Eyelid Surgery
"Eyelid surgery" covers several different operations. Some create or refine a crease, some help the eyelid open, some remove loose skin, and some smooth bags under the eyes. This page explains the main types Dr. Kim discusses in consultation and how to work out which problem you are trying to solve.
At Violacell Plastic Surgery, Dr. Kim currently provides non-surgical treatment and does not perform eyelid surgery there. This page is a plastic surgeon's guide: what eyelid surgery can and cannot do, and how to tell whether your concern needs surgery or can be treated without it, for example with Thermage with the eye tip.
- Main types
- Double eyelid surgery, ptosis correction, upper blepharoplasty, lower blepharoplasty and revision eyelid surgery.
- Anesthesia
- Most eyelid procedures are commonly done under local anesthesia, often with sedation. Larger or combined operations may use general anesthesia.
- Operating time
- Typically from under an hour to a few hours, depending on the procedure and whether several are combined.
- Visible recovery
- Bruising and swelling are usually most noticeable for 1–2 weeks. Final shape often takes several months to settle.
- First step
- An examination of the crease, eyelid height, lifting muscle, brow, skin, fat and lower eyelid support.
What a Surgeon's View Adds to Eye-Area Treatment
Eyelid problems look similar but have different causes. A surgeon's assessment decides whether a device, a booster or surgery is the honest answer.
Diagnosis first
Excess skin, fat, a low brow and ptosis need different treatments. He identifies which is present before suggesting anything.
Skin quality around the eyes
Thermage with the eye tip and skin boosters such as Re2O can improve thin skin and fine lines around the eyes.
Clear referral point
When the cause is a weak eye-opening muscle or significant excess skin, he explains that surgery is the effective option.
The Main Types at a Glance
| Procedure | Main concern it addresses | What it does not do |
|---|---|---|
| Double eyelid surgery | No crease, a faint or uneven crease, or a crease that hides when the eyes open | Does not strengthen a weak lifting muscle by itself |
| Ptosis correction | The eyelid edge sits low over the eye, so the eyes look sleepy or tired | Does not remove large amounts of loose skin by itself |
| Upper blepharoplasty | Loose, hooded upper eyelid skin and bulging fat with age | Does not lift a low eyebrow |
| Lower blepharoplasty | Under-eye bags, a groove between the lower eyelid and cheek, loose lower eyelid skin | Does not remove pigment-related dark circles |
| Revision eyelid surgery | Problems after a previous eyelid operation, such as a high or uneven crease | Cannot always fully restore tissue that has been removed |
When the heaviness comes from a low eyebrow rather than the eyelid, a forehead lift may be considered instead of, or along with, eyelid surgery.
How to Tell Which Problem You Have
Many people describe their concern as "tired eyes" or "heavy eyelids". The same description can come from very different causes, and each needs a different operation. These questions help narrow it down before an examination.
Is there a crease?
If you have no crease, or a crease that disappears or looks different on each side, the concern may be addressed with double eyelid surgery. Many Asian eyelids naturally have no crease or a low crease; this is a normal variation, not a defect.
Does the eyelid edge cover the pupil?
Look straight ahead in a mirror with your forehead relaxed. If the upper eyelid edge covers part of the dark center of your eye, or you lift your eyebrows to see, the lifting muscle may be weak. This points toward ptosis correction.
Is loose skin resting on the lashes?
If skin folds down over the crease or lashes and this has developed with age, the concern is mainly excess skin. Gently lift your eyebrow with a fingertip: if the heaviness mostly disappears, the brow may be the main cause.
Is the problem under the eye?
Puffy bags, a shadowed groove or loose skin below the eye involve the lower eyelid. Dark circles caused by skin pigment or thin skin with visible vessels are not corrected by surgery.
These questions overlap. A person can have a faint crease, mild ptosis and loose skin all at once, and the plan then combines procedures. An in-person examination measures eyelid height, lifting muscle function, brow position and skin, and checks for dry eye or other eye conditions. You can also read Upper eyelid surgery or a forehead lift?
Double Eyelid Surgery
Double eyelid surgery creates or refines the upper eyelid crease, the fold that appears when the eye opens. A crease forms when the skin is connected to the structures that lift the eyelid, so that skin folds in along a line as the lid rises. Many Asian eyelids have no such connection, or a weak one, and have a single eyelid or a low, partial crease.
The aim is usually a crease that suits the face and eye shape, not a fixed "ideal" height. A crease that is set too high or too deep can look unnatural and is difficult to lower later, so the height, shape (for example a parallel crease or one that tapers toward the inner corner) and depth are discussed carefully before surgery.
Non-incisional (suture) method
Fine stitches are passed through small punctures to link the skin to the deeper eyelid structures. There is no long incision and swelling is usually lighter.
