If you are considering double eyelid surgery, you may wonder, ‘Is double eyelid surgery alone enough, or should I have ptosis correction as well?’ Double eyelid surgery creates a crease line, while ptosis correction deals with eye-opening strength. Because the two surgeries do different jobs, not every double eyelid surgery needs ptosis correction. This post explains, step by step, what combining them can offer, which eyes it is considered for, and when the two are considered separately.
What do double eyelid surgery and ptosis correction each address?
A common thought
A double eyelid seems like enough — do I need ptosis correction too?
The two names may sound similar, but the surgeries deal with different things. Double eyelid surgery creates the line where the eyelid folds when the eye is open. Ptosis correction adjusts the function that lifts the eyelid, so that how much of the iris shows when the eye is open is set appropriately.
That does not mean the two are completely separate. The 1mm Plastic Surgery non-incisional double eyelid page explains that before the line is designed, the eye’s shape and skin thickness are analysed together with eye-opening strength. It also explains that the number of knot points is planned differently depending on eye-opening strength.
If eye-opening strength is weak, how might a double eyelid crease alone look?
When eye-opening strength is weak — in other words, when there is ptosis — the eyelid comes down over the top of the iris when the eye is open. If only a double eyelid line is created and ptosis correction is not done, the double eyelid may look as if it has loosened, or the eye may still look sleepy. This is because double eyelid surgery creates the line, while the function that lifts the eyelid is what ptosis correction deals with.
That is why, in a double eyelid consultation, we first check how much of the iris shows when you open your eyes comfortably with your brows and forehead relaxed, before choosing a line shape. If eye-opening strength is judged to be insufficient, ptosis correction is considered together.
What are the benefits of combining the two surgeries?
For eyes with insufficient eye-opening strength, planning the two surgeries together can offer the following.
- The line and iris exposure designed at once — The height of the line and how much of the iris shows can be matched within the same design. Rather than creating the line alone, the plan also aims for the iris to show to an appropriate degree.
- Non-incisional: the same knots do both — In non-incisional ptosis correction, tiny openings are made along the designed line, and knots reinforce eye-opening strength while setting the double eyelid crease.
- Incisional: both through the same incision line — In incisional ptosis correction, an incision is made along the designed line, and the eye-opening muscle is pulled and tied to adjust its length. Fat can also be addressed in the same process.
Each method has its advantages and points to consider. Which one suits you depends on the degree of ptosis and the thickness and amount of fat in the eyelid.
| Item | Combined, non-incisional | Combined, incisional |
|---|---|---|
| Method | Tiny openings and knots reinforce eye-opening strength and set the line | After an incision, the length of the eye-opening muscle is adjusted and the line is fixed |
| Eyes it mainly suits | Ptosis that is not severe; a thin eyelid with little fat | Severe ptosis, or thick skin with more fat |
| Advantages | Because the skin is not cut along a long line, scarring tends to be less of a concern | Can be applied to most cases, and fat can be addressed at the same time |
| Points to consider | Fat removal is hardly possible, and it may not suit severe ptosis | Fine scarring may occur |
The table summarises general criteria and is not a fixed formula. The exact surgical method is decided after an examination and consultation.
Which eyes may be considered for combined surgery?
If you want a double eyelid line and also notice the following, ptosis correction can be considered together during your consultation.
- Little of the iris shows when you open your eyes comfortably — The eyelid covers the top of the iris and may give a sleepy look.
- You open your eyes with your forehead and brows — Your forehead tenses or you raise your brows when you open your eyes.
- Your eyes do not open easily and feel uncomfortable — Opening your eyes may feel uncomfortable.
- Your eyelids look thick and heavy — Thick skin and more fat may make the eyes look heavy.
Which of these you have may also change the method. The 1mm Plastic Surgery ptosis correction guide describes eyes with mild ptosis and thin eyelids with little fat as candidates for the non-incisional method, and eyes with severe ptosis, thick skin with more fat, or weak opening strength that makes you use your forehead a lot as candidates for the incisional method.
The list above only shows what is checked together in a consultation; having one of these does not mean ptosis correction is necessary. Whether ptosis correction is needed is judged through an examination.
Do the two surgeries always have to be done together? When they are considered separately
Not necessarily. Ptosis correction is not a surgery that always comes with double eyelid surgery; it is considered when eye-opening strength is insufficient. In the following cases, a different direction may be discussed in the consultation.
