Doctor's Column

Watery eyes and drooping around the eyes seen in men in their 60s are not simply an issue of under-eye fat. The tearing, under-eye bulging, and drooping eyelids commonly observed in men in their 60s are often structural changes resulting from the combined aging of the eyes, forehead, and midface, rather than merely being caused by excess under-eye fat. In particular, when one excessively uses the forehead to open the eyes, the structural support on the outer side of the eyes weakens, and the midface sags along with it, tearing is frequently accompanied. In this article, through the actual case of a 65-year-old male patient, I will structurally explain why a forehead lift, sub-brow lift, lower blepharoplasty, and midface lift had to be considered together.

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

Hello.

I am Dr. Seong-hoon Kim, facial designer at SH Plastic Surgery.

There is something that male patients in their 60s frequently say when visiting the clinic:

“The wrinkles on my forehead are getting deeper,

and even when my face is at rest, I look like I'm crying or upset.”

These changes

often appear gradually as they unconsciously use their forehead

because their eyes do not open easily.

Patient Case

Born in 1960, a 65-year-old male patient

Persistent tearing from the outer corner of the left eye

Under-eye bulging and overall sagging around the eyes

A habit of excessively using the forehead when opening the eyes

Visited the clinic troubled by frequently being told, "You always look tired"

On the surface, it may seem like a simple under-eye fat problem,

but the examination revealed that this patient showed a typical pattern seen in middle-aged and older men, where aging of the eyes, forehead, and midface is interconnected as one.

1. The Cause of Watery Eyes

“Not a tear duct problem, but a collapse of the outer supporting structure”

In this patient's case,

The reason tears flowed only from the left eye

was not an issue with the tear duct itself,

but because the outer supporting structure of the eye had weakened

and the lower area sagged together with it,

creating a structure where tears could not drain through the normal pathway and leaked outward.

In this condition,

if you only remove or reposition the under-eye fat,

the sagging may actually become more prominent.

In this case, the core of the problem

is not the fat, but the 'structural support.'

2. The reason for excessively using the forehead is not a mere 'habit.'

This patient

When opening the eyes, the eyelid muscles alone were not sufficient to open them fully,

resulting in an anatomical structure where the forehead muscles were used to open the eyes.

On the surface,

the eyelids appear to be sagging,

but rather than being a condition where excess skin has stretched out,

it is closer to a state where the supporting strength has weakened, causing them to descend.

In such cases, if only the eyelids are operated on,

the balance of power needed to open the eyes remains unresolved,

and only the outward appearance changes.

As a result,

the forehead may suddenly appear hollow,

wrinkles between the eyebrows and on the bridge of the nose may become more prominent,

the upper eyelids may look bulging,

or left-right asymmetry may become more pronounced.

This is not because the surgery went wrong,

but because the issue with the eyes had already originated from the structures above the eyes.

3. Key Point of This Case

“The force used to open the eyes must be redistributed from above.”

A change commonly seen in 65-year-old men is

that the structure has shifted from opening with the eyes → to forcefully opening with the forehead.

Therefore, the key to this case is

not making the eyes bigger,

but restoring a structure that allows the eyes to open comfortably.

The starting point for that is precisely the Endotine endoscopic forehead lift.

Surgical Plan and Combination Description

① Endotine Endoscopic Forehead Lift

Correction of forehead overuse

Stabilization of eyebrow position

Reduction of strain on glabella and forehead wrinkles

Resolution of the root cause of aging around the eyes

② Sub-brow Lift

Precise removal of only sagging skin

The most natural method for men

Scars concealed under the eyebrows

Fine adjustment of eyelid drooping when combined with a forehead lift

③ Non-incisional Double Eyelid (Thin line)

Subtle, masculine design

No sense of incompatibility even after a forehead lift

Aimed at neatening the appearance rather than looking "operated on"

④ Lower Blepharoplasty + Midface Lift

Overcoming the limitations of lower eyelid fat surgery alone

Improving the tear troughs

Reinforcement of the supporting structure under the eyes

Helps alleviate tearing in the left eye

Dr. Kim Sung-hoon's Surgical Insights

Eye issues in middle-aged and older men

often cannot be explained by a single area alone.

In this case as well,

tearing, under-eye puffiness, drooping eyelids, and forehead overuse

were not separate problems,

but were connected as a single flow of aging.

In cases like this, correcting only one area

can actually lead to an unnatural result.

Rather than surgeries that make the eyes bigger,

I focus on

restoring the structure that allows the eyes to open comfortably.

An approach that considers the balance of the entire face

ultimately leads to the most natural result.

FAQ

Q1. If there is tearing, should tear duct surgery be done first?

A. Not necessarily. If structural drooping is the cause, it can be improved through correction alone.

Q2. Can a 60-year-old man have a forehead lift without it looking overdone?

A. Because the endoscopic method aims for a natural repositioning, it carries little burden.

Q3. Is the sub-brow lift scar noticeable?

A. It is designed along the lower margin of the eyebrow, making it barely visible in daily life.

Q4. Can't I just get lower blepharoplasty alone?

A. If accompanied by midface sagging, performing the surgery alone may actually accentuate the hollowness.

Q5. Is double eyelid surgery really necessary for men?

A. It is recommended to perform it thinly as a supportive measure only when there is a functional need.

Q6. Will my impression change significantly after the surgery?

A. The goal is not to "look younger," but to "not look tired."

Q7. Is it okay to undergo multiple surgeries at the same time?

A. Surgeries that belong to the same aging process are advantageous to perform together in terms of recovery and results.

At SH Plastic Surgery,

Rather than a surgery that looks at just one area,

the surgery is designed by considering both the interconnected structure and function of the entire face.

Like this case,

If your goal is to look "natural, masculine, and not tired,"

an approach that corrects the overall coordinates is most effective rather than partial correction.

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

SH Plastic Surgery Clinic