It tends to suit thin eyelids with little fat or excess skin. Because it relies on stitches, the crease can loosen or fade over time, and the method cannot remove skin or fat.
Incisional method
An incision is made along the planned crease. Skin, a strip of muscle and fat can be adjusted if needed, and the crease is fixed internally.
It suits thicker eyelids, more fat or skin, or a need for a more lasting crease. Swelling lasts longer, there is a fine scar in the crease, and changes are harder to reverse.
Partial incision
A shorter incision is used, allowing limited fat adjustment with less dissection than a full incision. It sits between the two in terms of recovery and what can be adjusted.
Combined procedures
Double eyelid surgery is often combined with ptosis correction when the eye also opens weakly. Inner-corner procedures (epicanthoplasty) change the inner fold of skin and leave a small scar; they are considered only when they suit the face.
Ptosis Correction
Blepharoptosis, or ptosis, means the upper eyelid edge sits lower than normal. It can be present from birth (congenital) or develop later (acquired), often because the tendon-like part of the lifting muscle stretches with age, contact lens wear or eye rubbing. In Korea, correction of mild ptosis is often called "eye-opening correction", because the goal is a more open, alert-looking eye.
Ptosis can also be a sign of nerve or muscle conditions. A drooping eyelid that appears suddenly, changes during the day or comes with double vision needs medical evaluation before any cosmetic surgery.
How It Is Corrected
- Levator advancement The lifting muscle's tendon is tightened or reattached, usually through a crease incision. This is common for acquired ptosis with reasonable muscle function.
- Suture-based or minimal-incision methods Sometimes used for mild ptosis, often together with double eyelid surgery. Their scope is more limited.
- Frontalis sling When the lifting muscle works very poorly, the eyelid may be linked to the forehead muscle so the forehead helps raise the lid.
The eyelid height after surgery needs careful judgment. Over-correction can make the eyes look startled or cause difficulty closing; under-correction leaves residual droop. Small adjustments are sometimes needed.
Upper Eyelid Surgery for Aging Eyelids
With age, upper eyelid skin loosens and folds over the crease, fat can bulge and the crease can become hidden. Upper blepharoplasty removes excess skin and, when needed, adjusts fat and re-forms the crease. It is a different goal from double eyelid surgery in a younger eyelid, although the techniques overlap.
Because a low brow and a weak lifting muscle often look like "too much skin", these are checked first. Removing eyelid skin when the brow is the real cause can pull the brow lower. Details are on the upper blepharoplasty page.
Lower Blepharoplasty
Under-eye bags usually form when fat around the eye pushes forward as the supporting tissue weakens. A groove can appear between the bag and the cheek (often called the tear trough). Loose or crepey lower eyelid skin and a lower eyelid that has lost firmness can add to the tired look.
Lower blepharoplasty is planned around which of these is present. It is not one fixed operation.
Transconjunctival approach
The incision is made on the inside of the lower eyelid, so there is no visible skin scar. Fat can be reduced or moved through this opening.
It suits bags with good skin quality and little excess skin. It does not remove skin; mild skin texture may be treated separately.
Fat repositioning
Instead of only removing fat, part of it is moved down into the groove below the bag to smooth the transition to the cheek. This can be done from inside the eyelid or through a skin incision.
It aims to avoid a hollow look that can follow fat removal alone.
Transcutaneous approach
An incision just below the lash line allows excess skin to be removed along with fat adjustment. The scar usually becomes faint.
Because removing skin can pull the lid down, support of the outer corner (canthopexy or canthoplasty) is often considered when the lower eyelid is lax.
Limits
Lower eyelid surgery does not change pigment-related dark circles, fine wrinkles from skin quality, or cheek descent. Malposition of the lower eyelid is one of the more significant risks and is why lower eyelid support is assessed carefully.
Revision Eyelid Surgery
Revision surgery is for concerns that remain or develop after a previous eyelid operation. Common reasons include a crease that is too high or too deep, a crease that has faded, uneven creases, multiple folds, residual ptosis or over-correction, a hollow upper eyelid after too much fat removal, visible scars and difficulty closing the eyes.
Revision is usually more complex than a first operation. Scar tissue changes the layers, and skin or fat that has been removed cannot always be fully replaced. Lowering a high crease, in particular, is one of the more difficult corrections.
Timing and Expectations
Unless there is an urgent problem such as inability to close the eye, revision is generally planned after swelling and scar tissue have settled, which often means waiting several months after the previous surgery. Early changes can look worse than the final result.
Bringing previous surgery details, if available, helps planning. The goal of revision is meaningful improvement; complete restoration or perfect symmetry cannot be guaranteed, and some cases need more than one stage.
