"Before cutting the eyelid, we ask where the eyebrow should be."
When eyelids droop, the body unconsciously recruits forehead muscle force to lift the eyebrow and maintain visual field. Over the years, this compensatory pattern becomes habitual, and the eyebrow you see in the mirror rests at a position "lifted by the forehead," not its true anatomical location.
What happens if upper blepharoplasty alone removes eyelid skin in this state? Since the eye opens more easily, the forehead no longer needs to elevate the brow, causing it to descend again. The eye-to-brow distance narrows, potentially creating a heavy and crowded or tired appearance, and the remaining skin laxity becomes more difficult to address later. This is why AVA Plastic Surgery's diagnostic process begins not with the eyelid, but with eyebrow position.
In practice, the lateral (outer) eyebrow typically sags more than the medial portion; forehead lift alone may not fully address lateral laxity. Therefore, combined forehead lift, sub-brow lift, and double eyelid procedures are frequently recommended. The required combination is determined via the five-case classification below.
※ Classification is based on eyebrow position and sagging pattern assessed with forehead muscle completely relaxed. Final determination is made during individual consultation.
| Case | Presentation | Recommended Design |
|---|---|---|
| 1 | Young, minimal sagging | Double eyelid surgery alone (incisional or non-incisional) |
| 2 | Mild sagging, crease formation does not intensify expression | Incisional double eyelid surgery |
| 3 | Minimal brow ptosis but significant lateral laxity obscuring crease | Sub-brow lift + non-incisional double eyelid |
| 4 | Case 3 + existing asymmetric or excessively high crease | Sub-brow lift + incisional double eyelid |
| 5 | Significant brow ptosis, deep deep frown lines, narrow eye-to-brow distance | Forehead lift + sub-brow lift (± double eyelid) |
| Feature | Upper Blepharoplasty / Double Eyelid | Sub-Brow Lift | Forehead Lift |
|---|---|---|---|
| Target Problem | Eyelid crease, thin skin above crease | Redundant skin below eyebrow | Eyebrow position itself |
| Incision Location | Double eyelid crease (or non-incisional) | Lower border of eyebrow | Within hairline |
| Scar Visibility | Concealed in crease fold | Concealed by eyebrow hairs | Concealed by scalp hair |
| Change in Expression | Moderate to significant depending on crease design | Minimal (crease preserved) | Minimal (position restoration) |
| Suture Removal | 5–7 days | 5–7 days | Within 7 days |
※ Scar color and texture typically fade over 3–6 months, though individual variation exists depending on constitutional factors.
The skin along the double eyelid crease is extremely thin. Removing excessive amounts may create a more "open" appearance immediately post-operatively, but risks an unnaturally enlarged, harsh, or "fierce" eye expression. Over-excision is difficult to reverse. Therefore, AVA Plastic Surgery adheres to the principle of excising only what is necessary from the eyelid crease area, addressing the bulk of sagging via thicker tissue below the eyebrow.
It is not about removing more, but about selecting precisely where to remove—naturalness in upper eye surgery hinges on this distinction.
As with any surgical procedure, the following complications and side effects may occur. Full disclosure is provided during consultation.
AVA Plastic Surgery operates under a single-surgeon model: Dr. Kim Seungsoo personally performs every procedure from first incision to final suture closure. No subsequent patient is scheduled until the current surgery is complete. Your surgery is never delegated — no ghost surgeons. Consultation, procedure, and follow-up care are all conducted by the same surgeon, ensuring continuity of medical information.
For full credentials, please visit the Surgeon Profile page.
When eyelids droop, the forehead muscle unconsciously lifts the eyebrow to open the eye. If you remove eyelid skin alone, the forehead no longer needs to lift the brow, causing it to descend again. This shortens the eye-to-brow distance and may create a heavy and crowded appearance. That's why we diagnose the eyebrow position first. Upper blepharoplasty alone may suffice in some cases; we assess with the forehead muscle fully relaxed during consultation.
A sub-brow lift removes redundant skin from the thicker tissue directly below the eyebrow, lifting the upper eyelid without altering the thin skin along the double eyelid crease. This approach minimizes changes to the eye's overall expression. Double eyelid surgery creates or refines the crease, while sub-brow lift addresses sagging skin—purposes differ, though they may be combined depending on the case.
The sub-brow lift incision follows the lower border of the eyebrow, designed to be concealed by eyebrow hairs. Forehead lift uses an incision within the hairline. Upper blepharoplasty and double eyelid incisions are placed along the natural crease. Scar color and texture typically fade over 3–6 months, though individual variation exists depending on factors like hypertrophic scarring or keloid tendency.
Swelling and bruising peak at 2–3 days post-surgery. Sutures are removed at 5–7 days depending on the site. Most patients resume daily activities within 1–2 weeks, with swelling stabilizing at 2–4 weeks, though individual variation applies. Strenuous exercise and sauna are restricted for 2–4 weeks.
No. We classify cases into five categories based on eyebrow position and sagging pattern assessed with the forehead fully relaxed, then combine only the necessary procedures. Young patients with minimal sagging may need double eyelid surgery alone, while those with significant lateral sagging may benefit from sub-brow lift combination. If the brow itself has descended significantly, a forehead lift may be added. However, because lateral brow sagging is common, combined procedures are often recommended.
Yes. Ptosis correction adjusts the function of the muscle that opens the eyelid (levator palpebrae), whereas the procedures on this page address sagging skin and brow position. If both skin laxity and muscle weakness are present, both approaches may be combined. Differential diagnosis is provided during consultation. For details, please refer to the Double Eyelid · Ptosis Correction page.
Pricing varies depending on whether a single procedure or combination is performed. Please contact us by phone or 1:1 consultation for an accurate quote. AVA Plastic Surgery operates a transparent fixed-price system with identical pricing for all patients.
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