Double Eyelid Surgery & Mild Ptosis Correction | Natural-Looking

By Dr. Pennung Thongtong, MD
Ophthalmologist | Oculoplastic Surgeon
Medical Licence No. 40888

Patient's Concern

This patient visited D Bangkok Clinic because she had always felt self-conscious when taking photos. She noticed that her left eye appeared smaller than the right, making her eyes look uneven and giving her a slightly tired or sad appearance. In addition, her original eyelid crease was very low, making eye makeup difficult and less defined.

Her goals were clear:

• Achieve more symmetrical eyes
• Make both eyes appear larger and brighter
• Create a natural-looking double eyelid
• Maintain facial harmony without looking overdone

Clinical Assessment

During examination, we found that the patient had:

• Mild ptosis (levator muscle weakness) of the left upper eyelid
• A naturally low and narrow eyelid crease
• Mild excess upper eyelid skin
• Uneven upper eyelid fullness caused by orbital fat distribution
• The combination of a small eyelid crease and mild ptosis caused the left eye to appear smaller than the right, especially in photographs.

Surgical Plan

To achieve balanced and natural results, a customized surgical plan was designed, including:

• Double Eyelid Surgery
• Mild Ptosis Correction (Levator Muscle Advancement)
• Conservative removal of excess upper eyelid skin
• Orbital fat repositioning and contour refinement
• Every procedure was tailored specifically to the patient's anatomy to preserve a soft, feminine, and natural appearance.

Why Ptosis Correction Was Necessary

Simply creating a higher eyelid crease would not have fully corrected the asymmetry.

Because the left eyelid had mild levator muscle weakness, ptosis correction was performed by reinforcing and advancing the levator muscle, allowing the eyelid to open more effectively.

This helped to:

• Improve eyelid opening
• Increase visible eye size
• Restore better symmetry between both eyes
• Reduce the tired or sad appearance
• Create a brighter, more refreshed look

Creating a Natural Double Eyelid

The eyelid crease was carefully elevated while maintaining proportions that suited the patient's facial features.

Rather than creating an excessively high crease, the goal was to produce a natural Asian double eyelid that enhances facial harmony and remains elegant both with and without makeup.

Additional contouring of the upper eyelid fat created a smoother transition from the eyebrow to the eyelid, resulting in a softer and more refined appearance.


Recovery at 2 Weeks

The postoperative photos were taken 2 weeks after surgery.

At this stage:

Mild swelling is still expected.
The eyelid crease will continue to soften over the next several weeks.
Most swelling typically improves significantly by 1 month, with the eyelid becoming even more natural as healing progresses.
Even at only two weeks, the patient's eyes already appear:

• More symmetrical
• Larger and brighter
• More open when looking straight ahead
• Better balanced with her facial features

Surgeon's Note

Successful double eyelid surgery is not simply about creating a crease. A thorough evaluation of eyelid anatomy—including levator muscle function, eyelid skin, fat volume, and facial balance—is essential to achieve long-lasting, natural-looking results.

For patients with even mild ptosis, correcting the muscle at the same time as double eyelid surgery often produces a more balanced, refreshed, and youthful appearance than eyelid crease surgery alone.


Disclaimer: Every patient has unique anatomy, and surgical outcomes may vary. A personalized consultation with an experienced oculoplastic surgeon is recommended to determine the most appropriate treatment plan.