Recovery in General
| Timing | Typical course |
|---|---|
| First 2–3 days | Swelling and bruising are at their peak. Cold compresses, keeping the head raised and avoiding bending over help. |
| About 5–7 days | Skin stitches, if used, are commonly removed. Non-incisional procedures often have less swelling. |
| About 1–2 weeks | Many people return to daily activities and work. Makeup is usually allowed once incisions have healed, as advised. |
| 1–3 months | The crease may still look a little high or stiff while swelling resolves. Scars are often pink and firm. |
| 3–6 months | Crease, eyelid height and scars continue to settle. The final result is usually assessed after this period. |
Recovery depends on the procedure, the number of procedures combined and individual healing.
Risks Shared by Eyelid Procedures
- Asymmetry The two eyes are rarely identical before surgery, and they may heal differently.
- Crease problems A crease that is too high, fades, or forms extra folds.
- Over- or under-correction of ptosis The eyelid may sit higher or lower than planned.
- Dry eye and incomplete closure Often temporary, but can persist if too much tissue is removed.
- Lower eyelid malposition After lower eyelid surgery, the lid can pull down or turn outward and may need correction.
- Hollowing From excessive fat removal.
- Scarring, infection and bleeding Uncommon. Bleeding behind the eye is rare but threatens vision and needs urgent treatment.
Before You Decide
- Tell the surgeon about dry eye, contact lens use, laser vision correction and any eye disease.
- Mention thyroid conditions, bleeding tendencies and medications or supplements that affect bleeding.
- Share previous eyelid or brow procedures, including fillers.
- Bring photos of yourself from earlier years if you want to discuss how your eyes have changed.
- Allow enough time near the clinic for stitch removal and an early check if you are traveling.
Combining with Other Procedures
The eyes are affected by the brow above and the cheek below. When the eyebrow has descended, a forehead lift may be planned with or before upper eyelid surgery. When the midface has descended, the lower eyelid groove may be part of wider changes addressed by a mini facelift or facelift.
Non-surgical treatments such as Ulthera, Thermage and Re2O or Sculptra address skin quality or volume in surrounding areas. They do not create a crease, correct ptosis or remove eyelid fat.
Glossary
- Crease (supratarsal fold)
- The fold in the upper eyelid that appears when the eye opens.
- Ptosis (blepharoptosis)
- A drooping upper eyelid edge, usually from a weak or stretched lifting muscle.
- Levator aponeurosis
- The tendon-like extension of the main eyelid-lifting muscle.
- Epicanthal fold
- A fold of skin covering the inner corner of the eye, common in Asian eyelids.
- Transconjunctival
- Through the inner lining of the eyelid, leaving no skin scar.
- Tear trough
- The groove that runs from the inner corner of the eye down toward the cheek.
- Canthopexy
- A procedure that tightens or supports the outer corner of the lower eyelid.
- Lagophthalmos
- Inability to close the eyelids completely.
Frequently Asked Questions
What is the difference between double eyelid surgery and blepharoplasty?
Double eyelid surgery mainly creates or refines a crease, usually in younger eyelids. Upper blepharoplasty mainly removes loose skin and sometimes fat in aging eyelids, and may re-form the crease. The techniques overlap, but the goals differ.
Should I choose the non-incisional or incisional method?
It depends on eyelid thickness, fat, excess skin, whether ptosis is present and how long-lasting you want the crease to be. The non-incisional method suits thin eyelids but may loosen over time; the incisional method allows more adjustment but has longer swelling and a fine scar.
How do I know if I have ptosis?
Signs include an eyelid edge that covers part of the pupil, raising your eyebrows to see, and eyes that look sleepy even when you are rested. Only an examination that measures eyelid height and lifting muscle function can confirm it.
Can under-eye bags be treated without a visible scar?
Often, yes. The transconjunctival approach works from the inside of the lower eyelid and leaves no skin scar. It is suited to bags with good skin quality; if there is excess skin, an incision below the lashes may be needed.
Will eyelid surgery remove my dark circles?
Only if the darkness is a shadow cast by bags or a groove. Dark circles from skin pigment or thin skin showing blood vessels are not changed by surgery.
How soon can revision eyelid surgery be done?
Unless there is an urgent problem such as difficulty closing the eye, revision is generally planned after swelling and scar tissue have settled, which often takes several months. The timing depends on the problem and the previous surgery.
Can several eyelid procedures be done at once?
Yes, procedures such as double eyelid surgery and ptosis correction, or upper and lower blepharoplasty, are often combined. Combining them can lengthen surgery and recovery, so the plan depends on your health and goals.
How long should I stay nearby after eyelid surgery?
Many patients plan to stay at least until stitches are removed, commonly around 5–7 days after surgery, and allow time for an early check. The exact time depends on the procedure and how you heal.