Actor

Recently, a post uploaded by actor Imido on her social media was reported in the media, attracting considerable attention.

After seeing it, many people responded empathetically, saying, “I’m experiencing the same symptoms,”

and “As I’ve gotten older, my eyelids suddenly developed multiple folds.”

Article about Imido’s eye surgery. Source: Media reports

Imido eye surgery. Imido ptosis. Imido double-eyelid surgery. Source: Media reports and social media

In plastic surgery clinics, this is actually one of the symptoms most frequently reported by patients in their 40s and 50s.

“I used to have monolids, but at some point my eyelids started folding into multiple layers.”

“My eyes feel heavy and are difficult to open.”

“I look sleepier and more tired than I used to.”

Many people simply think, “I developed double eyelids,”

but in most cases, these are actually multiple eyelid folds caused by a reduction in the fat around the eyes and sagging skin due to aging.

These changes affect not only appearance but also the function of opening the eyes,

so appropriate diagnosis and treatment are often needed.

• It is not that monolids have become double eyelids. -

It is common for people who had neat monolids when they were young to suddenly develop multiple eyelid folds as they age.

Many people think, “I developed double eyelids,” but in reality, multiple folds form as the eyelids crease repeatedly due to aging.

These changes generally result from three factors acting together.

• Atrophy of the fat around the eyes

• Sagging eyelid skin

• Aging of the tissues that lift the eyelids

• Why do multiple folds develop? -

The eyelids are not made up of skin alone.

Beneath the skin are a layer of fat and various soft tissues that help the eyelids move smoothly.

Eyelid structure. Levator muscle. Levator muscle. Orbital fat. Superior orbital fat. Source: Asian eyelid surgery

These tissues act as a kind of cushioning layer when opening and closing the eyes, helping the skin move smoothly.

However, as people age, the fat around the eyes decreases and the skin loses elasticity, reducing this cushioning function.

As a result, the eyelids can no longer move smoothly and

fold in several areas, creating two or three overlapping creases rather than a single line.

As the condition progresses, the upper eyelid may appear sunken, a form known as a Sunken Upper Eyelid.

Multiple eyelid folds do not indicate only a cosmetic issue.

Patients commonly report symptoms such as:

• Heavy eyes.

• Difficulty opening the eyes.

• Feeling more tired in the afternoon.

• Using the forehead muscles to open the eyes.

As aging progresses, the function of the levator muscle may also weaken along with skin sagging, and ptosis may occur as well.

• Double-eyelid surgery for multiple eyelid folds varies according to the condition -

The treatment method varies depending on the degree of the folds and eyelid function.

① Mild symptoms

Buried-suture double-eyelid surgery. Non-incisional double-eyelid surgery. Buried-suture double-eyelid surgery for middle-aged patients. Partial model shown with consent for publication.

If there is not much skin sagging and no ptosis,

some cases may be improved with non-incisional double-eyelid surgery alone.

However, these cases are limited, and this approach does not apply to every patient.

② The most common case

Upper blepharoplasty method. Upper blepharoplasty method. Repositioning of upper eyelid fat. Correction of sunken eyes. Repositioning of orbital fat. Sunken Upper Eyelid correction. Upper blepharoplasty for sunken eyes.

Before and after upper blepharoplasty. Before and after upper eyelid surgery. Before and after middle-aged eye surgery. Review of middle-aged eye surgery. Partial model shown with consent for publication.

The methods most commonly performed for people in their 40s and 50s are upper blepharoplasty and repositioning of the fat above the eyes.

By appropriately removing sagging skin and repositioning atrophied orbital fat downward,

restoring volume around the eyes can often reduce multiple folds and make the eyes feel lighter when opening them.

③ When ptosis is also present

Meaning of ptosis. Degree of ptosis. Ptosis and correction of the eye shape. Eye-opening correction surgery. Ptosis correction surgery.

Before and after eye-opening correction surgery. Review of eye-opening correction surgery. Before and after middle-aged eye surgery. Review of middle-aged eye surgery. Partial model shown with consent for publication.

If the strength used to open the eyes itself has weakened, upper blepharoplasty alone may not be sufficient.

In this case, eye-opening correction surgery (ptosis correction) should also be performed if functional improvement is to be expected.

④ When the eyelids are severely sunken

Fat grafting above the eyes. Fat grafting for sunken eyes. Fat grafting for the Sunken Upper Eyelid. Fat grafting around the eyes. Nanofat grafting. Nanofat. Partial model shown with consent for publication.

When the depression around the eyes is severe, fat repositioning alone may not be sufficient,

and autologous fat grafting may be performed together to help restore natural-looking volume.

• The important thing is not the “double eyelid,” but the cause. -

Not everyone with multiple eyelid folds undergoes the same surgery.

The surgical method may vary depending on

how much the skin has sagged,

how much fat remains around the eyes,

and whether ptosis has also developed.

Therefore, rather than simply creating a double eyelid, it is most important to accurately determine why the eyes have become heavy

and why multiple folds have developed, then choose treatment suited to the cause.

As in the recent case of actor Imido, the symptom of “having difficulty opening the eyes”

may be more than a simple cosmetic concern and could be a sign that aging of the eyelids has begun.

If you are experiencing discomfort from newly developed multiple eyelid folds and heavy eyes in your 40s or 50s,

looking at the function and structure of the eyelids together, rather than considering it simply a double-eyelid issue,

may provide a more fundamental approach to addressing the problem.

Fat grafting for sunken eyes. Fat grafting around the eyes. Fat grafting for the Sunken Upper Eyelid. Real model shown with consent for publication.

When is non-incisional double-eyelid surgery possible in middle-aged eye surgery? Please refer to the blog post below.