Korean Double Eyelid Surgery FAQs with Dr. Ko Young Il

Double eyelid surgery, is usually the gateway procedure for those who are considering plastic surgery, and true enough, it is the most popular procedure in South Korea. Despite its popularity, many people don't have a good understanding of how the surgeries actually work.

Dr. Ko Young Il with Jun, Eunogo's Concierge Manager

Eyelid surgery is truly an artform, so we wanted to make sure that the doctor we spoke to was experienced and knowledgeable about the inner workings of eye structure, so we reached out to Dr. Ko Young Il, a leading plastic surgeon at Ruby Plastic Surgery in Seoul, for answers. Let’s begin:

Q: Dr. Ko, There are 3 different surgical methods of double eyelids surgery, could you explain more about incisional, partial incisional and non-incisional methods?

There are currently 3 main techniques that we use for eye surgeries. The first would be as you've mentioned, the non-incisional method.

The non-incisional method would be literally when we use just tiny holes on the skin without removing any excess skin. It's got pros and cons. The advantages would be that the surgery is really simple, it's got a lesser downtime, it creates a more natural looking appearance, but one of the disadvantages would be that it does not create a strong hold as an incisional method so sometimes there is a risk of it being unfolded.

Non-incisional Double Eyelid Surgery Method

Non-incisional Double Eyelid Surgery: Before and After

One technique that we use at our clinic is what we call natural adhesion technique: we make 3 to 5, sometimes naturally 4 holes, and then we remove some excess fat or unnecessary tissues from these holes, so that it would create a natural adhesion between the outer skin and the underlying structures. You need to get this performed by a proper surgeon because otherwise it can create scars that you would not expect. But other than that, it creates a natural looking double fold, even when you close your eyes, so that's the technique we use the most in this hospital.

Natural Adhesion + Ptosis Correction Surgery: Before and After

Natural Adhesion + Ptosis Correction Surgery: Before and After

So if we use an incisional method, the eyelid has less risk of the double fold being unfolded, however, it creates visible scars and tends to have more of a prominent eyelid. But if someone needs to take out excess skin, then we need the incisional method.

Incisional Double Eyelid Surgery Method

Incisional Double Eyelid + Ptosis Correction Surgery: Before and After

Q: Some people can get the surgery with the non-incisional method, and some people cannot, and why?

Incisional method is appropriate for those that have too much fat or excess skin hooding on the eyelid, then there are no options rather than just to take the skin. Other than that, those who can get the non-incisional or natural adhesion, would be those that have thin skin, without much excess skin on the hooding, things like that.

Q: We see that there are many people who need ptosis correction, regardless whether they have double eyelids, or mono eyelids. What is ptosis exactly?

Simply put, it's what we call droopy eyelids. It's when we open your eyes but others would say, "You look sleepy, did you get enough sleep last night?" Some people’s eyelids droop so that they have a habit of raising their eyebrows to compensate for the lack of strength. You can check on yourself if you have some forehead wrinkles every time you open your eyes, that would mean you have weak muscles, so therefore you create a habit of habitually raising the eyebrows to help with the eye opening.

Non-incisional Double Eyelid + Ptosis Correction Surgery: Before and After

Q: Many Korean stars like Kim Go Eun and Kim Yuna have mono-eyelids, which we think are equally beautiful. Is it possible to make them even nicer without making it a double eyelid?

Yes, the double eyelid does not always have to stand up when you open the eyes, it's only an option of where we put the incision. So for example, especially for men who do not feel comfortable with thick double eyelids, what we do is we create the non-incisional lines right above the eyelash, so that when you open the eyes, ptosis correction would give them a more clear look, but without having prominent double eyelids.

Q: One of the most popular procedures for eyes is the canthoplasty. Who do you recommend canthoplasty to?

The most popular is called the medial epicanthoplasty. We recommend it for those who have short width of the eyes, who wish to get longer length of the eyes. That would be the first, and second would be the area called the caruncle, this pink tissue the inner eye. Now, most Asians have 'Mongolian bands', which is what we call it. It's when you have a skin band that makes your eyes look shorter so the medial epicanthoplasty would be used to remove this band, and gain some length as well.

