Guide by Concern

Ten concerns frequently raised by patients, with explanations of their causes and the corresponding surgical approaches.

Written and medically reviewed by Dr. Jung Su Lee, Chief Director (specialist in plastic surgery, PhD) · Last reviewed September 21, 2026

The information below is general guidance and does not replace a diagnosis.

Heavy, Tired-Looking Eyes

Common Cause: Four possibilities are distinguished before any recommendation is made: lowered eyebrows, excess eyelid skin, weakness of the muscles that open the eyes, or eyebrows that appear normal because the forehead has long been compensating by lifting them.
Appropriate Surgery: An endoscopic brow lift if the eyebrows are the cause; eyelid surgery if eyelid skin is the cause; or ptosis correction if the eye-opening muscles are the cause. Two procedures are often combined, with the sequence determined by the main cause.
Unsuitable Approach: Another eyelid operation when the eyebrows are the cause. This is the most common reason patients seek consultation after previous surgery.

Endoscopic brow lift

Deepening Forehead Lines and Reduced Botox Effect

Common Cause: Forehead lines often result from eyebrow descent. The forehead muscle works all day to lift the lowered eyebrows. The muscle thickens, the lines deepen, and Botox can no longer sufficiently counter the muscle's activity.
Appropriate Surgery: Lifting the eyebrows so that compensation is no longer needed. The principle is to preserve the frontalis muscle because it raises the forehead and eyebrows.
Unsuitable Approach: More frequent Botox injections, or a lift that raises the eyebrows excessively and creates a surprised expression.

Article: Surprised-Looking Eyes

A Face That Looks Wide from the Front

Common Cause: Lateral cheekbone prominence, or the zygomatic arch, widens the face when viewed from the front. The zygomatic body projects in profile. Most patients have some of both, so these are measured rather than assumed.
Appropriate Surgery: Endoscopic zygoma reduction accesses the arch and body through a single temporal incision and two dissection planes. When anterior prominence is the main issue, L-rotation osteotomy rotates the bone inward around a preserved cortical connection.
Unsuitable Approach: Reducing bone when the actual problem is descent of the overlying soft tissue. Facial width may change little while sagging becomes more apparent.

Endoscopic zygoma reduction

Cheek Sagging After Zygoma Surgery

Common Cause: Soft tissue that has lost its underlying bony support, or the result of dissection extending beyond what reduction required. This differs from residual bone prominence; CT and examination together are needed to distinguish them.
Appropriate Surgery: The previous operation is assessed first: where the osteotomy lines run, whether the segments have united, and how much of the visible problem is sagging. Bone, soft tissue, or both are then addressed in an order guided by the findings.
Unsuitable Approach: Further bone reduction. If sagging is the cause, additional reduction removes more of the support that is already failing.

View 11 revision cases from 2013

Residual Prominence After Zygoma Surgery

Common Cause: Three problems can look alike in the mirror: bone that was not reduced, a displaced or ununited segment, and soft tissue overlying adequately reduced bone.
Appropriate Surgery: 3D CT establishes the actual segment position, and the plan addresses whichever of the three applies. Nonunion may require rigid fixation rather than further osteotomy.
Unsuitable Approach: Planning a second operation from photographs alone. Revision surgery begins, above all, with understanding the first operation.

Zygoma surgery guide

A Crooked Nose and a Visible Implant

Common Cause: An off-center pocket created during the first operation, deviation of the septum itself, or an implant that is too thick or high beneath skin that is naturally thin or has thinned after surgery.
Appropriate Surgery: Recreating the pocket in the correct position and correcting the septum if it is the cause. If the skin has become severely thinned, the implant is replaced with the patient's own tissue alone.
Unsuitable Approach: Inserting a larger implant to hide the problem. Adding material beneath thin skin brings the same problem back later.

Revision rhinoplasty

A Nose That Has Had Multiple Operations

Common Cause: It is sometimes true, but often it is not. What determines the decision is the remaining tissue and blood supply: remaining cartilage, skin thickness, scars, previously placed materials, whether inflammation has settled, the degree of contracture, and breathing.
Appropriate Surgery: After these seven points are checked, if the septal and ear cartilage have been exhausted, a plan using rib cartilage or the patient's own dermis is tailored to the remaining tissue. If the tissues have not stabilized, postponing surgery is advised.
Unsuitable Approach: Operating on unstable tissue because the patient is in a hurry. This is a route to repeating the same failure.

View the seven assessment points

An Upturned Tip After Implant Removal

Common Cause: When an implant that has stretched the tissues for years is removed, the tissues shorten and the tip rotates upward until support and length are restored. This is a common change after implant removal.
Appropriate Surgery: Surgery to lengthen a contracted nose. This is a distinct procedure requiring different graft materials, planned according to the remaining tissue.
Unsuitable Approach: Replacing the implant at its former height. The original problem returns along with the shape.

Article: Timing of Revision Rhinoplasty

Lumps at Filler or Fat Injection Sites

Common Cause: Semipermanent filler that does not dissolve with hyaluronidase, a granuloma formed around the material through an immune reaction over years, or grafted fat that has lost its blood supply and calcified. These are difficult to distinguish by touch alone, so ultrasound is used.
Appropriate Surgery: Material in the forehead, between the eyebrows, or at the temples is removed directly under endoscopic visualization through small scalp incisions. For the cheeks, another approach is added if needed. The procedure is performed under magnification because these areas contain many nerves.
Unsuitable Approach: Another dissolving injection for a material that is not hyaluronic acid, or attempting complete removal at the expense of surrounding normal fat and nerves.

Foreign material removal

A Long Forehead and High Hairline

Common Cause: This concerns forehead length and is the opposite of a problem with eyebrow position. The two are often confused because both are described as forehead concerns.
Appropriate Surgery: Forehead reduction lowers the hairline through an incision along its front edge. A series of 641 Asian patients was reported in 2021.
Unsuitable Approach: A brow lift. Because it raises the eyebrows, it may make the forehead slightly longer. The two operations are not interchangeable.

View 641 forehead reduction cases

The Common Cause

The shared issue across these ten concerns is a mismatch between the cause and the operation: eyelid surgery for a brow problem, bone reduction for sagging, a larger implant beneath thin skin, or dissolving injections for material that cannot be dissolved.

Consultation begins by distinguishing the causes. Examination and 3D CT, with ultrasound when tissue layers are intermingled, are used to identify which of the ten applies. If it is better not to have surgery now, that is explained first.

Consultation information