Doctor's Column

This is an actual case of a 51-year-old woman who underwent non-incisional double eyelid surgery 15 years ago, and upon entering her 50s, experienced hooding of the double eyelid line, sagging eyelids, as well as simultaneous under-eye bulging and hollowing. Instead of an incisional double eyelid surgery, this case is a combined surgical procedure that first corrected the upper facial structure through a sub-brow lift and upper epicanthoplasty (epicanthoplasty directed upward), and went beyond the limitations of simple under-eye fat repositioning by combining lower blepharoplasty and a midface lift to fundamentally improve sagging. We structurally explain the double eyelid revision surgery for individuals in their 50s, the differences between a sub-brow lift and upper blepharoplasty, and the reasons why lower blepharoplasty and a midface lift are necessary, accompanied by photos.

Hello. I am Dr. Seong-hoon Kim, Face Designer at SH Plastic Surgery.

"I think my double eyelids have come undone."

This is the most common statement I hear during consultations with patients in their 50s and older.

However, upon diagnosis, the issue often lies not within the double eyelid line itself,

but rather in the structures of the upper face and under-eye area that cover that line.

The case introduced today is also the story of a patient for whom, rather than a "revision surgery,"

rebuilding the structure was the top priority.

CASE

Female born in 1975 / 51 years old

Underwent non-incisional double eyelid surgery around age 35 (about 15 years ago)

Chief Concerns

Hooding of the double eyelid line

Drooping eyelids

Under-eye fat bulging and hollowing

An overall tired and dull appearance

Preoperative Condition Analysis

A state where the 15-year-old non-incisional double eyelid line appears hooded due to sagging of the upper face

Not a matter of stretched eyelid skin,

but a structural lack of functional allowance to lift upward when opening the eyes

Upper facial descent that cannot be resolved solely by excising skin beneath the eyebrows

A typical under-eye structure of a person in their 50s,

with one side bulging and the other appearing hollowed

This was a case where performing an incisional double eyelid surgery would likely make the line thicker and the overall impression heavier.

Day 1 Post-Operation – Description of Performed Surgeries

① Sub-brow Lift (Infrabrow Excision)

Trims the sagging skin beneath the eyebrows

Reduces the weight of the upper face and improves conditions for double eyelid exposure

Secures a structure where the line can be revealed without incisional double eyelid surgery

② Upper Epicanthoplasty

Naturally relieves the Mongolian fold without excessive tension

Increases upper facial openness with an effect alternative to medial epicanthoplasty

③ Lower Blepharoplasty + Midface Lift

Not a simple fat repositioning,

A structural lifting that lifts both the under-eye muscles and the midface together

Simultaneously improves under-eye bulging, hollowing, and cheek sagging

Although there is swelling and bruising immediately after surgery, the structural changes have already been established.

1 Month Post-Surgery

The hidden double eyelid line is naturally revealed

Restored distance between eyebrows and eyes → The eyes no longer look heavy or cramped

Reduction of under-eye bulging + midface lift creates a cleaner, more refined facial impression

Even without incisional double eyelid surgery,

Light and clear eyes + overall improvement in impression

Why was this surgery necessary?

The key to this case was

Not a matter of "re-creating a double eyelid,"

But a matter of "creating a structure where the double eyelid can be revealed."

Sagging upper face → Sub-brow lift & Upper epicanthoplasty

Sagging under-eyes and cheeks → Lower blepharoplasty + Midface lift

Although each may seem like a minor procedure on its own,

Performing them together ensures long-lasting results without the need for revision surgery.

Considerations by Director Kim Sung-hoon

Eye surgery after the 50s should not be a "surgery to create lines,"

But a "surgery to correct the structure."

In cases like this patient, who has a history of non-incisional (buried suture) double eyelid surgery,

Failing to accurately identify the cause of the disappearing line will lead to repeated revision surgeries.

Performing incisional double eyelid surgery while the upper face is pressed down is very likely to result in a thick, harsh impression.

Sub-brow lift, upper epicanthoplasty, lower blepharoplasty, and midface lift each have clear purposes,

And combining them appropriately according to the anatomical structure yields the most natural and long-lasting results.

FAQ

Q1. Is incisional double eyelid surgery really not recommended in one's 50s?

A. It is not recommended when sagging of the upper face is the underlying cause.

Q2. Is the scar from a sub-brow lift very visible?

A. It is designed along the eyebrow grain, so it is barely noticeable in daily life.

Q3. Can it be improved without revision non-incisional double eyelid surgery?

A. It is entirely possible once the structural issues are resolved.

Q4. Doesn't an upper epicanthoplasty make your impression look sharp?

A. It is performed naturally by expanding only the upper part without overcorrection.

Q5. Can't I just get under-eye fat repositioning?

A. After your 50s, addressing muscle and cheek sagging is also necessary.

Q6. Is it absolutely necessary to do lower blepharoplasty and a midface lift together?

A. If sagging is present, doing them together reduces the risk of recurrence.

Q7. How long is the recovery period?

A. Major swelling takes about 2 weeks, and it looks natural within 1 to 3 months.

Q8. How long do the results of this surgery last?

A. It lasts stably for much longer than a simple revision surgery.

SH Plastic Surgery Clinic

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※ This content is intended for general medical informational purposes,

and results and recovery processes may vary depending on individual conditions.

Actual treatment and surgical methods are determined after diagnosis by medical staff.