Doctor's Column

An endoscopic forehead lift is not a surgery solely for the eyes. In this post, based on anatomical aging patterns and academic literature, I explain why an endoscopic forehead lift with thread fixation, brow lift, buried suture blepharoplasty, and lower blepharoplasty combined with a midface lift were designed together. I have detailed the significance of the scar placement extending from the temple hairline to behind the sideburns and ears, as well as why approaching the upper and midface as a single continuous structure yields natural and long-lasting results.

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

Hello. I am Director Kim Sung-hoon, facial designer.

It has been getting very cold lately.

Colds have been going around,

and I, too, need to pay closer attention to my immunity.

Yesterday, the very first thing a consultation patient said to me was,

“Doctor, I thought I only needed surgery on my eyes.”

So many people come in for consultations thinking this way.

However, when looking at the face as a whole,

eye concerns are rarely just about the eyes alone.

Sagging that begins in the forehead pushes down on the eyebrows,

the eyebrows hood over the eyelids,

and that downward weight connects all the way down to the under-eye area and the midface.

Today, for patients who visit us with these concerns,

I would like to explain the surgical approach along with a case study.

Let me explain why an endoscopic forehead lift + brow lift + buried suture blepharoplasty + lower blepharoplasty + midface lift

are designed as a single continuous flow.

The Interconnected Structure of Facial–Midface Aging

Upper facial aging can be explained in the following sequence:

Descent of forehead soft tissue

Brow ptosis (eyebrow sagging) ptosis)

Excess upper eyelid skin and heavy eye opening

Weakening of lower eyelid support

Midface descent connecting into the nasolabial folds

Surgical Details

1. Endoscopic Forehead Lift

An endoscopic forehead lift

is not a surgery that merely lifts the forehead.

Sufficient dissection extending to the temporal region

Resection of retaining ligaments that pull the eyebrows down

Long-term position maintenance through thread fixation

Only when these three elements are performed together

will the eyebrows "truly" be lifted.

2. Brow Lift

A brow lift is

a surgery that alleviates the weight pressing down on the upper eyelids from above.

Improves visual field without excising eyelid skin

Natural outcome without excessive changes to one's facial expression

Increases stability when combined with a forehead lift

3. Non-Incisional (Buried) Double Eyelid Surgery – 'Thin and Light'

With the forehead and eyebrows already lifted,

there is no need to recreate the double eyelid fold using an "incisional" method.

Assists in eye opening with a thin, buried suture line

Minimizes the burden of swelling and scarring

A design that preserves the effects of the forehead lift

Fix the underlying structure first, then create the line as a supplementary touch.

4. Lower Blepharoplasty + Midface Lift

If only the under-eye fat is repositioned,

it can become hollow and sag again over time.

Lower Blepharoplasty: Trims under-eye fat and sagging skin

Midface Lift: Restores cheek support structures

Improves the tear trough and nasolabial fold junction

Why Scar Placement Is Crucial

One of the biggest advantages of an endoscopic forehead lift

is that the surgery is designed so that scars are barely visible.

However, "small incision" does not mean "no scar."

To minimize scarring, the incision location, direction, and fixation method are all critical.

Principles of Scar Placement in Endoscopic Forehead Lift

The incision for an endoscopic forehead lift

is generally positioned 1.5 to 2 cm behind the hairline inside the scalp.

The incision is made in the **scalp**, not the forehead skin.

Hidden between the hair, it is barely visible externally.

Incisions are made parallel to the direction of hair growth to minimize damage to hair follicles.

Reflections by Facial Designer Dr. Kim Seong-hoon

“The key to this surgery

is not that multiple procedures were performed.

It lies in designing the forehead, eyebrows, eyelids, under-eyes, and midface

as a single, unified structure.

Focusing only on the eyes makes them look heavy and stifling,

while focusing only on the forehead leads to an unnatural look.

The face should not be viewed in separate parts,

but understood as an interconnected whole.”

FAQ

Q1. Who is this surgery suitable for?

It is suitable for those experiencing both heaviness in the upper face and sagging under the eyes.

Q2. Are the scars really not visible?

They are hidden within the hairline and behind the ears, making them virtually imperceptible in daily life.

Q3. How long is the recovery period?

Major swelling subsides in 2 to 3 weeks, and natural-looking results settle in within 2 to 3 months.

Q4. Wouldn't an endoscopic forehead lift alone be enough?

There are limitations if there is sagging in the under-eye and midface areas.

SH Plastic Surgery Clinic

Sub-brow Lift & Forehead Lift Case Studies! You Can Change Too~