허쉬성형외과의원

Upper eyelid and lower eyelid, which surgery do I need?

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​​​​​​​​​​​​​​​​When you start to notice changes around your eyes“My eyelids are droopy. Should I get an upper blepharoplasty?”

“I have puffy under eyes. Do I need a lower blepharoplasty?”

“What exactly is the difference between the upper eyelid and the lower eyelid?”I worry about this.

In particular, as we age, the area around the eyes may experience loss of skin elasticity, changes in fat, and muscle relaxation, 

so it is difficult to decide on a surgical method simply because the eyes are saggy.

The upper eyelid is a surgery that mainly looks at sagging of the upper eyelid, 

and the lower eyelid is a surgery that mainly looks at fat protrusion, sagging skin, and wrinkles under the eyes.

However, in an actual consultation, not only the skin condition of the eyelids, 

but also eye opening strength, double eyelid line, eyebrow position, amount and location of fat under the eyes, skin elasticity, etc. must be checked.

So what is the difference between the upper and lower eyelids, and which surgery should I consider?

Today, we will look at the differences between the two surgeries, as well as the standards for distinguishing between upper eyelid,

lower eyelid, and under-eye fat repositioning.

Upper eyelid and lower eyelid, what is the biggest difference?​​

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The simplest distinction is as follows:

Upper eyelid → sagging above the eye

Lower eyelid → Sagging, fat, and wrinkles under the eyes

Upper eyelid examination focuses on cases where sagging skin occurs on the upper eyelid, covering the eyes or making it difficult to open the eyes.

On the other hand, the lower eyelid approach focuses on cases where the fat under the eyes protrudes forward or the skin sags, causing wrinkles and sagging.

In other words, although the names are similar, the area and purpose to be checked and improved through surgery are different.

If your eyelids are droopy, you may want to consider an upper blepharoplasty.​​

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​​​​​​​​​​​​​​​​Upper eyelid surgery is literally a surgery targeting the upper eyelid.

As we age, our skin loses elasticity and as the skin on our eyelids sags, previously invisible skin may begin to cover our eyes.

At this time, you may not only experience changes in appearance, but also feel discomfort while living.

If you see these changes, you can check your upper eyelid.

It feels like the eyelids are drooping down and covering the eyes.

My eyes look smaller than before

The existing double eyelid line is covered by the skin.

My eyes feel heavy and stuffy

When I open my eyes, I put a lot of pressure on my forehead.

My vision feels stuffy because of my eyelids.

In particular, if you have developed the habit of straining your forehead when opening your eyes, 

you need to check whether it is simply sagging skin or whether there is an area related to the force of opening your eyes.

Hirsch Plastic Surgery's upper eyelid-related content also states that sagging eyelids cause blurred vision or excessive use of forehead muscles.

Cases where the double eyelid line is obscured are explained as representative situations in which the upper eyelid may be considered.

Is the upper blepharoplasty just a matter of removing sagging skin?​​​

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Not necessarily.

Not everyone who has droopy eyelids undergoes surgery in the same way.

If you look at the condition of the upper eyelid, each person hasThe extent of sagging skin,amount and location of fat

muscle condition,The power to open your eyes,Existing double eyelid line,position of eyebrowsBecause the backs are different.

Therefore, rather than thinking, “If I remove a lot of skin, my eyes will become clearer,” it is important to first check why the eyelids currently look saggy.

Depending on the individual's condition, the upper eyelid considers not only the skin but also muscle and fat, 

and if necessary, eye correction or double eyelid surgery may also be considered.

If the area under your eyes is bulging and saggy, you may want to consider lower blepharoplasty.

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​​​​​​​​​​​​​​​​Lower eyelid surgery is a surgery to look at aging changes in the lower part of the eye.

Typically, the fat under the eyes protrudes forward and becomes convex, or the skin loses elasticity, causing wrinkles and sagging.

If you have this concern, you can check your lower eyelid.

The fat under the eyes looks bulging

The skin under the eyes is saggy

The number of fine wrinkles under the eyes has increased

The undereye area looks saggy

The area under the eyes looks sunken and shadowy

Even if I get enough rest, I am concerned about looking tired.

In particular, there are cases where fat protrudes and disappears simultaneously under the eyes.

If the area below the area where the fat protrudes appears relatively lighter, it may look like a dark circle due to the difference between light and shadow.

Therefore, rather than simply judging that “there is a lot of fat under the eyes,”

it is important to look at the location of the fat and the degree of skin sagging and sagging.

Are lower blepharoplasty and under-eye fat repositioning the same surgery?​

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​​​​​​​​​​​​​​​​This part is often the most confusing.

To conclude, lower blepharoplasty and under-eye fat repositioning are not the same surgery.

