50s Eyelid Sagging, Multiple Creases, Tired Eyes Solution: Actual Surgical Case Corrected with Ptosis Correction + Fat Grafting

50s Eyelid Sagging: It wasn't just simple skin excision.

An actual case corrected with ptosis correction + upper eyelid fat grafting.

A 50-year-old woman recently visited our clinic complaining that her eyes were sagging, and it was difficult and tiring to open them.

She had undergone double eyelid surgery 20 years ago, and specifically, her left eye repeatedly developed multiple double eyelid creases, leading to asymmetry. She also mentioned that she had developed a habit of using her forehead and eyebrows excessively when opening her eyes.

Upon examination, it wasn't just 'sagging'.

The examination revealed the following:

• Bilateral ptosis (weakness of the eye-opening muscles)
• Deeply sunken eyelids due to reduced upper eyelid fat
• Severe asymmetry, with the left side being more deeply sunken
• Noticeable excessive sagging of the inner (nasal side) skin of the eyes
• Weak eye-opening strength and severe hollowness, giving a perpetually tired impression

Many patients believe that ‘the outer eyelids sag with age’, but this patient showed a relatively rare pattern where the medial skin sagging was more prominent.

Patient's request: ‘Can't it be solved with a sub-brow lift like my friend's?’

The patient wanted to resolve her issues with a sub-brow incision (sub-brow lift), recommended by an acquaintance.

However, in this case, simply excising the sagging skin would make it difficult to fundamentally correct:

• Ptosis
• Sunken eyelids
• Multiple double eyelid creases
• Asymmetry

In other words, addressing the root cause of the problem leads to natural and long-lasting results.

✔️ Chosen surgery: Ptosis correction + upper eyelid fat grafting

The following method was most suitable for the patient:

1) Ptosis correction (Blepharoplasty)

Corrects weakened eye-opening muscles to improve basic eye-opening strength.

2) Upper eyelid fat grafting

A small amount of fat is harvested from the abdomen and grafted into the deeply sunken areas.

This process helps to:

• Prevent the formation of multiple double eyelid creases
• Improve the tired impression caused by hollowness
• Alleviate asymmetry

3) Excision of excess skin

As it was a revision surgery, it was performed with greater care.

During the surgery, we focused on achieving maximum symmetry and maintaining a natural double eyelid line.

Fortunately, after thorough consultation and building trust with the patient, the surgery proceeded smoothly.

Immediately after the surgery, we observed significant improvements in eye-opening strength and line stability.

‘I thought it would just be a simple surgery…’

Cases like this are often challenging from a medical perspective.

The patient came expecting ‘simple sagging resolution’,

but the true cause was muscle dysfunction → fat loss → structural changes.

For eyes, the ‘visible symptoms’ and the ‘actual cause’ often differ,

making accurate diagnosis paramount.

Thanks to the patient's trust,

we were able to create a more natural and less fatigued eye appearance.

In summary, a ‘sub-brow incision’ is not sufficient in these cases:

• Multiple double eyelid creases
• Weak eye-opening strength
• Sunken eyelids
• Severe asymmetry

➡️ In such cases, ptosis correction and fat grafting combined are necessary to achieve the most natural and satisfactory results.

Frequently Asked Questions

Can 50s eyelid sagging be resolved with simple skin excision?

No, simple skin excision alone is often not enough. Especially when the eye-opening muscles are weak or upper eyelid fat is reduced, addressing the fundamental cause is necessary to achieve natural results.

What surgeries correct ptosis and upper eyelid hollowness?

Ptosis correction (blepharoplasty) and upper eyelid fat grafting are performed together. Weakened eye-opening muscles are corrected, and fat is grafted into the sunken areas for improvement.

Where is the fat harvested from for upper eyelid fat grafting?

For upper eyelid fat grafting, a small amount of fat is harvested from the abdomen. The harvested fat undergoes a purification process before being grafted into the sunken eyelid area.

What effects can be expected from ptosis correction and fat grafting?

Effects such as preventing the formation of multiple double eyelid creases, improving a tired impression due to hollowness, and alleviating asymmetry can be expected. Eye-opening strength and line stability can be significantly improved.

When is a sub-brow incision (sub-brow lift) alone not sufficient?

When there are multiple double eyelid creases, weak eye-opening strength, sunken eyelids, or severe asymmetry, a sub-brow incision alone is not sufficient for a fundamental solution. In such cases, ptosis correction and fat grafting are necessary.