Medial Epicanthoplasty Surgery Method

Medial Epicanthoplasty + Canthoplasty Surgery: Before and After

Q: What about lateral and lower canthoplasty?

For those who have shorter widths of the eyes, and they wish to increase the length as much as possible, they'll get both medial and lateral to increase as much distance as they can. And lower canthoplasty would mean for those whose skin is upper slanted, we would pull this skin downward to gain some more exposure on this area.

Lateral Canthoplasty Surgery Method

Lateral + Lower Canthoplasty Surgery Method

Medial Epicanthoplasty + Canthoplasty Surgery: Before and After

Q: Canthoplasty can change a person’s appearance by quite a lot, even though it's a small incision. Is it possible to reverse the canthoplasty because some people don't like the results?

In some cases, say, after the medial epicanthoplasty, they feel that they have too much exposure of the inner pink area so they want to cover it back. It is possible, but only up to a certain point. It is not possible to change it 100% just as they had it before the surgery because once the surgery is done, irreversible changes are done. But revision surgeries are possible, up to a certain degree.

You need to consider it carefully with an experienced medical professional, so that you would not have over-correction or under-correction. 

Q: Are there any ideal proportions of the eyes? How do you decide the thickness of the double eyelids?

The thickness actually depends on the patient's preference, and our standards, because if someone wants a thick double eyelid, but from our perspective, if we think that it would result in too thick of a double eyelid, we will recommend that they expect it a little lower after the surgery. There isn't a set definite standard but the books say, the proportion would be, the distance between the eyes, and the length of the eyes, the ratio should be equal, approximately 1:1. That would be the ideal proportion. This distance is, anywhere between 34 to 36 millimeters, but don't be obsessed with the numbers, because it depends on the case.

Q: What kind of anti-aging eye surgeries are there? 

The main reason for anti-aging procedures actually results from a patient’s dissatisfaction from the eyelid hooding as they age. There are many procedures, one would be, for example, a browpexy (eyebrow lift) will actually remove skin from under the brows, and the other would be upper blepharoplasty which would actually create a double eyelid as well as removing excess skin, and another would be forehead lifting, because as you age, your eyebrows tend to come down as well, so you have droopy, downward eye shifting, so it would help with the elevation of the brows as well.

Eyebrow Lift Surgery Method

Upper Blepharoplasty Surgery Method

As you age, you tend to develop these eye bags here, which will make you look always tired and sleepy and cause dark circles under here as well. In these cases, we will do lower blepharoplasty and fat repositioning where we remove excess skin and redistribute this fat bulging under here, so that you would have a flatter, smoother curvature.

Eyebrow Lift + Under-eye Fat Repositioning Surgery: Before and After

Q: Lower blepharoplasty is one of the most popular procedures, but for those in their 20s to 30s that already have eye bags and dark circles, what kind of procedures would you recommend?

Well, in younger people, as mentioned, some people have the eye bags even when they are not that old, so in those cases we would recommend that you get the fat repositioning, which would mean that we would approach through the inner side of the eyes, so that you leave no visible scars, and then we would redistribute this fat bulging under this area, to fill the dark circles here, the depressed areas here. So the bulging would become flat, and the depression would become elevated so that you would have less of a dark circle, or a tired-looking appearance.

The incision is done through the conjunctiva areas here, so that you would have no visible scars. Also, there's always a possibility of recurrence as time goes by, because fat tends to come forward as you age. We use what we call "double lock" technique which is that the repositioned fat, we fix it on the inner side as well as on the outer skin. Those two fixation techniques would make the recurrence rate much lower and the patient would have a much longer-lasting effect.

Under-eye Fat Repositioning Surgery: Before and After

Under-eye Fat Repositioning Surgery: Before and After

A big thank you to Dr. Ko for all the detailed explanations!

We hope that was informative, dear Eunogo readers, and if you want a more in-depth and detailed look at our discussion with Dr. Ko, please click to watch the video below.

If you have any further questions or would like to get a personalized consultation, please feel free to reach out to us.


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