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Revision Surgery

Fold Depth Alteration

Another aspect of the eyelid crease is the depth of the fold. Patient may seek revision surgery, because their eyelid crease is too deep or too shallow. This detail of the eyelid fold may be subtle but important nonetheless as a fold that is too deep can make a person appear harsh, while a fold that is too shallow can give someone the appearance of lacking sharpness and clarity. Clearly, a surgeon must have an expertise in eyelid surgeries to calibrate the depth of the crease by understanding the individuals' thickness of skin, fat and muscle, and muscle strength as these components may vary from person to person.

Too Shallow

A sharp, crisp crease is more appealing as well as desirable. A fold that is too shallow can occur when the surgeon fails to calibrate the fold properly, or due to loosening over time due to age. In addition, there is a higher chance of loosening if the patient has previously undergone the suture technique. (see [insert section]). In order to correct a crease that is too shallow, the fold must be reinforced with either the incisional technique, the suture technique, or 3D suture technique (Refer to 3D ST™)

Too Deep

A fold that is too strong can cause the crease to look static and unnatural. A static fold is when the fold does not change with eye movement. (i.e., the fold should soften with eye closure and sharpen with eye opening.) A deep fold typically results when the skin is attached to the eye elevating muscle too high (i.e., was not attached to a surgically created septo-levator complex), or when the skin attached to the tarsus. In order to correct this problem, the surgeon must dissect and release the fold and place the new fold at an ideal anatomical location in order to create a fold with adequate depth.

Heavy Eyes

Many times, patients can experience the heaviness of their eyelid, when they have ptosis, the weakening of eyelid elevating muscle. However, patients that have undergone double eyelid surgery may also experience another form of heaviness due to the puffiness (swelling) of their eyelid. If the patient is experiencing heaviness of the eyelids as a result of ptosis, the surgeon must strengthen the eye muscle by performing ptosis correction (Refer to Ptosis).

Puffiness

There are two types of puffiness that can result in heavy eyelids --fullness in the area between the lash line and the crease or puffiness above the crease up to the brow.

Sausage - When fullness occurs between the lash line and the crease it is referred to as "sausage". When the patient's face is viewed at the side, the "sausage" area will protrude under the crease, appearing unnatural and unattractive. The cause of sausage can be due to the spontaneous development of ptosis or induced ptosis by the high fold that was created at the levator muscle (where a patient's eye muscle develops intolerance to the newly created fold). If this occurs due to spontaneous ptosis or induced ptosis, the heaviness can be alleviated by ptosis correction. If the heaviness occurs because the patient's fold is too high, it can be corrected by lowering the fold.

Crease to Brow Puffiness – Puffiness in the area between the fold and the brow can be corrected by removal of skin or with a brow lift. There are two types of brow lifts: (1) traditional lift by pulling brow from the hairline or above the hairline (2) sub brow lift (Refer to Sub Brow Lift). A traditional lift (otherwise called forehead lift) requires lifting of eyelid by pulling up the brow. A sub brow lift is done by excising a portion of skin immediately under the brow. Some individuals may require such brow lift when getting double eyelid surgery if their brow skin is too puffy or extremely thick.