2026-05-18
Natural Adhesion, Ptosis Correction & Upper Eyelid Fat Grafting: A Real Case Review
A first-time eye surgery case review for a patient who wanted a semi-outline. Considering insufficient upper eyelid volume and left-right asymmetry, non-incisional natural adhesion, ptosis correction, and abdominal fat grafting (0.3cc on the left, 0.4cc on the right) were performed together. At 1 week post-op, some initial swelling remained but the line had settled stably, and by month 4, the hollowness had improved with a clear yet soft semi-outline finish.
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Hello~
💎Your beauty universe! This is Dr. Shim Jeong-hwan from Weverse Plastic Surgery :)💎
Today, I'd like to review a case involving natural adhesion (dermal adhesion), ptosis correction, and hollow eye correction.
Before Surgery
This patient underwent her first eye surgery, combining natural adhesion, ptosis correction, and upper eyelid fat grafting.
She had always wanted a semi-outline style of double eyelid,
and due to the stuffy appearance at the outer corners of her eyes, she hoped for a more refreshed impression.
However, when examining the overall structure of her eyes, the outer portion was already sufficiently large
and open enough that we determined sufficient improvement could be achieved with double eyelid surgery alone,
without the need for additional lateral canthoplasty.
Differences between the left and right eyes were also identified.
👉Left eye (from photo): narrow distance between brow and eye, thicker
👉Right eye (from photo): wider distance between brow and eye, appearing hollow due to insufficient fat
Particularly when there is insufficient volume above the eye, the skin can pull tight, causing the double eyelid line to appear shallow
or to look as though it's loosening, which means simple natural adhesion alone might struggle to maintain the line.
POINT
✔️Desired semi-outline
✔️Eye condition allows improvement without lateral canthoplasty
✔️Left-right eye asymmetry present
✔️Potential reduction in line retention due to upper eyelid hollowness
Diagnosis & Surgical Method
Because the patient's upper eyelid lacked volume—creating a risk that the double eyelid line would not hold well—
we planned to combine ptosis correction and fat grafting rather than relying on natural adhesion alone.
First, we designed a semi-outline using non-incisional natural adhesion,
and performed bilateral ptosis correction to more clearly improve the eye-opening strength.
This reinforced the line so it could be maintained more distinctly and stably.
When designing the line, we also accounted for left-right asymmetry.
The left eye (from photo) had a relatively narrow distance between the brow and eye, which meant the line could appear covered.
So we designed the left line slightly higher than the right, ensuring that when the eyes were opened,
both lines would align more naturally.
Additionally, a small amount of fat was harvested from the abdomen and grafted into the hollow area above the eyes.
Left: approximately 0.3cc
Right: approximately 0.4cc
Although a small amount of fat grafting, when it engrafts stably,
it can help improve hollowness and enhance retention so the double eyelid line doesn't loosen.
POINT
✔️Combined natural adhesion + ptosis correction
✔️Line design tailored to left-right eye conditions
✔️Reinforced retention through upper eyelid fat grafting
✔️Small amount of abdominal fat grafting performed
1 Week Post-Op
In the 1-week photo, because it was right after fat grafting,
some swelling and thickness remained above the eyes.
However, overall the eye-opening strength was noticeably clearer than before,
and the double eyelid line was forming stably as well.
In particular, as the upper eyelid hollowness improved,
the eyes appeared softer and more defined than before.
POINT
✔️Some initial swelling and thickness present
✔️Improved eye-opening strength
✔️Semi-outline forming stably
✔️Upper eyelid hollowness beginning to improve
4 Months Post-Op
At the 4-month follow-up, most of the initial swelling and thickness had naturally subsided.
The fat above the eyes had engrafted stably, maintaining the natural improvement in hollowness,
and the double eyelid line had also settled in stably without any loosening.
The balance between the left and right lines had aligned naturally,
resulting in an overall clear yet soft semi-outline impression that was well expressed.
POINT
✔️Stabilized fat engraftment
✔️Naturally improved upper eyelid hollowness
✔️Double eyelid maintained without loosening
✔️Clear yet natural semi-outline complete
Eye surgery isn't simply about creating a double eyelid line—
only when the eye's structure, left-right balance, and upper eyelid volume are all considered together
can natural and stable results be achieved.
Before / 1 Week / 4 Months
In this case as well, we designed the line to match the patient's eye conditions,
and by combining ptosis correction and upper eyelid fat grafting, we were able to create
a clearer yet softer semi-outline impression.
Because we considered both the improvement of upper eyelid hollowness and the retention of the double eyelid,
this is a case where we could see the results settling in even more naturally as time passed.
Frequently Asked Questions
When is it difficult to maintain the line with natural adhesion alone?
When upper eyelid volume is insufficient, the skin can pull tight and cause the double eyelid line to appear shallow or loosened. In such cases, combining ptosis correction and fat grafting alongside natural adhesion may be considered rather than natural adhesion alone.
Why is ptosis correction performed together?
When ptosis correction is performed in conjunction, eye-opening strength can be improved more clearly, and it serves to reinforce the double eyelid line so it remains more defined and stable.
How is left-right eye asymmetry considered?
The side with a narrower distance between the brow and eye can have its line appear covered, so it's designed slightly higher. In this case, the left line was designed slightly higher so that both lines would align naturally when the eyes are opened.
Where 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 hollow area above the eyes—approximately 0.3cc on the left and 0.4cc on the right, a small quantity.
What is the progress at 1 week post-op?
Because it's immediately after fat grafting, some swelling and thickness may remain above the eyes. However, the eye-opening strength becomes clearer and the semi-outline double eyelid line is confirmed to form stably.
What changes appear at 4 months?
Most of the initial swelling and thickness subside, and the grafted fat engrafts stably, maintaining improved hollowness. The double eyelid line also settles in without loosening, achieving a clear yet soft semi-outline impression.