Do some surgeons take fat and muscle from eyelids & move the eyelid crease very high? Is this an antiquated technique from the 1960's & 70's? For what reason should the eyelid scar be moved so high that 1 year later you have very hard scar tissue and visible scars that extend up toward your brow? (I was told that this is exactly where eyelid scars should be). I thought it should always be in the natural eyelid crease. I used eyepencil to show exactly where my eyelid incisions are.Please advise.
Doctor Answers (5)
Eyelid crease location after upper eyelid blepharoplasty
When I sit down with a patient prior to their upper eyelid surgery, I discuss the normal position and placement of the eyelid crease and placement and position after surgery. In women, I have found that the normal eyelid crease is usually located about 11 mm above the upper eyelid eyelashes (about 1/2 inch). I verify this by having the patient hold a mirror and look with them.
At the time of surgery, the surgeon should use what is called a caliper to measure the distance of the eyelid crease and mark it in both upper eyelids. At the same time, I measure down from the lower edge of the eyebrow and mark out the top portion of the blepharoplasty incision. Although a different amount of skin may be removed at the time of surgery from each eyelid, what remains behind is the same amount of skin and the "new" eyelid crease is in the same position.
The eyelid crease can migrate upwards over time. An experienced eye and facial plastic surgeon can advise you on what measures can be taken to correct a high eyelid crease.
Briggs Cook, MD
Eyelid crease location with Upper Blepharoplasty
The upper eyelid crease location is generally established and visible is most eyelids, men and women. Some patients, especially from Asian countries such as South Korea or China, will not have a natural eyelid crease. A plastic surgeon will typically create or use an existing eyelid crease to help hide the blepharoplasty incision. The exact position varies, ranging from approximately 6mm to 10mm from the eyelid edge. The eyelid plastic surgeon can tailor the operation to the needs of each patient. Only after a comprehensive evaluation can a surgeon help determine appropriate options for you. Best of luck.
Scar Placement in Blepharoplasty
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The height crease should be determined by the patient and surgeon together
Most patients want the crease to remain at the height it was before their eyelids aged, but sometimes a patient wants a high deep crease that they did not have before. Usually I sit down with the patient and a mirror and we determine what height crease they had before, and wherre we agree it should be after surgery.
It is true that in the '60's and '70's a high deep upper eyelid crease was considered the standard of beauty, but in the past 20 years a lower crease and fuller eyelid have become more accepted as another standard of youth and beauty.
Unfortunately, the photos that you have posted are out of focus, except for the last photo [full face]. On that photo, it seems that you have multiple eyelid creases, which is not unusual as you age and have more redundant skin.
As far as eyelid incisions go, most surgeons place the lower incision line at where the patients natural crease lies. In some patients this line may be higher and the surgeon might want to lower the crease or adjust it to the other lid for symmetry. Every patient is different and needs a different plan.
Another point to consider is whether the patient has concurrent brow ptosis. If so, this will lead to increased hooding of the eyelid laterally which cannot be addressed ideally, except to raise the brows as well. If a patient does not want to have this address with an additional surgical procedure, some surgeons may take the lateral extent of the incision further out past the outside corner of the eyelids to remove this excess skin. While this may better address the lateral hooding, it often will leave a scar that is visible because it is no longer hidden in your natural eyelid crease/fold.
You need an in person evaluation with a surgeon with extensive oculoplastics experience.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.