Fold height refers to how high above the upper lash line the fold is. If the eye is large, a higher crease is recommended. However, the patient must keep in mind that the higher the fold is, the more weight that is placed on the eye elevating muscle. A prior determination must be made whether the patient’s eye elevating muscle can tolerate the additional weight created by a high fold before the surgery.
A high fold is ideal for patients with large eyes and strong eye elevating muscle function. As stated above, a complication associated with a high fold is that additional weight is placed on the eye elevating muscle, as the eyelid skin is attached to the muscle that is situated anterior to tarsus. Therefore, creating a high fold can induce ptosis in patients who have weak eye muscles (Refer to Ptosis). However, if all criteria are met, a high fold can have a dramatic and glamorous effect on someone’s appearance.
A lower fold is ideal for patients with protruding eyes as well as for patients with ptosis. Patients may desire a low fold if they prefer subtle changes. Low folds are prone to more hooding with age, as there is less distance for the skin to descend beyond the double eyelid crease.
An ideal fold size is the height in which the eyelid functions optimally. The eyelid height at which the eyelid functions well tends to look most natural and suitable to a patient’s overall face, hence the phrase “form follows function”. It is important to find a surgeon that understands this balance between form and function of the Asian eye.