#7-1. Surgical methods for different degrees of sagging

In the previous article, we discussed how the face changes as the skin sags with age. In this article, we will briefly cover surgical techniques that can be applied to different areas of sagging.

I often seen patients complain about their droopy eyes or eyelids. And they also often think that the correction is only possible with surgical removal of tissues. The truth is, however, the sagging begins from the forehead. Therefore, an ideal treatment is a forehead lift combined with upper and lower eyelid blepharoplasty. Such multi-pronged approach is desirable but patients may be averse to it due to its invasiveness, downtime, and high cost.

Recommend the following techniques for such cases.

1. The eyebrow and eyelash are close together and the eyelid skin is thick: I recommend forehead lift first. Forehead lift will lengthen the gap between the eyebrow and eyelash, creating a more open countenance. In many cases, this can improve the heaviness of the upper eyelid and sagging of the nasal dorsum and outer corners of the eyes. With the recent introduction of endoscope-assisted microsurgery, quicker recovery with minimal scarring has become possible.

2. The eyebrow and eyelash are far apart and the eyelid skin is thick: I make an incision under the eyebrow. This is called brow lift but there is a limit to the lifting effect. As the incision is made in the thicker part of the upper eyelid, the thinner skin is left intact, creating a more natural outcome.

3.The eyebrow and eyelash are far apart and the eyelid skin is thin: If the patient does not already have the double eyelid (fold in the upper eyelid), I make an incision in theupper eyelid for resection and create the fold.

If any of the above cases are accompanied by ptosis, ptosis correction can be simultaneously carried out. I often use the combination.

The septum of the lower eyelid can sag with age and cause the lower eyelid to protrude and droop. In such cases, I tighten the loosened septum (septal reset) or spread the fat pad downward to flatten the protrusion (fat reposition). If the lower eyelid is very droopy, lifting the SOOF(suborbocularis oculi fat) can correct the sagging.