Drooping eyes: double-eyelid surgery or a forehead lift? It depends on the cause.
Many people consider double-eyelid surgery because their eyes look small or sleepy.
However, not all drooping-looking eyes have the same cause.
The appropriate surgery may differ depending on whether the eyelids themselves droop or the eyes look droopy because the eyebrows and forehead have descended.
If double-eyelid surgery or ptosis correction is performed without identifying the cause, the eyes may become larger while still looking hooded.
Conversely, a forehead lift alone may not adequately improve drooping of the eyelids themselves.
It is therefore important to diagnose the cause of drooping accurately first.
[ Before and after endoscopic forehead lift surgery ]
Q. What are the main causes of eyes looking droopy?
The causes can be broadly divided into three groups.
1. Drooping of the eyelid itself (ptosis)
This occurs when the muscle that lifts the upper eyelid (the levator palpebrae superioris, or levator) functions less effectively, allowing the eyelid to cover the pupil. People often unconsciously use their forehead muscles to open their eyes, which may also cause readily visible forehead wrinkles or a raised eyebrow position.
2. Drooping of the eyebrows and forehead (brow ptosis)
As aging causes the forehead skin and tissues around the eyebrows to descend, the eyes can look droopy. Even without a significant problem in the eyelids themselves, eyebrows descending closer to the eyes can create a hooded appearance and make a person look more tired or sleepy than they are.
3. Sagging upper eyelid skin (dermatochalasis)
Loose eyelid skin and fat can fold over the upper eyelid area. Muscle function is often normal, but excess skin can make the eyelid crease look smaller or obstruct vision.
In practice, two or more causes often occur together rather than just one, so an accurate examination to identify the main cause is important.
Q. When can double-eyelid surgery or ptosis correction help?
Double-eyelid surgery or ptosis correction is mainly considered for problems affecting the eyelids themselves.
- Drooping caused by reduced levator function (ptosis)
- Loose eyelid skin covering the eyes (dermatochalasis)
- An existing eyelid crease that has loosened or become asymmetric
In these situations, direct correction of the eyelids is central to treatment.
However, if the eyebrows themselves have descended considerably, double-eyelid surgery alone may not sufficiently improve the hooded appearance.
It is therefore important to assess the position of the eyebrows and forehead as well.
[ Before and after incisional double-eyelid surgery, ptosis correction, lateral canthoplasty, and lower lateral canthoplasty ]
Q. When is a forehead lift considered?
A forehead lift is considered when drooping of the eyebrows and forehead, rather than the eyelids, is the main cause.
- The eyebrows have descended close to the eyes
- Many forehead wrinkles appear when opening the eyes
- The eyes open much more comfortably when the eyebrows are gently raised by hand
- Double-eyelid surgery alone is unlikely to sufficiently improve the hooded appearance
A forehead lift repositions the drooping forehead and eyebrows upward to improve skin hooding over the eyes. It does not directly remove or correct eyelid tissue, so double-eyelid surgery or ptosis correction may also be considered when eyelid sagging or ptosis is present.
Q. How is the appropriate procedure determined?
During consultation, we assess several factors together rather than looking only at the eyes.
- Eyebrow position and the distance between the eyes and eyebrows
- Patterns of forehead muscle use and the degree of forehead wrinkling
- The degree of eyelid drooping with the forehead relaxed
- Levator function (the range of eyelid movement)
- The degree of excess eyelid skin
These findings are considered together to determine whether brow ptosis, eyelid ptosis, or both are responsible and to plan surgery accordingly.
Q. Is there a simple way to check at home?
Different causes have different features, so the following checklist may help you see which pattern is more relevant to you.
However, this checklist is for reference only. An accurate diagnosis requires assessment by a specialist.
Features that may suggest drooping of the eyebrows and forehead (brow ptosis)
- Your eyes open much more comfortably when you gently lift your eyebrows by hand
- You use considerable forehead effort to open your eyes, and forehead wrinkles appear easily
- Your eyebrows always look raised in photographs
Features that may suggest an eyelid problem (ptosis or dermatochalasis)
- You feel that your eyelids cover your pupils
- Your eyelid creases look smaller or less defined than before
- People often tell you that you look tired or sleepy
If only one list applies, the cause may be relatively clear.
If features from both lists apply, both causes may be present, making clinical assessment particularly important.
UVOM Plastic Surgery's approach
1. Diagnosis that first distinguishes the cause
Rather than selecting a procedure first, we assess eyebrow position, the degree of eyelid drooping, and patterns of forehead muscle use to identify why the eyes look droopy.
2. Surgery limited to what is needed
If eyelid drooping is the main cause, we consider double-eyelid surgery or ptosis correction. If eyebrow and forehead drooping are the main cause, we consider a forehead lift.
When both causes are present, the decision to combine procedures is made after a thorough consultation based on the individual condition.
3. An approach that considers the balance of the whole face
We aim to plan surgery for a natural appearance by considering the balance between the forehead, eyebrows, and eyelids, rather than correcting the eyelids or lifting the eyebrows in isolation.
Frequently asked questions
Q. For drooping eyes, is a forehead lift or upper eyelid (double-eyelid) surgery better?
A. Neither is universally better. The choice depends on whether the main cause lies in the eyelids themselves or in the eyebrows and forehead.
Upper eyelid or double-eyelid surgery is considered when eyelid sagging is the main cause, and a forehead lift when eyebrow and forehead sagging are the main cause. Combined treatment may be considered if both are present.
Q. What happens if double-eyelid surgery is performed without distinguishing brow ptosis from eyelid ptosis?
A. If brow ptosis is the main cause, double-eyelid surgery alone may not provide enough space between the eyes and eyebrows, leaving a hooded appearance.
Accurately identifying the cause first is therefore important.
Q. If lifting my eyebrows by hand makes my eyes feel more comfortable, do I need a forehead lift?
A. If raising the eyebrows makes opening the eyes easier, brow drooping may be contributing.
However, this alone does not establish a need for a forehead lift. Eyelid ptosis and excess eyelid skin must also be assessed before deciding on surgery.
Q. Can a forehead lift alone improve the appearance of my eyelid creases?
A. A forehead lift improves eyebrow position.
In some cases, the eyelid creases may look more defined afterward. However, it does not directly correct eyelid sagging or crease problems, so a separate correction may be needed.
Q. Can both procedures be performed together?
A. When eyebrow and forehead drooping coexist with eyelid drooping, both procedures may be planned together depending on the condition.
The decision takes into account the individual's eye shape, facial structure, and overall health.
The cause of drooping-looking eyes varies from person to person. Establishing whether the problem lies in the eyelids themselves or in the descent of the eyebrows and forehead is the first step in choosing an appropriate procedure.
For questions, call 02-545-3700 or contact UVOM Plastic Surgery on KakaoTalk,
or visit for a consultation and an accurate assessment of your eyes.