Doctor's Column

A 54-year-old female patient who was considering double eyelid revision surgery. The root cause of the problem was not the eyes, but sagging of the forehead and upper face. We introduce a structure-centered lifting case by Dr. Seong-hoon Kim of SH Plastic Surgery, who reduced the burden on the eyelids and naturally restored the double eyelid line through an Endotine endoscopic forehead lift.

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

Hello. I am Dr. Seong-hoon Kim, facial designer and director of SH Plastic Surgery.

Among those considering revision surgery because their double eyelids seem to have come undone,

in quite a few cases, it is actually not the eyes, but the forehead descending and covering the eyes.

Today, through the case of a 54-year-old woman who needed a forehead lift rather than double eyelid revision surgery, I will explain why.

“Has my double eyelid come undone again?”

This is the question I hear most often in the consultation room.

However, looking closely, the problem is often not with the eyes, but with the forehead.

Today, I would like to talk about this representative case of a 54-year-old woman.

Patient Basic Information

Female born in 1971 / 54 years old

2019: Sub-brow lift

2021: Lower blepharoplasty

After a consultation for double eyelid revision at another clinic,

she was told that “the cause of eye sagging is not the eyes, but the forehead,”

and subsequently visited SH Plastic Surgery, a hospital specializing in forehead lifts.

Preoperative Condition Analysis

“My eyes look saggy, but is the double eyelid really the problem?”

This patient already had a history of undergoing a sub-brow lift.

Nonetheless, as time passed, her eyes looked heavy and hooded again,

and she complained that her double eyelid line had blurred and felt covered.

The reason is relatively clear.

Because a sub-brow lift is a surgery focused on excising skin beneath the eyebrows,

over time, the weight of the forehead and upper facial muscles presses down again.

Especially in cases where more than 5 years have passed,

gravitational sagging of the forehead and upper cheekbones often covers the eyelids again.

In other words,

on the surface, it looks “as if the double eyelid has come undone,”

but the actual cause is not the eyelids, but the descent of the entire upper face.

If revision double eyelid surgery is performed in this state,

the line will become thick,

the impression will become harsh,

and over time, it will sag again, carrying a high possibility of leading to a third surgery.

This case is not simply a matter of sagging eyes.

It is a state where the forehead and the entire upper face have descended, pressing down on the eyes.

Eyelids pressed down due to the descent of the forehead and upper face

Decreased distance between the eyebrows and eyes

Double eyelid line blurred as the eyelids hood over

Left-right asymmetry becomes pronounced as the descent of the left eyebrow is more severe

Although a sub-brow lift was performed in the past,

because it is a surgery focused on skin excision,

over time, the weight of the forehead and muscles acts downwards once again.

→ As a result,

it looks like an eye problem, but the actual cause is the structural descent of the forehead and eyebrows.

In the end, this case

was a case where surgery to correct the structure was needed first, rather than surgery to recreate the line.

7 days post-surgery

For this patient,

the forehead, eyebrows, and the entire upper face were repositioned upwards.

As the forehead tissue moves upward,

the position of the eyebrows naturally rises,

the eyebrow–eye distance is immediately restored,

and asymmetry improves as the difference in height between the left and right eyebrows is alleviated.

The important point is

that "the eyes were not directly touched."

The double eyelids were not recreated,

nor was eyelid skin excised.

Instead, viewing the forehead–eyebrow–eyelid complex as a single structure,

it is a method of lifting the whole area from above.

In the photo taken 7 days after surgery,

although swelling and bruising still remain,

you can see that opening the eyes has become much more comfortable.

The position of the eyebrows has naturally lifted,

and the space above the eyelids is gradually being secured.

Photo 1 month after surgery

"What kind of changes have occurred?"

As one month passed after the surgery,

the key changes in this case became clear.

Eyelids became lighter

Field of vision widened

The double eyelid line settled naturally without being artificially created

The overall impression became much brighter and more comfortable

What is particularly noteworthy is

that "it doesn't look awkward even though the forehead was lifted."

This patient

has a relatively long face

has a relatively long philtrum

does not have a long nose

was a type whose upper face was compressed, making the impression look stuffy

In this type of facial proportion,

even if the forehead is lifted to a certain extent,

the central balance of the eyes, nose, and mouth often improves instead.

In other words,

A forehead lift is not simply a "surgery to lift the forehead,"

but rather played a role in harmonizing the overall facial proportions.

CASE Summary

If your double eyelid line keeps collapsing

and your eyes look heavy and stuffy,

the cause may not be the "eyelids," but the "forehead."

Even if you have already had a sub-brow lift or double eyelid surgery

If sagging has reoccurred over time,

the next choice should not be a stronger double eyelid,

but surgery that corrects the structure of the upper face.

Reflections by Facial Designer Dr. Kim Seong-hoon

The core problem for this patient was not the double eyelid,

but the forehead and upper facial structure that continuously pressed down on the double eyelid.

Although the patient had already undergone a sub-brow lift,

surgeries focused primarily on skin excision can, over time,

lead to re-sagging as the weight of the muscles and forehead acts downward again.

If double eyelid revision surgery is performed in this state, the lines are likely to become thick

and the impression is very likely to become heavy.

Endotine endoscopic forehead lift is a surgery that reduces the burden on the eyelids

by lifting the entire upper facial structure without touching the eyes directly.

In cases like this where structure is the cause, a forehead lift is the most rational answer.

SH Plastic Surgery's Endotine endoscopic forehead lift

analyzes the eyes, forehead, and upper face as a single structure,

corrects the muscles and positions rather than just the skin,

without excessive changes to the impression,

and aims for long-lasting results.

Like this case,

"when structural improvement is needed before double eyelid revision surgery,"

you can expect a more natural and stable change.

FAQ

Q1. I already had a sub-brow lift, so why can it sag again?

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

Over time, as the weight of the forehead and upper facial muscles presses downward again,

a phenomenon where they cover the eyelids again can occur.

This type of re-sagging is especially common when more than 5 years have passed.

Q2. Can't I just get double eyelid revision surgery in this state?

It is possible, but not recommended.

If you recreate the line while the upper face is heavy,

the eyes may look thick or the impression may become harsh, and

In the end, it is highly likely to sag again and lead to revision surgery.

Q3. Doesn't a forehead lift make the eyes look too pulled up?

It depends on facial proportions.

In cases like this where the face is on the longer side and the philtrum is long,

even if the forehead is raised to a certain degree, it does not look awkward,

and in many cases, it actually improves the central balance of the eyes, nose, and mouth.

Q4. What makes an Endotine forehead lift different?

An Endotine forehead lift

uses minimal incisions inside the scalp,

precise dissection using an endoscope,

and fixes the muscles and structures from above;

through this method,

it is possible to achieve a clearer and softer impression

it aims for a natural and long-lasting lift.

Q5. Will the double eyelid line be maintained without having separate double eyelid surgery?

Once the upper facial structure is corrected through a forehead lift,

the downward pressure on the eyelids disappears,

and in many cases, the existing double eyelid line naturally reveals itself and stabilizes.

This case is a prime example.

Q6. Does everyone in these situations need a forehead lift?

No.

If the eyelid skin itself is the primary issue, upper blepharoplasty or double eyelid surgery may be appropriate.

However, if the line keeps getting covered and you find yourself repeatedly undergoing revision surgeries,

an evaluation of the upper face and forehead structure must be performed first.

(545) Sub-brow Lift & Forehead Lift Case Introduction! You Can Change Too~ - YouTube

SH Plastic Surgery Clinic

※ This content is intended for general medical informational purposes,

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

The actual treatment and surgical methods are determined after diagnosis by a medical professional.