Why is my eyelid scar above the crease? Shouldn't it be in the natural eyelid crease? (photos)

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.

Best regards

seattleface com

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

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.

Dr. Chaboki

 

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.

Scar placement in blepharoplasty for the upper eyelid is typically either in the natural crease, called the supra-tarsal crease, or about 10 mm. from the eyelid margin in the center (about pupil level), which is then gently curved to follow the shape of the eyelid margin.. At times it may be necessary to have what appears to be a little excess upper eyelid skin after surgery because you need enough skin to be able to completely close your eyes. I don't think that most surgeons would extend the scar out on the thicker skin of the eyebrow unless absolutely necessary because on average the thicker eyebrow skin does not scar as well as the thin eyelid skin. For the lower eyelid, the scar can be placed inside the eyelid if no skin removal is needed (trans-conjunctival), or on the skin just below the eyelashes (sub-ciliary).