2026-05-18
Real Case Review: Natural Adhesion, Ptosis Correction, and Upper Eyelid Fat Grafting
This is a case review of a first-time double eyelid surgery patient who desired a semi-out line. Considering the lack of volume above the eyes and left-right asymmetry, non-incisional natural adhesion, ptosis correction, and abdominal fat grafting (left 0.3cc, right 0.4cc) were performed together. At 1 week post-op, some initial swelling remained, but the line was stably positioned. By 4 months, the sunkenness was improved, and a clear, soft semi-out line was successfully achieved.
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Hello~
💎your beauty universe! This is Dr. Shim Jeong-hwan from Uber Plastic Surgery :)💎
Today, I would like to review a case involving natural adhesion (dermal adhesion), ptosis correction, and sunken eyes.
Before Surgery
This patient is a case where natural adhesion, ptosis correction, and upper eyelid fat grafting were performed together for her first eye surgery.
She had always wanted a semi-out line style double eyelid,
and desired a more refreshing impression because the outer corners of her eyes felt somewhat stuffy.
However, upon checking the overall structure of her eyes, the outer parts were already sufficiently large
and openly wide, so I determined that sufficient image improvement could be achieved
with just the double eyelid surgery, without the need for an additional lateral canthoplasty.
Additionally, a difference in the conditions between the left and right eyes was observed.
👉Left eye (based on the photo): The distance between the eyebrow and the eye is narrow and somewhat thick.
👉Right eye (based on the photo): The distance between the eyebrow and the eye is wide, and it appears sunken due to a lack of fat.
In particular, when there is a lack of volume above the eye, the skin can be pulled, making the double eyelid line appear shallow
or prone to loosening, so there was a possibility that maintaining the line would be difficult with simple natural adhesion alone.
POINT
✔️Desired a semi-out line
✔️Eye condition that can be improved without lateral canthoplasty
✔️Difference in left and right eye conditions
✔️Possibility of decreased line retention due to sunken upper eyelids
Diagnosis and Surgical Method
Because the patient was in a state where the double eyelid retention could decrease due to a lack of volume above the eyes,
we planned to combine ptosis correction and fat grafting rather than performing natural adhesion alone.
First, we designed a semi-out line with non-incisional natural adhesion,
and performed bilateral ptosis correction to clearly improve the eye-opening muscle strength.
Through this, we reinforced the line so that it could be maintained more vividly and stably.
When designing the line, left-right asymmetry was also taken into consideration.
Since the left eye (based on the photo) had a relatively narrow distance between the eyebrow and the eye, there was a possibility that the line would appear covered.
Therefore, we designed the line slightly higher on the left side so that when the eyes are open,
both lines would match more naturally.
In addition, a small amount of abdominal fat was harvested and grafted into the sunken areas above the eyes.
Left approx. 0.3cc
Right approx. 0.4cc
Although it is a small amount of fat grafting, if it engrafts stably,
it can help improve the sunkenness and increase retention so that the double eyelid line does not loosen.
POINT
✔️Combined natural adhesion + ptosis correction
✔️Line design tailored to left and right eye conditions
✔️Reinforced retention with upper eyelid fat grafting
✔️Small amount of abdominal fat grafted
1 Week Post-Op
In the 1-week post-op photo, because it is right after the fat grafting,
some swelling and a thick feeling above the eyes still remained.
However, the overall eye-opening strength became clearer than before,
and we could see that the double eyelid line was also stably well-positioned.
In particular, as the sunkenness above the eyes improved,
the eyes showed a much softer and clearer impression than before.
POINT
✔️Some initial swelling and thickness present
✔️Improved eye-opening strength
✔️Stable formation of semi-out line
✔️Improvement of sunken upper eyelids begins
4 Months Post-Op
At the 4-month progress mark, the initial swelling and thick feeling had mostly resolved naturally.
The fat above the eyes had also stably engrafted, maintaining a naturally improved appearance of the sunkenness,
and we could confirm that the double eyelid line had settled stably without loosening.
The left-right line balance also matched naturally,
showing a result where a clear yet soft semi-out line feel was well expressed overall.
POINT
✔️Stabilized fat engraftment
✔️Natural improvement of sunken upper eyelids
✔️Double eyelid maintained without loosening
✔️Completion of a clear and natural semi-out line
Eye surgery is not just about creating a double eyelid line;
the structure of the eye, left-right balance, and upper eyelid volume must all be considered together
to lead to natural and stable results.
Before Surgery / 1 Week Post-Op / 4 Months Post-Op
In this case as well, we designed the line tailored to the patient's eye conditions,
and performed ptosis correction and upper eyelid fat grafting together to create a clearer yet
softer semi-out line feel.
In particular, as we considered both the improvement of sunken upper eyelids and the retention of the double eyelid,
this was a case where we could see it settling more naturally over time.
Frequently Asked Questions
When is it difficult to maintain the line with natural adhesion alone?
If there is a lack of volume above the eyes, the skin can be pulled, making the double eyelid line appear shallow or prone to loosening. In such cases, combining ptosis correction and fat grafting rather than natural adhesion alone can be considered.
Why is ptosis correction performed together?
Combining ptosis correction can more clearly improve the eye-opening strength and plays a role in reinforcing the double eyelid line so that it is maintained more vividly and stably.
How is left-right eye asymmetry considered?
The side where the distance between the eyebrow and the eye is narrow can make the line appear covered, so it is designed slightly higher. In this case, we set the left line slightly higher so that when the eyes are open, both lines match naturally.
From which area and how much fat is harvested for upper eyelid fat grafting?
In this case, a small amount of fat was harvested from the abdomen and grafted into the sunken areas above the eyes, using small amounts of approximately 0.3cc for the left and 0.4cc for the right.
What is the progress at 1 week post-op?
Because it is right after fat grafting, some swelling and a thick feeling above the eyes may remain. However, it was confirmed that the eye-opening strength became clearer and the semi-out double eyelid line was stably formed.
What changes appear at 4 months post-op?
Most of the initial swelling and thickness resolve, and the grafted fat stably engrafts, maintaining the improved appearance of the sunkenness. The double eyelid line also settles into a clear yet soft semi-out line feel without loosening.