- When eye-opening strength is sufficient — Double eyelid surgery alone is considered. If the eye already has enough opening strength and is corrected more than needed, the eyes may feel as if they open too wide.
- When you already have a double eyelid line — If eye-opening strength is still insufficient after double eyelid surgery, ptosis correction alone can be considered without touching the existing line.
- When sagging skin is the bigger cause — If loose skin covering the lashes is the bigger cause, upper blepharoplasty or a sub-brow lift may be considered.
Which eyes need ptosis correction and which do not is covered in an earlier post, 「눈매교정, 내 눈에는 해야 할까? 하면 안 될까?」 (Ptosis correction: should my eyes have it, or not? — Korean), and how to tell apart the causes of a sleepy look is covered in “Sleepy Eyes or Ptosis?”
With both surgeries together, what more should you check about recovery and side effects?
Combined surgery creates a line and deals with the function of opening the eye at the same time. So both the recovery of the crease line and the degree of ptosis correction need to be checked. Whether non-incisional or incisional, it is surgery, so there is a recovery process and side effects may occur. The recovery period differs depending on the surgical method and the condition of your eyes, and is explained individually during the consultation.
Side effects and points to note
Common recovery reactions — Swelling, bruising and a difference between the two sides may occur. The course of recovery differs from person to person and is checked through a consultation.
Eye discomfort — You may feel a gritty or tight sensation, a foreign-body sensation or dryness.
Degree of correction — If the eye is corrected more than needed, the eyes may feel as if they open too wide. That is why it is important to correct within the range your current condition needs. Depending on the individual, the degree of correction and differences between the sides may not match what you expect.
Double eyelid line — If fat removal was insufficient or the fixation was not secure enough, the double eyelid may loosen in some cases.
Scarring — The incisional method may leave fine scarring.
Symptoms to report to your surgeon right away — If you have severe pain or pressure in the eye that painkillers do not control, an eye that does not close fully, a scar that becomes red and hard, a small lump you can feel, or recurring inflammation, seek care right away.
Ptosis correction with double eyelid surgery: frequently asked questions
Can double eyelid surgery and ptosis correction be done at different times?
You can have them separately. If eye-opening strength is still insufficient after double eyelid surgery, ptosis correction can be considered without touching the existing line. However, if there is ptosis and only the line is created first, the eyelid may look loosened or sleepy, so it is a good idea to check eye-opening strength at the first consultation.
Can combined surgery be done with the non-incisional method?
Non-incisional ptosis correction uses tiny openings and knots to reinforce eye-opening strength while setting the double eyelid line at the same time. However, it is a method suited to cases where ptosis is not severe and the eyelid is thin with little fat, so if the eyelid is thick or the ptosis is severe, the incisional method is considered.
How can I tell whether my eyes also need ptosis correction?
We look at how much of the iris shows when you open your eyes comfortably. The 1mm Plastic Surgery ptosis correction guide explains that about 80% of the iris showing is regarded as the normal range, and less than that can give a sleepy look. This number is only one reference point, however, and the actual judgment is made through a consultation.
Can the double eyelid loosen after combined surgery?
It can. If fat removal was insufficient or the fixation was not secure enough, the double eyelid may loosen in some cases. Also, if eye-opening strength remains insufficient, the line may look loosened. If you feel the line has changed, see the clinic where you had surgery to find out the cause.
What happens in a consultation
Before choosing a line,
we check eye-opening strength first
- Checking how much of the iris shows when you open your eyes comfortably
- Checking eyelid skin thickness, fat and sagging
- Checking the line you want and differences between the sides
- Explaining whether to combine, the method and side effects
We check the structure of your eyes together with the function of opening them, and discuss whether to add ptosis correction and which method suits you. Results and the course of recovery may differ from person to person. Surgical methods are also described in the 1mm Plastic Surgery ptosis correction guide.
Consultation and booking
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This post was written by the founder of a medical institution to provide medical information. The eye images in this post are concept illustrations and diagrams made to aid understanding; they do not show real people and are not before-and-after images. The interior image is from the ‘Clinic tour’ on our website and may differ from the actual premises. For any surgery, its suitability for you, the result and the course of recovery may differ depending on your eye condition, and side effects may occur. Please confirm the details through a consultation.
