60s Male Tearing & Periorbital Sagging: Why Endotine Endoscopic Forehead Lift, Lower Blepharoplasty, Midface Lift, and Sub-brow Lift are Needed Together_SH Plastic Surgery

60s Male Tearing & Periorbital Sagging: Why Endotine Endoscopic Forehead Lift, Lower Blepharoplasty, Midface Lift, and Sub-brow Lift are Needed Together_SH Plastic Surgery

For men in their 60s, tearing and periorbital sagging are not merely simple under-eye fat issues. The tearing, under-eye bulging, and eyelid sagging commonly seen in men in their 60s are often structural changes resulting from the combined aging of the eyes, forehead, and midface, rather than just an excess of under-eye fat. In particular, when one uses the forehead excessively to open the eyes, the outer support of the eyes weakens, and the midface sags, tearing is often a concomitant symptom. In this article, I will structurally explain, through the case of a 65-year-old male patient, why a forehead lift, sub-brow lift, lower blepharoplasty, and midface lift needed to be considered together. – Dr. Kim Sung-hoon, Facial Designer, SH Plastic Surgery

Hello.

I am Dr. Kim Sung-hoon, Facial Designer at SH Plastic Surgery.

Men in their 60s often visit us and say:

‘My forehead wrinkles are getting deeper, and even when I’m still, I look like I’m about to cry.’

These changes

often appear gradually as the eyes don’t open well, leading to unconscious use of the forehead.

Patient Case: Male, born 1960, 65 years old

• Persistent tearing from the outer corner of the left eye
• Under-eye bulging and overall periorbital sagging
• Habit of excessively using the forehead to open the eyes
• Visited due to concerns about often being told, ‘You always look tired.’

Outwardly, it might seem like a simple under-eye fat problem,

but upon examination, this patient exhibited a typical middle-to-older-aged male pattern where eye-forehead-midface aging was interconnected.

1. Cause of Tearing: ‘Not a tear duct issue, but a collapse of the outer supporting structure’

In this patient's case,

the reason for tearing only from the left eye was

not a problem with the tear duct itself,

but rather due to the weakening of the outer supporting structure of the eye

and the sagging of the lower part,

which prevented tears from draining through the normal pathway and caused them to leak out.

In this state,

if only under-eye fat is removed or repositioned,

the sagging might appear even more prominent.

In this case, the core of the problem is

‘support,’ not fat.

2. Excessive forehead use is not a ‘habit.’

This patient

had a structure where the eyelid muscles alone were insufficient to open the eyes fully,

requiring the use of the forehead muscles to open the eyes.

Outwardly,

the eyelids appear saggy,

but this is less about excess skin due to stretching

and more about weakened support causing them to descend.

In such cases, if only the eyelids are operated on,

the balance of the eye-opening force remains unresolved,

and only the external appearance changes.

As a result,

the forehead might suddenly appear sunken,

glabellar and nasal bridge wrinkles might become more prominent,

the upper eyelids might look bulging,

or left-right asymmetry might become more pronounced.

This is not because the surgery was performed incorrectly,

but because the eye problem had already originated in the structures above the eye.

3. Key Point of This Case: ‘The force to open the eyes must be distributed from above.’

The common change seen in 65-year-old men is

a shift from a structure where the eyes opened naturally → to a structure where the forehead is forced to open them.

Therefore, the key to this case is

not to make the eyes bigger,

but to restore the structure that allows the eyes to open comfortably.

The starting point for this is the Endotine endoscopic forehead lift.

Surgical Plan and Combination Explanation

① Endotine Endoscopic Forehead Lift

• Correction of excessive forehead use
• Stabilization of eyebrow position
• Reduction of burden on glabellar and forehead wrinkles
• Addressing the fundamental cause of periorbital aging

② Sub-brow Lift

• Precise removal of only sagging skin
• Most natural method for men
• Scar hidden beneath the eyebrow
• Fine-tuning of eyelid sagging when combined with forehead lift

③ Buried Suture Double Eyelid (Thin Line)

• Masculine design that is not excessive
• No unnatural feeling even after forehead lift
• Purpose of refining the impression, not to look ‘surgically altered’

④ Lower Blepharoplasty + Midface Lift

• Complements the limitations of isolated under-eye fat surgery
• Improvement of tear trough
• Strengthening of under-eye supporting structure
• Helps alleviate left-sided tearing

Dr. Kim Sung-hoon’s Surgical Reflection

Eye problems in middle-to-older-aged men

are often not explainable by a single area.

This case also showed that

tearing, under-eye bulging, eyelid sagging, and excessive forehead use were

not separate issues,

but rather interconnected as a single aging process.

In such cases, correcting only one area

can actually lead to an unnatural appearance.

I focus

on restoring the structure that allows the eyes to open comfortably,

rather than on surgeries that make the eyes bigger.

An approach that considers the overall balance of the face

ultimately leads to the most natural results.

FAQ

Q1. If there is tearing, is tear duct surgery always first?

A. Not necessarily. If structural sagging is the cause, correction alone can improve it.

Q2. Is it possible for men in their 60s to have a forehead lift without it looking excessive?

A. The endoscopic method aims for natural position restoration, so it is less burdensome.

Q3. Is the sub-brow lift scar noticeable?

A. It is designed along the natural brow line and is almost invisible in daily life.

Q4. Can’t I just have lower blepharoplasty alone?

A. If midface sagging is also present, isolated surgery can actually emphasize hollowness.

Q5. Is a male double eyelid always necessary?

A. It is best to proceed with a thin line as an auxiliary concept when there is a functional need.

Q6. Will my impression change a lot after surgery?

A. The goal is not to look ‘younger’ but to look ‘less tired.’

Q7. Is it okay to have multiple surgeries simultaneously?

A. Surgeries that belong to the same aging process are advantageous to perform together in terms of recovery and results.

At SH Plastic Surgery,

we design surgeries by considering the interconnected structure and function of the entire face,

not just focusing on one area.

As in this case,

if the goal is to look ‘natural, masculine, and less tired,’

an approach that corrects the overall coordinates is most effective, rather than partial correction.

Sub-brow Lift & Forehead Lift Case Introduction! You can change too~

SH Plastic Surgery Clinic