How to Choose the Right Middle-Aged Eye Surgery for You, Including Eyelid Surgery for Age-Related Changes and Upper and Lower Blepharoplasty

 

Hello! This is Dr. Han Kyu-nam, Director of Samsao Plastic Surgery. 😊

 

Moving forward, to ensure safe cosmetic procedures and surgeries, we would like to share information that will be helpful from the perspective of consumers and customers. We call this initiative 'Creating a Proper Cosmetic Culture.'

 

I’m going to take some time to examine plastic surgery in detail, divided by topic. Today, as the first part, we will look at facial changes caused by aging, specifically focusing on the 'eyes'.

 

Let's go over the surgeries one by one that you have likely heard of, such as upper blepharoplasty, lower blepharoplasty, eyebrow lift, and endoscopic forehead lift, but which can be confusing regarding the differences between them.

 

1️⃣ Why are the eyes the first part of the body to show signs of aging?

Ten thousand blinks a day, and the place where shutting off and sagging begin

 

While no part of the body is insignificant, the eyes are truly special. This is because vision is the most important sense for perceiving the surrounding world, just as the saying goes, "Seeing is believing."

 

The eyes are also the windows to the soul. Being able to look someone straight in the eye means that your heart is truly open.

 

The eyes are the first organs on the face to finish growing. While the nose continues to grow late into puberty, the function of the eyes is fully developed by the time a middle school student is born. Blinking is fundamentally a movement intended to protect the eyeballs, and it occurs more than 10,000 times a day on average.

 

Perhaps that is why the two typical signs of aging—sagging and hollowing—usually begin around the eyes first.

 

📌 Young Eyes vs. Aged Eyes · Wrinkles around the eyes and hollowness under the eyes are the first areas where aging becomes apparent.

 

2️⃣ Why do eyelid sagging and under-eye hollowness occur?

Upper eyelids with three overlapping causes, and tear troughs and under-eye fat

 

The skin on the eyelids is the thinnest on the face. Aging, which begins in the mid-20s, reduces skin elasticity, and as subcutaneous fat around the eyes decreases, fine wrinkles start to form due to repetitive movement and loss of volume.

 

Asians have sunken areas around the eyes, particularly the brow bone, so if the eyebrows droop, it causes sagging of the upper eyelid skin.

 

🔸 Three Causes of Upper Eyelid Drooping
It is essentially the result of the combined effects of sagging forehead and eyebrows, reduced volume around the eyes, and loosening of the eyelid skin.

🔸 If the skin is thick
Except for cases where the face is generally thin, eyelid hollowness is concealed by sagging skin; conversely, if there is a lot of fat or the skin is thick, the eyelids are more likely to appear puffy.

 

As we age, it is common for the area under the eyes to become sunken or puffy, leading to the formation of dark circles. This is a relative phenomenon where if one area becomes puffy, the surrounding area appears sunken, and conversely, if it becomes sunken, the rest of the area appears protruding. The sunken area is usually the tear trough, while the puffy area is where the fat is located. As the skin in front is pushed by the fat, it stretches and wrinkles form.

 

💡 Director Han Kyu-nam's Tip
If skin sagging is minimal, it is corrected through a surgical procedure called fat redistribution, which involves removing some orbital fat from the convex area and filling the tear trough. If the sagging is significant, the excess skin can be removed through lower blepharoplasty. The only optional step is whether to additionally fill in the surrounding hollows with fillers or fat grafting.

 

3️⃣ Why is upper eyelid ptosis difficult to diagnose?

Cases requiring a forehead lift and changes in eyebrow descent after surgery

 

The difficult part is upper eyelid ptosis. Since eyelid ptosis is not caused by a single factor, it is best in principle to correct each one simultaneously.

 

However, if the drooping of the eyebrows caused by forehead sagging is the most significant factor in causing eyelid sagging, then a lifting surgery called endoscopic forehead lift is necessary instead of eyelid surgery.

 

🔸 Endoscopic forehead lift
Since it is an endoscopic surgery performed through 3 to 5 small incisions inside the scalp, the scars are concealed and the procedure is relatively simple. However, compared to upper eyelid surgery or brow lift (bropexy) surgery, the cost is burdensome, and many people find it difficult to make a decision due to a vague fear that it is too major a surgery.

 

🔸 If you are someone who usually keeps your eyebrows raised
(These individuals often have many forehead wrinkles.) After upper eyelid surgery or eyebrow lift, sagging is corrected, so there is no longer a need to lift the eyebrows. However, as the eyebrows descend, additional sagging occurs, which can negatively affect one's appearance.

 

Since this change does not occur in all patients, we explain in advance that in such cases, an additional endoscopic forehead lift may be necessary after surgery.

 

4️⃣ What is the difference between upper blepharoplasty and eyebrow lift?

Double eyelid formation and scarring vary depending on the location of the incision line

Although upper eyelid surgery is relatively simple, a double eyelid is inevitable due to the location of the incision line, even if desired. Since this method involves removing the thinnest part of the upper eyelid skin, the resulting double eyelid may appear thick and distinct, resembling a sausage shape, especially in Asians with thicker skin.

 

Although the problem can be corrected by removing fat and not fixing the double eyelid deeply, patients who did not have double eyelids cannot avoid a change in their appearance.

 

🔸 Browpexy
Many people prefer this method because it involves removing thick skin, preventing the formation of double eyelids, and allows the scar to be hidden along the border below the eyebrow. However, there are downsides, such as the eyebrow shape becoming slightly flatter and the space between the eyebrow and the eye appearing slightly narrower after the surgery.

 

💡 Director Han Kyu-nam's Tip
If a doctor accurately assesses the patient's condition and formulates a sound plan, the surgery can be performed in stages without having to complete it all at once. For example, upper eyelid surgery can be performed first, followed by an endoscopic forehead lift if necessary.

 

 

💬 Frequently Asked Questions

Q1. My under-eye area looks puffy. Should I get fat repositioning or lower blepharoplasty?

 

A. If skin sagging is minimal, consider fat redistribution to remove some orbital fat from the bulging area and fill the tear trough. On the other hand, if skin sagging is significant, lower blepharoplasty may be necessary to remove the excess skin.

 

Q2. Does upper eyelid surgery always result in a double eyelid?

 

A. Due to the location of the incision line, a double eyelid is inevitable even if you do not want it. While this can be corrected by removing fat and avoiding deep fixation, it is difficult to completely avoid a change in appearance if you did not have double eyelids before. If you do not want double eyelids, it is recommended that you consider a brow lift as well.

 

Q3. A forehead lift feels like too major a surgery. Is it really necessary?

 

A. This surgery is considered when eyebrow sagging caused by forehead drooping is the most significant cause of eyelid ptosis. It is not necessary for everyone; it can be planned in stages after performing upper eyelid surgery or eyebrow lift first and observing the progress.

 

🎯 Conclusion

Changes in the eyes during middle age are not a problem of the eyelids alone, but the result of the forehead, eyebrows, volume around the eyes, and skin thickness working together.

 

✔️ Even with the same 'eyelid drooping,' the answer varies: upper eyelid surgery for some, eyebrow sublift for others, and endoscopic forehead lift for still others.

 

📌 Rather than making a decision based solely on the name of the surgery, the proper procedure is to first identify where your sagging originated. In some cases, addressing the issue in stages may be more stable than attempting to resolve it all at once.

 

If the doctor explains in detail so that the patient can fully understand, and the patient listens carefully to the doctor's explanation and makes a rational choice based on trust, a good outcome that satisfies everyone can be achieved.