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2025.11.14
The Difference Between Brow Lift and Upper Eyelid Skin Resection: How to Address Skin Sagging?
As a board-certified plastic surgeon, I have handled numerous cases involving trauma, reconstruction, and congenital conditions, cultivating precise techniques and deep anatomical understanding. Driven by the desire to deliver the transformative power of beauty—where visible change uplifts the spirit—I pursued a career in cosmetic surgery. My areas of expertise include comprehensive eye treatments, injectable therapies, and anti-sagging procedures. Guided by a commitment to sincerely address each patient's aspirations, I provide meticulously crafted treatments focused on achieving beauty.
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Designing natural beauty with trust.
I am Masataka Fujihashi, a board-certified plastic surgeon.
When seeking to improve upper eyelid drooping, a common approach is "Brow Lift」and「Upper Eyelid Skin Resection」です。
Both procedures remove excess skin, but the incision location, amount of skin removed, and the resulting aesthetic outcome differ significantly.
This is a very common topic in counseling and is also closely related to double eyelid surgery, so I'll organize it clearly here.
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■ Upper Eyelid Skin Resection (a method of removing skin along the double eyelid line)
Upper eyelid skin excision is, “A method for excising skin along a double line”.
The advantage is that it allows for simultaneous double eyelid creation and skin excision, as it uses the same incision line as double eyelid surgery (incision method).
However, the skin of the upper eyelid has both "thick areas" and "thin areas," which significantly affects the final result.
Specifically,The skin near the eyelashes is very thin, and it becomes thicker as it approaches the eyebrow area.。
Therefore, removing too much skin with a double incision line results in suturing "thick skin × thin skin" together, making it more likely to cause a step-like appearance or an uncomfortable feeling of the incision digging in.
For mild sagging in younger individuals, approximately 2–3 mm resectionThen it will come together nicely.
From experience,at most 4mmIt's best to keep it to a minimum.is.
Removing any more can easily look unnatural, so caution is especially needed for those who wish to maintain natural double eyelids.
The risk of lines breaking down or indentations appearing unnatural increases dramatically if the product doesn't suit your skin type.
If it is determined that the desired amount and the amount obtainable via the double incision do not match, the alternative option is a brow lift.
However,In cases where elderly patients have significant sagging and inherently have a large amount of excess skin, removing approximately 8 to 10 mm along the double eyelid line is often feasible without issue.
The reason is that the skin becomes thinner and more elastic with age, making it less prone to gaps.
In other words, depending on the quality and excess amount of skin in older individuals, larger excisions are possible even with a double eyelid line.
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■ Brow Lift (a method of removing skin beneath the eyebrows)
Brow lift surgery is a procedure that removes excess skin beneath the eyebrows.
The skin around the eyebrows is relatively uniform in thickness, making it less prone to developing unevenness.Suitable for removing large amounts of skin。
However, you can't just cut anywhere.
• Within the eyebrow area or toward the outer edge → Less noticeable scarring
• Inside the eyebrows (between the eyebrows) → Absolutely not allowed because the scar will be highly noticeable
Therefore, with a brow lift procedure,The heaviness of the skin can be improved."The outer area from the inner edge of the pupil to the outer corner of the eye, including the excess skin near the outer corner"is limited to.
Any excess skin within that range must be removed along the double crease.
Sometimes only the inner portion is partially excised, while in other cases, a double eyelid incision is performed again for adjustment about a month later.
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■ About the Fat (ROOF) Removed Through Brow Lift Surgery
For brow lift surgery ROOF (pre-diaphragmatic fat) can handle.
This can be removed with a double incision.It is distinct from "orbital fat."is.
On the contrary,Accessing orbital fat through a brow lift incision Double incision to remove up to the ROOF
This is not recommended.
Both would amount to "forcing contact with distant layers,"Risk of developing planned double eyelid lines (unexpected triple lines)is high That's why.
It is extremely important for the surgical procedure to approach the target layer from the “correct distance.”
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■ Actual Treatment Plan for Significant Sagging
Even if you come in for a second consultation, if there is significant excess skin,
① First, lower brow lift → ② After one month, buried suture or double eyelid surgery
This often becomes a two-step plan.
• Thin skin with little fat → Buried sutures are fine
• Thick eyelids (orbicularis oculi muscle and fat) → Double eyelid surgery provides more stable results
That would be the conclusion.
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■ Summary
• Skin excision within 3mm is acceptable → Upper Eyelid Skin Resection
• Want to take 4mm or more → Brow lift surgery is the standard procedure.
• Never trim hair inside the eyebrow line (scars will be noticeable)
• In cases of severe sagging Brow Lift → Double Eyelid Surgery The two-step process is optimal.
Rather than saying one is superior to the other, “Surgery tailored to the skin area to be removed and the extent of excision” is.
During consultations, we propose the optimal combination by comprehensively considering factors such as eyelid skin thickness, the direction of sagging, and double eyelid design.
If you're concerned about sagging skin or worried whether a single procedure can deliver good results, please feel free to consult with us.
We will recommend the optimal method tailored to the condition of your eyelids.
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【Profile】
Masataka Fujihashi, MD, Plastic Surgeon
Leveraging expertise as a board-certified plastic surgeon, I offer comprehensive facial cosmetic procedures including eyelid and nose surgery, facial liposuction, thread lifts, and hyaluronic acid injections. From incisional surgeries and revision procedures requiring delicate design to minimally invasive injections and lifts with minimal downtime, I strive to provide treatments tailored to each patient's ideal outcome.
We are dedicated to achieving natural results and minimizing downtime, pursuing medical care that leaves you feeling confident in your choice through sincere consultations.
Designing natural beauty with trust.
We cherish that sentiment and apply it to our daily practice.
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【Career】
March 2015: Graduated from the School of Medicine, Showa University
April 2015 Showa University Yokohama Northern Hospital Initial Clinical Training
April 2017 Showa University Hospital Department of Plastic Surgery
October 2017 Maebashi Red Cross Hospital Plastic Surgery / Cosmetic Surgery
April 2019 Nishio Municipal Hospital Plastic Surgery Department
April 2020 Showa University Fujigaoka Hospital Plastic Surgery Department
November 2020 Ota Nishinouchi Hospital Plastic Surgery / Cosmetic Surgery
July 2022 Tokyo Rosai Hospital Plastic Surgery / Cosmetic Surgery Department Head
July 2022: R.O.clinic (Part-time), Kusano Taro Clinic (Part-time)
April 2024 Deputy Director, Ginza TA Clinic
November 2025 BIANCA CLINIC
【Professional Affiliations and Qualifications】
Japanese Society of Plastic and Reconstructive Surgery Board-Certified Plastic Surgeon
Member of the Japanese Society of Aesthetic Plastic Surgery (JSAPS)
Member of the Japanese Society of Aesthetic Surgery (JSAS)
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