A Case Where Upper Blepharoplasty in Gangnam Won’t Help, a Plastic Surgeon’s Honest Opinion

Hello.

I’m Ban Ho-kyung, a board-certified plastic surgeon whose specialty is eye surgery and whose strongest skill is revision eye surgery.

Many children are preparing eyelid ptosis surgery as a gift of filial piety for their parents, right?

In our clinic as well, many middle-aged and older patients come alone or with friends, but there are also many who visit because their children brought them in.

And there is something common among children who come with their parents: they are considering upper blepharoplasty.

That is only natural, since when you look up information about droopy-eyelid surgery, upper blepharoplasty comes up most often and, above all, the name itself suggests that it improves the area above the eyes.

But not all eyelid drooping can be solved with upper blepharoplasty alone.

Some people have only slight drooping in the front of the eyes, while in others the drooping extends all the way to the outer corners. Even though it is all drooping, the affected areas, skin elasticity, and whether there was previous surgery differ from person to person, so it is not something that can always be solved with only “upper blepharoplasty.” For some people, brow lift is appropriate, for others forehead lift is appropriate, and for some, upper blepharoplasty alone is appropriate.

So then, among upper blepharoplasty, brow lift, and forehead lift, which surgery is appropriate for our parents?

I’ll go through each one clearly and specifically, so please follow along step by step.

Left: Before surgery / Right: After upper blepharoplasty + lower blepharoplasty

Left: Before surgery / Right: After brow lift + lower blepharoplasty

Left: Before surgery / Right: After brow lift + lower blepharoplasty

Left: Before surgery / Right: After forehead lift

Upper blepharoplasty, brow lift, forehead lift

I’ll organize them for you clearly.

1. If the drooping is mild, upper blepharoplasty

If the upper eyelid drooping is relatively mild, and especially if the skin has stretched mainly in the front part of the eye, upper eyelid surgery is appropriate.

How is upper blepharoplasty performed?

The procedure begins with a careful diagnosis of the eyelid condition, then designing the double-eyelid line or incision line while considering the individual’s facial shape, eye shape, and skin thickness.

After that, skin is removed along the designed incision line, and the loosened skin, unnecessary fat, and muscle are trimmed.

At this point, depending on the patient’s request or need, a new double-eyelid line may be created or the existing line may be preserved, and finally the area is sutured naturally and securely.

Though it may look similar to incisional double-eyelid surgery performed in younger people, there are important differences in the actual purpose and surgical method.

What is different from double-eyelid surgery?

Incisional double-eyelid surgery is mainly intended to create or improve the appearance of the double eyelid, and the candidates are usually people in their 20s or 30s who have good skin elasticity, right?

In that case, skin removal is minimized and the approach focuses on line design, so it is completed relatively simply.

By contrast, in middle-aged people in their 40s and older, eyelid drooping progresses in earnest along with reduced skin elasticity, so if surgery is performed in the same way as in younger people, the result can look awkward and unnatural.

Therefore, the amount of skin to be removed, the fixation position and strength of the eyelid, and even the degree of looseness in the suturing must all be adjusted delicately.

Because it is a surgery focused on improving drooping and supplementing elasticity, it is called upper blepharoplasty, distinct from incisional double-eyelid surgery.

In conclusion, upper blepharoplasty is more accurately understood not as an extension of double-eyelid surgery, but as an anti-aging procedure for improving droopy eyelids in middle age.

If the eyes feel heavy and stuffy but the drooping is not severe, upper blepharoplasty alone can restore a clearer and more natural eye shape.

2. If the outer corners are significantly drooped, brow lift

If the eyelid drooping extends to the outer corners of the eyes, upper blepharoplasty alone is not enough to bring sufficient improvement.

Especially as people age, the eyelid skin cannot resist gravity and stretches down toward the outer corners of the eyes, blocking vision or causing discomfort from rubbing and irritation. This is when we recommend sub-brow lift surgery, commonly known as brow lift.

How is sub-brow lift performed?

This surgery is performed in a completely different area from the familiar double-eyelid incision line.

It involves making an incision just beneath the eyebrow, selectively removing only the loosened skin, lifting it upward, and then suturing it.

In other words, because the double-eyelid line is not affected, it can be performed independently of double-eyelid surgery. In particular, when the drooping extends far toward the outer corners of the eyes, it can lift a wider area of skin, creating a refreshing and lifted effect.

Why can’t upper blepharoplasty alone solve it?

When drooping is severe, the skin comes down toward the outer side.

However, upper blepharoplasty can only address drooping centered on the front of the eyes through an incision along the double-eyelid line, so there is a limit to how completely it can lift skin that has stretched all the way to the outer side.

