"Thin eyelid skin cannot be restored once cut. That is why we simulate the crease before we ever make an incision."
AVA Plastic Surgery treats the full spectrum of eyelid surgery — double eyelid creation, ptosis correction, epicanthoplasty, and revision. That breadth has taught us one thing: eyes do not sort into types. Two sets of "heavy eyelids" carry very different amounts of lax skin, and two "monolids" can call for entirely different answers once a trial crease is placed. Your consultation begins not with a classification chart but with placing, adjusting, and confirming a trial crease on your own eyes.
Two core principles guide our practice: ① We prioritize the natural adhesion (non-incision) technique for double eyelid surgery, and ② Even when incision is necessary, we approach thin eyelid skin as conservatively as possible. Once skin is excised, it cannot be restored.
The choice between the two comes down to how much lax skin is present and how your expression changes when a trial crease is placed. In practice, that in-office simulation is what determines the surgical plan.
| What the Trial Crease Shows | Assessment | Rationale |
|---|---|---|
| Significant skin laxity (even in younger patients) | Natural adhesion alone is approached with caution | Natural adhesion alone may result in skin folding below the crease approximately six months later, diminishing eyelid definition. |
| Thick skin folds into the trial crease and the expression hardens | Consider brow lift + natural adhesion combination | Excess skin is addressed below the eyebrow (thicker skin) rather than on the eyelid, with the crease formed via natural adhesion — the same principle as our Upper Eyelid Lift Guide. |
| Laxity is present, but the expression does not harden when the crease is simulated | Incisional blepharoplasty | Only in this case does excising the excess skin while forming the crease create a more defined eyelid. |
Incisional blepharoplasty is an irreversible procedure that excises thin eyelid skin. AVA is deliberately conservative with incisions — we reserve them for eyes where the indication is clear.
Unlike conventional buried suture methods that rely solely on the tension of suture knots, natural adhesion creates tissue-to-tissue adhesion along the folding plane to reduce the likelihood of loosening (individual variation applies). If loosening does occur, the loosening pattern, residual crease, and skin redundancy are evaluated to transition to re-adhesion, partial incision, or full incision as appropriate.
The crease design principle is to harmonize patient preference with anatomical feasibility. We assess what is achievable, explain it plainly, show you the result to expect — and then the choice is yours.
| Crease | Characteristics | Suitable For | Considerations |
|---|---|---|---|
| In-out line | Moderate height that suits most eyes | The most common choice | Requires an absent epicanthal fold for completion; often necessitates concurrent epicanthoplasty |
| Out-line · Semi-out | High crease — dramatic and defined with makeup | Individuals with frequent heavy makeup (stage, performance) | May appear somewhat unnatural without makeup |
| In-line | Low crease — natural without makeup | Individuals who rarely wear makeup | Less eye-enlarging effect, as eyeliner space is limited; the epicanthal fold remains, so the inner corners can feel slightly closed-off |
A harsh look is created when too much skin is excised — closing the distance between eye and brow — or when thick skin is made to fold. When a brow lift feels premature at your age, yet an excision at the crease would sacrifice too much thin skin, AVA's answer is not to cut more — it is a staged design:
We recommend the path that prioritizes long-term outcomes over immediate dramatic transformation.
Ptosis correction is a procedure that shortens the levator palpebrae superioris muscle. AVA determines ptosis correction necessity based on measurable criteria.
The muscle has a finite range of motion, and ptosis correction shortens that muscle; roughly half of what you gain in eye opening is traded away as reduced eye closure. Over-correction can lead to lagophthalmos (visible sclera above the iris when eyes are open) and dryness due to incomplete closure. Milder cases tend to improve substantially within 1–3 months, but a pronounced over-correction is best revised early.
Medial, lateral, and lower canthoplasty each have sound indications. But these are technically demanding procedures; done poorly, they can leave conspicuous scarring — or under-correct and relapse. AVA employs methods that minimize scar burden while aiming for definitive correction.
More critical is proportion — the ratio of the eyes within the face, and the ratio within the eyes themselves. Disregard it — remove the epicanthal fold "completely, simply because it is there" — and the eye's internal proportions can break down, leaving a result that reads as uncanny, or simply older. When that happens, an epicanthoplasty reversal (restoration) can bring back a softer look.
