelid line, but an issue with the upper facial structure and the position of the forehead and eyebrows. This article explains, based on anatomy and medical literature, why an endoscopic forehead lift and revision non-incisional double eyelid surgery were planned together through an actual case where the patient actually preferred the loosened state of the line after non-incisional double eyelid surgery, but redesign was necessary because it could look even more loosened after a forehead lift. We summarize the core strategies that consider eyebrow–eye distance, line stability, and changes in impression simultaneously through an endoscopic forehead lift + revision non-incisional double eyelid surgery.

Face Designer, Dr. Sung-Hoon Kim, Director of SH Plastic Surgery

Hello. I am Dr. Seong-hoon Kim, a board-certified plastic surgeon and facial designer.

The patient introduced this time

visited the clinic with the concern, "The distance between my eyebrows and eyes looks narrow, so I wish it looked a bit wider."

The patient had undergone non-incisional double eyelid surgery in the past, and the line was currently loosened.

Interestingly, the patient stated, "I actually like the loosened look."

However, upon examination, if a forehead lift were planned,

there was a high possibility that the existing double eyelid line would look even more loosened or become unstable,

making it a case where both an endoscopic forehead lift and revision non-incisional double eyelid surgery had to be performed concurrently to achieve both the desired impression and stability.

Summary of Key Patient Information

Surgery: Endoscopic forehead lift + revision non-incisional double eyelid surgery

Chief complaint: Eyebrow–eye distance looks narrow

Past surgery: Non-incisional double eyelid surgery → currently loosened state

Patient preference: Wishes to maintain the "loosened look"

Final plan: Endoscopic forehead lift + revision non-incisional double eyelid surgery

Why can't it be solved with "double eyelids alone"?

The distance between the eyebrows and eyes is

determined together by

double eyelid line height,

eyebrow position, and

the condition of the forehead–temporal ligaments.

If you only adjust the double eyelid, the line changes but the eyebrow position remains the same,

so the impression of a narrow distance does not change significantly.

Evidence from research papers

Knize DM. The importance of brow position in upper eyelid surgery.

→ The impression of the upper eyelid is influenced more by eyebrow position than by double eyelids

Why is revision non-incisional double eyelid surgery needed when performing a forehead lift?

When the eyebrows are elevated through a forehead lift,

The upper facial skin redundancy increases,

and the tension applied to the existing non-incisional fixation point decreases.

In this case, if the existing non-incisional double eyelid is already loosened,

the line may appear even fainter or asymmetric after a forehead lift.

Evidence from research papers

McCord CD et al. Upper eyelid changes after brow lift.

→ Forehead and eyebrow lifts directly affect the position and stability of the double eyelid fold

Therefore,

while maintaining the "relaxed, loose look," structural restabilization was necessary.

Final surgical strategy: Forehead lift + Non-incisional double eyelid revision

1. Endoscopic Forehead Lift

Elevating the eyebrows to their anatomical position

Naturally widening the distance between the eyebrows and eyes

Brightening and refreshing the upper facial impression

Evidence from research papers

Nahai F et al. Endoscopic forehead lift: anatomy and fixation.

→ Resection of the temporal ligament and stable fixation determine the longevity of the results

2. Non-incisional double eyelid revision

Redesigning a thin, low line without overdoing it compared to before

Maintaining the "relaxed, loose look"

Supplementing only the fixation strength in accordance with the changed tension after the forehead lift

This was a case where sufficient stability could be secured without an incision.

Reflections by Facial Designer Dr. Kim Seong-hoon

The key to this case was

It was not a matter of "whether to create a line,"

but rather "how the line would look even after the forehead lift."

The impression the patient desired

was not sharpness, but relaxation and softness,

and in order to maintain that direction,

endoscopic forehead lift + non-incisional double eyelid revision could not be viewed separately.

A forehead lift is not a surgery that eliminates double eyelids.

However, it can become a surgery that requires redesigning the double eyelids.

FAQ

Q1. Does the distance between the eyebrows and eyes widen just with a forehead lift?

Yes. Structurally it does, but supplementary adjustments may be needed depending on the condition of the existing double eyelids.

Q2. If I don't mind the double eyelids looking loose, is revision surgery absolutely necessary?

Since there is a possibility that they may become more unstable after a forehead lift, minimal refixation is recommended.

Q3. Is it sufficiently stable without an incision?

It is entirely possible if the conditions of skin thickness and tension are suitable.

SH Plastic Surgery Clinic