Double Eyelid Surgery Overview, Part 3 (Ptosis Correction Methods, Cases by Type, and More)

Double eyelid surgery is the most commonly performed cosmetic surgery, yet it is a very demanding procedure,

and there is no doubt that a good result is not easy to achieve.

The reasons are:

First, the eyelid is not a fixed structure but a dynamic one.

Second, there are two eyes, one on each side, and they must be symmetrical.

Third, the tissues around the eyes are connected to one another, so age-related 

changes affect one another, and unexpected results can occur. 

This is not for ptosis in which the eyes open poorly because the levator muscle is weak from a clear myogenic or neurogenic lesion;

rather, when the eyes look slightly small, it tightens the levator muscle to make it taut,

so that the eyes can open wider.

Performed together with double eyelid surgery, it has the effect of making the eyes look larger and giving them an open look.

Ptosis correction also has incisional and non-incisional methods.

When Non-Incisional Ptosis Correction Is Used

- The eyelid skin is thin

- There is a fair amount of eye-opening strength

When Incisional Ptosis Correction Is Used

- The eyelid skin is thick

- Eye-opening strength is insufficient

The levator aponeurosis, which opens the eye, is either dissected, advanced, and fixed to the tarsal plate as in figure (A),

or folded and tied as in figure (B),  so that the levator muscle lifts well.

*Eyes That Need Ptosis Correction*

The left eye is within the normal range, but the right eye, marked with a yellow circle,

appears to open slightly less by comparison.

In such a case, tightening the levator muscle just slightly improves the eye-opening strength

and the eye opens wider, so the degree of eye opening can be made symmetrical.

This patient, looking at both eyes, wished them to be a little larger (upward).

Ptosis correction was therefore performed.

Case 1) Ptosis Correction Without a Crease

The patient did not want a visible crease, so only ptosis correction was performed, leaving the eyes without a crease.

This shows that ptosis correction allows the eyes to open larger and more clearly.

Case 2) Double Eyelid + Epicanthoplasty + Ptosis Correction

By performing epicanthoplasty, double eyelid surgery, and ptosis correction together, the eyes were lengthened and their vertical opening was also increased.

This shows that performing double eyelid surgery and ptosis correction together can produce large, open-looking eyes like these.

Case 3) Double Eyelid (Incisional) + Ptosis Correction

In this case, double eyelid surgery and ptosis correction were performed together; after surgery,

the eyes have an open look and can also open wide.

As it has been only about a month since surgery, some swelling remains,

but you can see that the crease also extends smoothly and naturally.

A woman in her 20s; despite her young age, the eyelid skin sags and covers the frame of the eye.

In such a case, the eyelid skin should be lifted slightly to check whether, beneath that skin, the frame of the eye sits higher

or stays at the covered boundary line.

In this patient, the frame of the eye sat higher and was merely covered by the eyelid skin,

so ptosis correction was not needed; only skin excision and double eyelid surgery were performed, and you can see that the eyes now look open.

Because sagging skin was covering the eyes, skin excision and double eyelid surgery alone were enough to create large,

well-defined, open-looking eyes.