The sequence AVA follows during revision surgery consultation:
| Situation | Timing |
|---|---|
| Within 2 weeks of previous surgery | Golden window for early correction — dissection is straightforward and issues are immediately identifiable. |
| Golden window has passed | It is usually better to wait 6 months — or 8 months if adhesion is severe. |
| Extreme stress impairing daily life | Early correction may be attempted depending on patient condition — determined jointly during consultation. |
Once excised, skin cannot be regenerated. However, for eyes with a harsh impression due to over-excision, lowering the crease with a double-crease correction lets the thin skin fold once more, which can soften the expression noticeably. The trade-off is a lower crease height — a compromise we spell out precisely before surgery.
| Method | Advantages | Considerations |
|---|---|---|
| Buried Suture (Non-incision) | Rapid recovery, minimal external scar burden | Long-term loosening risk, limited applicability to thick eyelids |
| Partial Incision | Addresses loosening of buried suture, relatively rapid recovery | Limitations with significant skin redundancy |
| Incisional Method | Allows skin and fat refinement, stable crease | Extended recovery (1–2 weeks for social activities, 1–3 months for stabilization) |
| Ptosis Correction | Alert eyes, improved vision | Levator muscle evaluation essential, bilateral balance critical |
※ The appropriate method is determined during consultation after evaluating eyelid thickness, muscle strength, and skin redundancy.
Living tissue pushes back: after any surgery, the body tends to drift roughly 30% of the way back toward where it started. Therefore, in cases of severe unilateral ptosis, slight initial over-correction may be performed to achieve final symmetry — settling may take 3–4 months, during which some patients find the over-correction uncomfortable. So we put the choice to you before surgery: match both sides now and accept a slightly under-corrected result later, or accept a period of over-correction now so both sides settle into balance. There is no single right answer — we decide it together.
Consultation, design, surgery, and post-operative care are all performed by Dr. Kim Seungsoo. No subsequent patient's schedule begins before the current patient's surgery is completed, and delegated (ghost) surgery does not occur.
Not necessarily. On eyes with significant lax skin, natural adhesion alone can allow skin to fold below the crease around six months later, blurring the definition of the eyelid. We decide by how your expression changes with a trial crease in place: if thick skin folds in and hardens the look, we consider a brow lift combined with natural adhesion; if laxity is present but the expression stays soft, an incisional approach creates a more defined eyelid.
Gently lift the eyebrow to tighten the eyelid skin, then press down with your hand to immobilize it (blocking forehead muscle assistance). Open your eyes and observe how much of the iris is exposed. The natural standard is 80–90% exposure; if significantly more is obscured, ptosis correction may be indicated.
When the epicanthal fold is removed completely without regard for facial proportion, the eye's proportions can break down, leaving an uncanny or older-looking result. In such cases, an epicanthoplasty reversal (restoration) can bring back a softer impression.
Within two weeks of the previous surgery you are still in the golden window for early correction — dissection is straightforward and problems are easy to identify. Once that window closes, it is usually better to wait 6 months, or 8 if adhesion is severe. That said, if the distress is disrupting your daily life, early correction can be considered — please raise it during your consultation.
After evaluating the loosening pattern, residual crease, and skin redundancy, the appropriate method among re-adhesion, partial incision, or full incision will be recommended.
It is determined based on levator muscle strength testing. If the pupil is obscured, causing visual discomfort or making the eyes appear less alert, simultaneous correction will be considered.
With the non-incision method, most patients return to daily routines in 1–2 weeks; with the incisional method, the result stabilizes over 1–3 months (individual variation applies).
Cost depends on the method (non-incision / partial incision / full incision), whether ptosis correction is included, and whether it is a revision. We will walk you through it in a one-on-one consultation. Pricing is transparent and fixed — the same for every patient.
Reservation · Consultation
Clinic Hours: Weekdays 10:00–19:00 / Sat 10:00–17:00 / Closed Sun & Holidays · Phone +82-2-6958-6881
One-on-One Consultation Request Homepage KakaoTalk Channel Consultation Call