Just because the area under the eyes is bulging does not necessarily mean that you should get a lower blepharoplasty.

When considering under-eye fat repositioningfor exampleThe fat under the eyes is relatively protruding., The skin under the eyes does not sag significantly., 

When the lower part of the fat looks sunkenUndereye fat relocation may be considered.

Under-eye fat relocation does not simply remove the protruding fat, 

but rather focuses on relocating it to the necessary area to relieve the curve caused by the convexity and sagging under the eyes.

On the other hand, if the skin is stretched a lot and fine wrinkles or sagging appear, the story may be different.

If you have sagging skin and wrinkles, you can consider lower blepharoplasty.

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​​Lower eyelid surgery is a surgery that comprehensively checks the skin, muscles, and fat depending on the condition under the eyes.

Especially in cases where fat protrudes under the eyes, sagging skin, and wrinkles increase, removing the fat alone may not be enough.

At this time, the sagging skin and muscle condition can be checked together to determine the surgical method.

To easily distinguish,

The focus is on the protrusion of fat under the eyes → Consider relocation of fat under the eyes

Fat protrusion + skin sagging + wrinkles → lower eyelid consideration

You might think:

However, this is a general standard to aid understanding, and the actual surgical method may vary depending on the individual's eye condition.

So, are there cases where the upper and lower eyelids need to be done together?​

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it's possible.

This is because aging around the eyes does not only appear on one side, but sometimes appears simultaneously on the top and bottom.

for exampleThe upper eyelid is drooping,The double eyelid line is hidden,The area under the eyes is bulging

If you have wrinkles and sagging skin under your eyes,The upper and lower eyelids can be considered together depending on the area needed.

But the important thing is not “it is better to do both surgeries together.”

The first step is to determine what your actual needs are based on your current eye condition.

If there is only sagging above the eyes, the upper eyelid alone may be sufficient, 

and if the changes are mainly under the eyes, lower eyelid or under-eye fat repositioning can be considered.

If changes in both areas appear together, it is important to check each condition separately to determine the necessary surgery.

What is the difference between upper blepharoplasty and sub-brow lift?​

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If you look into the upper eyelid, you will also come across a surgery called sub-brow lift.

Both surgeries can be considered if you are concerned about sagging upper eyelids, but there are differences in the location and method of approach.

The upper eyelid is generally approached along the double eyelid line to trim saggy upper eyelid skin.

On the other hand, sub-brow lift is performed by pulling the saggy eyelids upward through the area just below the eyebrows.

Therefore, the surgical method varies depending on whether you want to maintain the existing double eyelid line, whether the sagging is a problem with the eyelid itself, or whether it needs to be checked along with the eyebrow position.You may consider it.

in other words,“Because my eyelids are saggy, I always have an upper eyelid”It may not be appropriate to simply decide that this is the case.

Take a quick look at what kind of surgery your eyes need.​

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Yes, it is possible.If you think about what you're most concerned about at the moment, it's easier to distinguish between them.

1. When it is possible to check the upper eyelid first

Eyelids droop and cover the eyes

Existing double eyelids are covered

My eyes feel heavy

Strengthen your forehead when you open your eyes

My vision feels stuffy

2. Cases where the lower eyelid can be checked first

The skin under the eyes is saggy

There are more wrinkles under the eyes

Fat under the eyes is bulging

The area under the eyes looks completely saggy

I am worried about looking tired.

3. Cases where under-eye fat repositioning can be confirmed

The fat under the eyes is bulging

The bottom looks off

Skin sagging is not severe

I am concerned about the rough edges under my eyes.

4. Cases where the upper and lower eyelids can be checked together

Aging appeared simultaneously in the upper and lower eye area.

The upper eyelids are droopy and the undereyes are also bulging or sagging.

I am concerned about the overall tired and aged appearance around my eyes.

Lastly, let me summarize briefly.

If sagging eyelids are a concern → Upper eyelid

If you are concerned about sagging skin and wrinkles under your eyes → Lower eyelid

If you are concerned about the fat protruding and sagging under the eyes and the sagging skin is not significant → Under-eye fat relocation

If you have concerns about both the area above and below your eyes → Check each condition and consider a combination method.

However, this is only a general classification method, and in reality, the skin and fat of the eyelids, muscle condition, eye opening force, eyebrow position,

You must also check the elasticity under your eyes to choose a more appropriate method.

If you are considering surgery around the eyes, it is important to first ask, “Why do my eyes look so different?” rather than deciding, “What kind of surgery should I have?”

Although the names of the upper and lower eyelids are similar, they are surgeries with different purposes and areas to approach.

It is a good idea to accurately understand your current eye condition and then decide which treatment you need.