#28 60s Male Eye Surgery, Reasons for Tearing_ Middle-Aged Male Complex Lifting Case

Tearing, under-eye bags, and eyelid ptosis, commonly seen in men in their 60s, often stem not from a simple under-eye fat issue but from the interconnected aging process of the forehead, upper eyelids, lower eyelids, and midface. This article uses the real case of a 65-year-old male patient to explain, from an anatomical and functional perspective, why an endotine endoscopic forehead lift, sub-brow lift, thin buried double eyelid surgery, and lower blepharoplasty + midface lift were planned together. It discusses tearing due to weakened lateral canthal support, habitual overuse of the forehead, and the cascading effect of midface descent, supported by research, to present the principles of a complex surgery aimed at achieving a ‘refreshed, masculine, and natural look’. – Dr. Sung-Hoon Kim, SH Plastic Surgery, Face Designer

Hello. I'm Sung-Hoon Kim, Face Designer at SH Plastic Surgery.

The biting wind started blowing yesterday, signaling the onset of winter with its severe cold.

At times like these, tears often stream down my face without me realizing it.

However, the problem isn't that my eyes are watering due to the cold wind;

it's that tears keep flowing

even on normal days, in daily life.

It's truly regrettable that many people don't know whether they should visit a hospital for such concerns.

CASE

‘My under-eyes are puffy, and people keep telling me I look tired. And tears keep flowing from my left eye.’

These were the first words from a male patient, born in 1960, aged 65.

Upon closer inspection, under-eye puffiness, eyelid ptosis, and compensatory eyebrow movement (using the forehead to open the eyes) were observed together.

This is a typical pattern in middle-aged and elderly individuals, where aging is interconnected across the entire eye area, not just a problem in one part of the eye.

Patient Basic Information

Age: 65

* Main Symptoms

Persistent tearing from the left eye

Coexistence of under-eye puffiness and hollowness

Overall sagging around the eyes

Habit of opening eyes with the forehead (compensatory eyebrow movement)

Cause Analysis ①

Cause of tearing: Outer sagging + weakened lateral canthal support

The biggest reason for the excessive tearing from the left eye was

weakened lateral canthal support and lower eyelid sagging.

When the lower eyelid sags, the position of the punctum (tear duct opening) can be subtly misaligned,

leading to a functional problem where tears cannot drain and overflow from the eye.

Cause Analysis ②

Reason for excessive forehead use = ample upper eyelid skin

This patient was the type who primarily used their forehead muscles to open their eyes.

This indicates significant sagging due to ample upper eyelid skin and a lowered eyebrow position.

If only upper blepharoplasty (SB) or double eyelid surgery is performed in this state, the following problems may arise:

Sudden drop of eyebrows, leading to eyebrow ptosis

Worsening of frown lines and nasal bridge wrinkles

Upper eyelid puffiness

Aggravation of left-right asymmetry

In other words, performing surgery that only removes saggy skin without addressing decades of compensatory eyebrow movement

is likely to create a harsh impression and an unnatural look that clearly shows signs of surgery.

Key to this case

The ‘power to open the eyes’ must be distributed from above.

A common aging pattern in 65-year-old men is a structure where they cannot open their eyes with their eyelids but instead use their forehead.

Therefore, the solution required both:

Correcting the position of the forehead and eyebrows

Structurally addressing sagging around the eyes

Final Surgical Plan and Rationale

1. Endotine Endoscopic Forehead Lift

Alleviates compensatory eyebrow movement -> corrects eye-opening habit

Anatomically stabilizes eyebrow position

Reduces risk of upper eyelid puffiness, frown lines, and nasal bridge wrinkles

2. Sub-brow Lift (replaces/supplements SB)

Precise excision of only saggy skin -> most natural result

Especially suitable for men

Design minimizes scar exposure

When combined with a forehead lift, allows for precise refinement of the upper face

3. Thin Buried Double Eyelid Design

Excessive double eyelids in men look unnatural

Selection of a thin, stable line that complements the forehead lift

4. Lower Blepharoplasty + Midface Lift

Simple fat repositioning has limitations

Lifts sagging midface together

Improves tear trough

Strengthens lower eyelid support

Helps alleviate tearing from the left eye

Conclusion

A typical 65-year-old case where the forehead, eyes, and midface are interconnected:

Left eye tearing

Under-eye puffiness

Eyelid ptosis

Forehead overuse

Frown lines and nasal bridge wrinkles

Because all these causes were linked by a single aging process,

a forehead lift + sub-brow lift + lower blepharoplasty + midface lift + thin double eyelid surgery

was the most harmonious approach.

Dr. Sung-Hoon Kim, Face Designer's Reflection

‘For men in their 60s, eye surgery isn't about ‘looking younger’.

The key is to look refreshed, masculine, and natural.

In cases like this, focusing on just one area often doesn't provide the answer.

By viewing the forehead, eyes, and midface as a single structure,

and designing both function and impression together, the results last longer.’

FAQ

Q1. Do men also need a forehead lift?

Yes. If there is excessive forehead use and eyelid ptosis, it can be quite effective.

Q2. Can tearing also be improved with surgery?

If the cause is structural (lower eyelid sagging), it can help with improvement.

Q3. Is double eyelid surgery mandatory for men?

It's not essential, and if needed, it's designed to be very thin.

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