In fact, about 20 to 30 years ago, when people tried to solve all drooping with upper blepharoplasty alone, there were many cases where the impression became overly sharp and unnatural.

The skin of the eyelid is thin, while the skin under the eyebrow is relatively thicker. When thin eyelid skin and comparatively thicker brow-area skin were forcibly sutured together, the scar became more noticeable and the facial impression changed unnaturally.

By contrast, sub-brow lift removes skin beneath the eyebrow, so there is little difference in skin thickness above and below the incision line, and the suturing is done naturally, making the scar less visible.

And people often ask, “If I get a brow lift, can’t I have double eyelids made?” but that is not the case. Because the loosened skin beneath the eyebrow is removed, the skin remaining below becomes suitable for forming a double eyelid.

Therefore, afterward, it is possible to create clear and natural double eyelids using a non-incisional natural adhesion method without cutting.

But if brow lift leaves almost no scar

and improves drooping at the outer corners of the eyes,

is there really any need to do upper blepharoplasty?

In some cases, upper blepharoplasty is definitely necessary.

A representative example is when someone has previously had double-eyelid surgery but the result was unsatisfactory.

If the line is uneven, the scar is severe, or there is a lot of fat in the eyelid making the line blurry, the double-eyelid line must be newly designed and refined through incision, so the problem can only be solved by directly addressing the double-eyelid line.

Checklist to know before looking for a Gangnam upper blepharoplasty clinic

If a person like this also undergoes brow lift, there will be two scars between the eyes and eyebrows: one from the double-eyelid line incision and one from beneath the eyebrow.

So in such cases, unless the skin drooping is extremely severe, it is better to avoid brow lift and instead solve both the drooping and the line issue with upper blepharoplasty alone.

3. If the space between the eyes and eyebrows is too narrow, or if there is drooping between the brows, forehead lift

Both upper blepharoplasty and brow lift are performed by removing and suturing skin between the eyes and eyebrows. Because of that, both have the common feature of making the distance between the eyebrows and eyes shorter after surgery.

If this removal method is applied to people who already have a narrow space between the eyes and eyebrows, the eyes and eyebrows can end up even closer after surgery, making the expression look stuffy and strong. In some cases, the eyes may even look smaller or unnatural.

In such cases, rather than removing skin, a more suitable method is forehead lift surgery, which lifts the entire forehead upward to secure space between the eyes and eyebrows while also improving drooping. It is also suitable when drooping between the eyebrows, the area above the nose, is more severe than expected.

Will there be scars or significant swelling?

Since forehead lift involves the entire forehead, some people worry that the scars or swelling may be severe.

In most cases, it is performed as an endoscopic forehead lift. After making a few small incisions along the scalp line, the surgery is performed while precisely viewing the inside of the forehead through an endoscope.

Although the surgical area itself is relatively large, the operation does not expose the entire area, so swelling and bleeding are minimal and recovery is relatively quick. The scars are hidden within the scalp, so they are barely visible.

To summarize simply,

If the eyes are mildly droopy, or if a previous double-eyelid surgery result is unsatisfactory, upper blepharoplasty is appropriate.

If the drooping extends significantly to the outer corners of the eyes, brow lift is appropriate.

If the eyebrows and eyes are close together, or if drooping between the brows above the nose is severe, forehead lift is appropriate.

Today’s conclusion

For middle-aged eye surgery, it is important to find the method that suits you best through an accurate diagnosis and consultation.

Middle-aged eye surgery, meaning anti-aging surgery, is not simply a procedure that pulls up a drooping area.

Because every patient has different conditions, such as the stage of aging, the location and degree of drooping, and whether they have had previous double-eyelid surgery, the same surgery cannot be applied to everyone.

That is why the key to middle-aged eye surgery is to carefully judge all factors together—where and how much has drooped, what the skin elasticity is like, and whether the double-eyelid line should be preserved or newly created—and then choose the most suitable surgery precisely.

This is also why our clinic does not charge a consultation fee.

I believe consultation should not be a place to simply recommend surgery, but a time to help patients make the most reasonable choice for themselves based on objective information, in a neutral and honest way.

If you heard different opinions at other clinics and felt confused, feel free to come and compare them.

I’ll help you make the right decision about which surgery is most suitable for your eyes.

This is Ban Ho-kyung, because that’s why you fall for it.

Thank you.

[Helpful article for those considering lower blepharoplasty]

https://blog.naver.com/rush_724/223790861572

[Helpful article for those considering under-eye fat repositioning]

https://blog.naver.com/rush_724/223737127404

[Gangnam Banni, the reason there is no consultation fee (+ Ban Ho-kyung’s philosophy)]

https://blog.naver.com/rush_724/223776150003