Why is my eyelid not folding properly after double eye-lid surgery? (photo)

When
evaluating the stability of the eyelid crease, it is important to understand
that there are many dynamics in the outcome of this type of surgery. When you
are the 7-week point, there is still some degree of swelling which may not
always be apparent. The process of fluid absorption related to surgery happens
not only at the superficial level like in the eyelash or eyelid margin or the
crease, but also in the deeper levels of the tissue underneath the skin. There
is a lot of healing going on and the healing process has several stages. True
healing goes on for months and can take up to a year to settle.



If your
doctor feels that the eyelid is still swollen, then any further enhancement
surgery is not likely beneficial. I always explain to my patients that swelling
changes the dynamics of the predictability of how you place the tissue when
doing surgery. Unless there is a specific indication that requires earlier
treatment, then it is usually best to allow swelling to resolve to a reasonable
level, to the point the surgeon feels comfortable about going in and doing
something to revise the result. I have seen patients who came in for revision
surgery who had several surgeries done in a very short time frame, with the
doctor trying their best efforts trying to make the patient happy. Unfortunately,
with every trauma there is the potential of scar tissue formation and other
issues. More importantly, swelling is a moving target and therefore it changes
the dynamic.



If there
are multiple folds and if the crease is not well delineated, it’s usually
something that is amenable with a procedure such as a non-incisional fixation.
Little openings are made and a connection between the eyelid and the levator
muscle is created. A principle of most eyelid crease surgeries is to create a
connection between the skin and levator muscle. If there is fat in the way of
the space, then the fat is reduced or shifted out of the way in order to create
the connection. However, when the sutures are removed, there is a possibility
that the skin can detach a little and does not create the crisp, nice-looking
fold.



My advice
is not to lose hope and continue communicating with your doctor. I’m sure your
doctor will see you at regular visits. In our practice, we see our patients at
1, 3 and 6 months and beyond and the doors are always open if they have
questions or concerns at any time. Once you have this continuous dialogue and
observation, and if your doctor takes photos and documents the progress, it
might be easier for you to see where things are going. Surgical healing can
take up to a year and swelling can be a factor. I hope that was helpful, I wish
you the best of luck, and thank you for your question.



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Crease failure is possible after Asian eyelid surgery, and can occur from 5-10% of the time after surgery, depending on the technique.  That being said, give your eyes at least 6 months to heal before assessing the need for a revision procedure.  Follow up closely with your surgeon to ensure the best result.  He/she may suggest some measures to help proper crease formation.  

There appears to be more swelling on the right than the left and this may contribute to the issues you ignore with the crease on the right. Give your self more time to heal but discuss your concerns with your surgeon.