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2025.07.18

【By Age】Has Your Double Eyelid Narrowed? How to Treat Upper Eyelid Sagging?

夏目 隆太郎
Supervising Physician
Ryutaro Natsume

A dual-specialty doctor with a background in plastic surgery, bridging cosmetic surgery and ophthalmology. At the university hospital, he performed numerous high-difficulty cases, primarily focusing on eye and facial bone surgeries, cultivating precise techniques grounded in anatomy. He prioritizes achieving both aesthetic beauty and functional safety, offering customized treatments around the eyes that incorporate ophthalmological expertise. He actively utilizes not only incisional surgery but also non-invasive procedures like hyaluronic acid injections. By carefully assessing each individual's condition and unique appeal, he provides bespoke treatments that guide patients toward naturally harmonious, well-defined eyes.

Hello, I'm Ryutaro Natsume, a plastic surgeon specializing in impression design.

”My eyes have started developing double eyelids,” ”I've always had monolids, but I've become concerned about the skin covering them.”

Many people start experiencing this around age 30.

That”Upper eyelid skin laxity” is the causeis.

I don't necessarily want a big change, but I want to make my eye area look more refreshed. For those of you feeling this way, I'll explain it clearly!

 

”Upper eyelid skin laxity” is,Fold it in or cut it out There are only two possible solutions (for simplicity, we assume there is no ptosis).

 

The upper eyelid,Thinner toward the lash line, thicker toward the brow boneIt will become.

 

So originally

Single eyelid or deep-set double eyelid → Buried suture methodto create a fold

Double eyelid surgery → Brow liftand cut away the thick skin

This can eliminate sagging.

 

However, the buried method alone may be insufficient in some cases.

In cases where the sagging is severe and a large amount of skin is required for the fold, the crease will form on the thicker, brow-side portion of the eyelid.

Folding the eyelid inward makes it thicker, which can give the eyelid a puffy appearance, cause ham-like eyes, or make the double eyelid fold less stable.

(※For an explanation of ham eyes, click here) https://biancaclinic.jp/blog/42944/  )

 

In that case, the excess skin is buried with moderate folding, and the remaining sagging is excised via a brow lift incision.

 

Depending on the condition of the eyelid, a full incision may be more appropriate than a buried suture. Please read this for more information.

( https://biancaclinic.jp/blog/42926/ ) 

 

Q: For the buried suture method plus brow lift, which procedure is done first? Can they be performed together?

Conclusion: It depends on the patient's wishes.

If you're okay with just a moderate double eyelid width and don't have strong preferences → Simultaneous surgery

If you have specific preferences regarding double eyelid width → Brow lift surgery first, buried suture procedure 1-2 months later

That's because,Brow lift surgery is ideal for reducing the appearance of sagging, but it is not suitable for fine-tuning the width of double eyelids.So.

Therefore, let's first remove some of the sagging with a brow lift, then adjust the ideal width with suture-based eyelid surgery.

 

Q: What are the general guidelines by age?

Late 20s to early 30s: Double eyelid suture procedure

Late 30s to early 40s: Buried suture method if originally single-lidded; brow lift if satisfied with original double-lid shape.

Late 40s-: Combined buried suture and lower brow incision

 

Q: Does it have any other effects?

Easier to open your eyes

Even without BotoxReduce forehead wrinkles

Relief from headaches and stiff shouldersYou can also expect

 

Finally, we present an actual case for your review!

・Buried only

(Top: Preoperative, Bottom: 3 months postoperatively)

・Brow lift only 

Learn more about brow lift surgery here https://biancaclinic.jp/blog/42704/ )

・Buried + Brow Lift

(Top: Pre-surgery, Middle: 1 month after buried suture procedure, Bottom: 1 month after brow lift)

 

【Summary】

This time, we explained upper eyelid lift procedures.

With buried suture techniques or brow lift surgery, you can achieve natural-looking improvements with relatively minimal downtime.

If you are experiencing difficulties, we can assess your suitability during counseling. Please feel free to consult with us.

 

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※There are various approaches to aesthetic medicine, and opinions and practices may differ among physicians. Please consider the information provided here as one reference only, and we hope you will choose medical care that suits you and meets your expectations.

We apologize if any unintended inaccuracies or misleading expressions were included. In such cases, we will make appropriate corrections or additions.

 

【Profile】

Plastic Surgeon Dr. Ryutaro Natsume

https://biancaclinic.jp/doctor/natsume/

Performed numerous facial surgeries, particularly focusing on the eye area and facial bones, in the field of plastic surgery.

Regarding treatments for the eye area, I believe that not only aesthetic appearance but also ophthalmic functionality is extremely important. To provide safer and more reliable treatments, I am currently deepening my expertise as an ophthalmologist.

We actively incorporate non-surgical procedures such as hyaluronic acid injections, in addition to treatments requiring surgical instruments.

From a multifaceted professional perspective encompassing cosmetic surgery, cosmetic dermatology, reconstructive surgery, and ophthalmology

BIANCA CLINIC, a leading Japanese clinic specializing in beauty and regenerative medicine, provides the latest aesthetic treatments.

【Career】

2020: Graduated from Tokyo Medical University Tokyo Metropolitan Saiseikai Central Hospital

2022 Jikei University Hospital Department of Plastic Surgery

2023 Department of Plastic Surgery Jikei University School of Medicine Kashiwa Hospital

2024 BIANCA CLINIC

【Professional Affiliations/Qualifications】

Japanese Society of Aesthetic Surgery (JSAS)

Full Member of the Japan Society of Plastic and Reconstructive Surgery

Full Member of the Japanese Society of Craniofacial Surgery

Full Member of the Japanese Ophthalmological Society

【SNS】

Instagram account 

 https://www.instagram.com/dr.natsume?igsh=OHBvd3VtajV1bmY1&utm_source=qr

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