When this patient first came to our clinic, her main concern was not simply looking younger. She had begun to experience actual discomfort from the aging changes around her eyes.
As her brows and the tissues around her eyes gradually descended, opening her eyes had become increasingly uncomfortable. Tears would frequently collect around the outer corners of her eyes, sometimes causing irritation of the surrounding skin.
She was also concerned about forehead and glabellar wrinkles, increasingly prominent under-eye bags and wrinkles, and deepening nasolabial folds that made her midface appear as though it was gradually descending.
After carefully evaluating how these changes were occurring together, we decided to perform an Endoscopic Brow Lift (Forehead Lift), Midface Lift, and Lower Blepharoplasty.
One of the most important decisions in this case was how to approach the heaviness around the upper eyelids.
At first glance, it could appear that the upper eyelid skin itself had simply become excessive and droopy. However, on closer examination, much of this heaviness was actually caused by descent of the eyebrows rather than true excess eyelid skin.
This distinction matters.
If we had simply removed the upper eyelid skin through an upper blepharoplasty, the distance between the eyes and eyebrows could have become even shorter. In her case, this could have resulted in a stronger or less natural expression, while still leaving some of the heaviness around the outer corners of the eyes unresolved.
Instead, through an Endoscopic Brow Lift, we repositioned the descended brows closer to their natural position.
As the brows returned to a more appropriate position, much of the apparent upper eyelid sagging improved naturally without having to remove a large amount of eyelid skin. The heaviness around the outer corners also improved, and the issue of tears repeatedly collecting in this area became much better.
At the same time, the forehead and glabellar wrinkles softened. From the side view, another subtle change can be seen: the forehead contour has become smoother and more rounded.
A well-planned brow lift is not simply about raising the eyebrows. In the right patient, it can improve the relationship between the forehead, brows, and eyes while preserving the patient's natural expression.
The lower eyelid and midface required a different approach.
Before surgery, there was a combination of loose and wrinkled lower eyelid skin, protruding under-eye fat, loss of volume over the anterior cheek, and descent of the midface. As these changes occurred together, the nasolabial folds also became more prominent and the overall face appeared more tired.
For this reason, we did not treat the under-eye area alone.
Through Lower Blepharoplasty, we addressed the loose skin and protruding fat beneath the eyes. At the same time, the Midface Lift allowed us to reposition the descended tissues of the cheek closer to their original position.
As a result, the transition from the lower eyelid to the cheek became smoother, while the anterior cheek regained a more natural sense of volume.
The nasolabial folds also became softer, and the fullness that had accumulated above them improved as the midface tissues were repositioned.
What I find particularly important about this case is that the individual changes do not compete with one another.
The brows are higher, but the eyes do not look unnaturally lifted. The under-eye area is smoother, but it does not appear hollow. The midface has been repositioned, but the patient's original facial character remains.
Rather than creating an obviously “lifted” appearance, our goal was to make the entire eye and midface area look less heavy, less tired, and naturally younger.
We also paid careful attention to the incisions.
The incisions for the Endoscopic Brow Lift are hidden within the hairline. For the Lower Blepharoplasty and Midface Lift, the incision was placed just beneath the eyelashes and carefully closed so that the scar would remain as inconspicuous as possible.
At 30 days after surgery, the incisions are already difficult to notice, although the tissues will continue to settle and soften with time.
What I remember most from her follow-up was not simply the change in the photographs, but what she told us about her daily life.
She said:
“Before surgery, my eyes always felt heavy, and having tears constantly collect around the outer corners was really uncomfortable. Now opening my eyes feels much easier, and that problem has improved a lot. I was worried that lifting surgery might make me look too different, but I still feel like myself—just less tired and younger. That’s what I’m happiest about.”
For me, this case is a good example of why rejuvenation surgery should not simply focus on removing skin or pulling tissues tighter.
The important part is identifying where the aging change actually begins and choosing the appropriate approach for each area.
In this patient, restoring the position of the brows, improving the lower eyelids, and repositioning the descended midface together allowed us to achieve a younger appearance while preserving the expression that was naturally hers.