Clarifying Upper Eyelid Surgery Terms: Double Eyelid Surgery, Upper Blepharoplasty, and Ptosis Correction

Double eyelid surgery? Upper blepharoplasty? Ptosis correction?

These are all familiar concepts, yet it's often hard to pinpoint and explain the exact differences.

Does this sound familiar?

This article clarifies terms related to eye surgery that you have probably heard of, but still find confusing.

Double Eyelid Surgery vs. Upper Blepharoplasty vs. Upper Eye Lift

What is Double Eyelid Surgery?

Double eyelid surgery creates a double eyelid fold on the upper eyelid.

It can be performed using either the incision method, which involves cutting the skin, or the non-incision method, which does not require cutting. The non-incision method is also colloquially referred to as ‘stitching’.

The choice of surgical method depends on the individual's natural conditions... Typically, factors like the degree of eye protrusion, eyelid opening strength, skin thickness, and excess skin are considered to determine the most suitable approach.

One common question many people ask is

‘Can my eyes be done with the buried suture method?’

A self-check method for double eyelids involves using a double eyelid stick to create a line. If the line remains visible for 3-5 seconds or longer after removing the stick, it indicates the eyes are suitable for the buried suture method.

What is Upper Blepharoplasty

Upper eyelid surgery typically refers to procedures performed on individuals in their 40s and older that address sagging skin while creating double eyelids.

Since sagging skin must be removed, the incision method is commonly used. However, depending on the case, sagging skin may be improved through infra brow lift or forehead lift, and non-incisional upper eyelid surgery may be used to create double eyelids.

For younger individuals in their 20s and 30s, it's occasionally double eyelids with minimal skin removal.

After the age of 40, however, more skin excision is needed and the procedure is known as upper blepharoplasty.

While this distinction is sometimes made as above,

In reality, the amount of skin removed varies depending on the individual's needs and circumstances; it's not determined uniformly by age. 

Therefore, it is meaningless to distinguish between double eyelid surgery and upper blepharoplasty.

Unlike Asians, Westerners have a natural double eyelid crease, so removing sagging skin is enough to create the crease. However, in Asian eyelid surgery, 'double eyelid fixation suturing' must be performed during the procedure, regardless of age or existing double eyelid.

Therefore, the distinction between double eyelid surgery and upper blepharoplasty is largely insignificant.

As demonstrated in the video below, when a Western surgeon who is unfamiliar with Asian eyes, they will often simply remove skin without performing fixation sutures.

🔗Incorrect example of not fixing the double eyelid on an Asian eye

This is how Westerners perceive upper blepharoplasty. As demonstrated in the above video, without double eyelid fixation, it is difficult to ensure that the desired height of the double eyelid line is achieved.

What about Upper Eye Lift

Broadly speaking, an upper eyelid lift refers to the various methods used to treat skin laxity in the upper eyelid area. These include upper blepharoplasty, subbrow lift, suprabrow lift and endoscopic brow lift.
In a more specific sense, an upper eyelid lift may refer solely to an upper blepharoplasty procedure.
The slight differences in meaning between these terms stem from the coexistence of precise academic terminology and terms used by the general public.

Eyelid Correction vs. Ptosis Surgery

When the dark pupil is covered by more than 15%, the eyes look sleepy. This is known as 'cosmetic ptosis' (in ophthalmology, ptosis typically refers to cases where more than 50% of the pupil is covered, which usually qualifies for insurance coverage).

The treatment for ptosis is called eyelid correction or ptosis surgery. I emphasise the cosmetic aspect because we commonly find eyes attractive when 90–95% of the iris is visible.

Doesn't getting Double Eyelids make your eyes look bigger?

Many people think this way. However, experienced eyelid surgeons answer this question by saying, “It varies from person to person.”

1) Cases where eyes appear larger with double eyelid surgery alone

In some cases, the iris appears larger as a result of double eyelid surgery alone. This occurs when there is sufficient muscle strength to open the eyes and expose over 90% of the iris, but the skin still covers the eyelashes and obscures the iris.

This type of eye is known as pseudoptosis. Correcting the eye shape isn't necessarily needed.

However, in reality, cases where the actual eyelid-opening strength is insufficient are more common in Asians.

2) Cases where eye size doesn't increase after double eyelid surgery

The above case shows the result seven weeks after undergoing buried suture double eyelid surgery only.

Although the eyelid has folded, the pupil does not appear any larger. This is because the strength of the muscle that opens the eyelid is diminished. 

How is Ptosis correction performed?

So, what exactly is this 'eye-opening strength' that was mentioned earlier? It refers to the ability of the muscle or tendon that lifts the eyelid (known as the levator aponeurosis) to open the eye.

The muscle that opens the eyelid attaches to the eyelid plate(tarsus). When you try to open your eyes, this muscle contracts and lifts the eyelid. 

However, just as some people can easily lift a 10 kg barbell while others struggle, the strength of this muscle varies from person to person. This muscle cannot be strengthened through training and its function tends to decline with age. This is why eyelid lift surgery becomes more common in middle age.

Fortunately, eyelid correction is performed in the same area as double eyelid surgery, meaning no additional incisions are required.

Just as folding a stretched rubber band twice creates greater tension,

▪︎Ptosis correction involves overlapping the muscles responsible for opening the eyes, resulting in the eyes looking larger (= increased pupil exposure).

▪︎Double eyelid surgery, on the other hand, only creates a crease on the upper eyelid.

At Noonopi Plastic Surgery, our eyelid surgery is performed using a systematic approach and proven surgical techniques.
If you have any questions, please contact us via 🔗WhatsApp consultation!