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Eyelid Fold Height Alteration

Patients may seek to alter the height/size of the upper eyelid fold after double eyelid surgery when they believe that their double eyelid fold is either too high or too low.

HIGH TO LOW FOLD

A patient can seek revision surgery to change a high fold from their initial double eyelid surgery to a lower fold due to: (1) patient changing their mind, (2) inadvertent high fold as a result of a weak eye muscle (see Ptosis), or (3) inadvertent high fold as a result of surgeon fixing fold to the high aspect of the eye muscle rather than the lower aspect as the surgeon had intended. The method for correcting this complication can depend on the presence of excess eyelid skin and the cause of the high fold.

  • Excess Skin – If the patient has excess skin (some signs of hooding), the surgeon simply corrects the high fold by excising excess skin and creating a newer fold at a lower aspect of the eyelid.
  • No Excess Skin – When the patient does not have redundant or excess skin, the surgeon dissects the fold in two separate planes and releases the high fold. Additionally, a buffer (most of the time with fat) is placed on the upper eyelid and the skin is then reset to the lower aspect of the elevating muscle in order to prevent reattachment. If excess fat does not exist and cannot be mobilized by wide dissection of the eyelid, fat must be grafted from another area of the patient’s body. Furthermore, if the eyelid muscle is weak, ptosis correction must also be performed.

LOW TO HIGH FOLD

A patient can seek to change a lower fold from their initial eyelid surgery to a higher fold due to: (1) a patient’s change of mind, (2) a smaller fold incongruous to the shape of patient’s eye, or (3) a decreased fold due to sagging skin. A low to high fold revision is easier than a high to low fold revision. With the low to high fold revision, the patient’s fold from the previous surgery becomes negligible as the higher fold becomes the dominant fold.