#26 Why Double Eyelid Revision Wasn't the Answer: A Case of Endotine Endoscopic Forehead Lift in a 50s Patient

If your double eyelid line repeatedly collapses and your eyes look heavy, the cause might be forehead and upper facial sagging, not just the eyelids. This content explains, with anatomical evidence and research-based insights, why a ‘forehead lift first’ decision was made after a double eyelid revision consultation, using a real case of a 50s female patient. It presents an approach to simultaneously improve the brow, forehead, and upper facial structure through an Endotine endoscopic forehead lift, clearly addressing re-sagging after a sub-brow lift, the limitations of double eyelid revision, and the precise indications for a forehead lift. Face Designer, Dr. Sung-Hoon Kim, SH Plastic Surgery Clinic

‘I had a double eyelid consultation, and they told me, ‘It's not a double eyelid problem, it's a forehead problem.’’

These were the words of a 54-year-old female patient when she first visited our clinic.

While consulting for double eyelid revision at another hospital,

she was told that the fundamental cause of her eyelid sagging was in her forehead and upper face.

She then sought out a specialized forehead lift clinic and visited SH Plastic Surgery Clinic.

Before and After Comparison Photos

CASE _ Why wasn't double eyelid revision prioritized?

<Before Surgery>

Limitations of Sub-Brow Lift – Skin was reduced, but the weight remained

A sub-brow lift is primarily a skin excision surgery.

While it may make the eyelids appear lighter in the short term,

over time, the weight of the forehead muscles and upper soft tissues again pulls downwards.

Especially in cases observed for over 5 years,

gravitational sagging of the forehead–upper cheek often re-covers the eyelids,

causing the double eyelid line to blur.

▶ Related ResearchKnize DM. Limited incision forehead lift. Plast Reconstr Surg.→ Explains that the primary cause of upper facial sagging is the descent of muscles and soft tissues, not just skin.

Risks of Double Eyelid Revision Surgery

If the upper face is already heavy,

re-lifting the double eyelid line can lead to the following problems:

The line appears thick

The impression becomes strong and unnatural

Potential for re-sagging over time, leading to further revision surgeries

In other words, it becomes a superficial surgery that doesn't address the root cause.

Direction of Solution: Cases where a forehead lift is needed first

<After Surgery>

By lifting the upper facial structure first with a forehead lift,

Reduced eyelid weight

Expanded field of vision

Brighter impression

Natural restoration and stabilization of the existing double eyelid line

In this case,

forehead lifting was the primary improvement solution.

Why Endotine Endoscopic Forehead Lift?

The Endotine endoscopic forehead lift is a method that reduces the possibility of re-sagging through:

Full dissection of the temporal–forehead area

Severing of the retaining ligaments that pull the eyebrows down

Stable position maintenance with Endotine fixation devices

▶ Research BasisNahai F et al. Endoscopic brow lift with Endotine fixation.→ Points out that fixation failure is a major cause of forehead lift failure, emphasizing the stability of Endotine fixation.

Facial Ratio Analysis – Why the forehead lift doesn't look awkward

This patient had:

A relatively long face

A relatively long philtrum

Nose length not excessively long

In other words, her facial structure would not be disrupted even if her forehead was slightly lifted.

On the contrary, lifting the forehead

improved the central balance of the eyes–philtrum–nose.

Reflections by Face Designer, Dr. Sung-Hoon Kim

‘When the double eyelid line keeps collapsing,

the problem is often the forehead, not the eyes.

A forehead lift is not a surgery to make the eyes bigger,

but a surgery to prevent the eyes from being covered.

For patients like this case,

who need structural improvement before double eyelid revision,

an Endotine endoscopic forehead lift

can be the most natural and long-lasting choice.’

FAQ

Q1. Do I necessarily need to redo my double eyelids if I get a forehead lift?

→ No. Often, the existing line revives once the structure is lifted.

Q2. Is a forehead lift possible even if I've had a sub-brow lift?

→ Yes, it's possible. The surgical scope and purpose are different.

Q3. Is Endotine fixation permanent?

→ It's an absorbable material that induces tissue adhesion during the fixation period.

Q4. Won't my face look shorter?

→ It is only performed after analyzing facial ratios and if the indications are appropriate.

(197) Endotine vs. Bone Tunneling Forehead Lift: What's the Difference in Fixation Methods? - YouTube

SH Plastic Surgery Clinic