Can the position of the crease be changed with upper bleph?

I had bilateral upper bleph since one of my eyes had slightly more holding than the other (other eye had a tiny amount of excess skin too). Both my eyes look better now, but equally asymmetric. Before surgery, I did see that my creases were positioned differently which is what I guessed caused the slight asymmetry. The crease position appears unchanged post op. Does this sound like something that could have been corrected or should I be satisfied with the improvement in each eye separately?

Doctor Answers 7

Asymmetric upper eyelid creases

yes the level of creases can be altered by lightly tacking the skin to the levator muscle indirectly using the orbicularis muscle to the levator.  Jack sheen adressed this decades ago, and I am sure others as well.  I reccommend you get an opinion from an oculoplastic surgeon who is usually an ophthamologist with additional fellowship training in plastic surgery of the eyelids.

Eyelid crease asymmetry with blepharoplasty

Thank you for your question.  It is not uncommon for the natural eyelid creases to be slightly asymmetric.  Surgery can address the position of the crease, but other factors may be involved that can contribute to the asymmetry.  Without photos, it would be difficult to provide a more detailed and exact answer to your question.  I would ask your surgeon these questions, and perhaps consider a second opinion with a surgeon who specializes in eyelid surgery.    

Paul Nazemi, MD
Newport Beach Oculoplastic Surgeon

Eyelid crease issues after blepharoplasty

Yes, the position of the upper eyelid creases should be addressed at the time of blepharoplasty. Creases may be asymmetric for a variety of reasons including ptosis. Oculoplastic surgeons are trained to pay attention to the intricate details of the eyelid anatomy, and repairing abnormalities of the crease, fold, lid level, and three-dimensional contours of the eyelids. In my opinion, it is important to use an anterior approach to upper eyelid surgery so that all of these anatomic details may be addressed. If you are not satisfied, seek a second opinion. Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

The position of the crease can and should be controlled by the surgeon.

However, this requires a level of attention not exerted by all surgeons.  Blepharoplasty seems simple because it is such a common cosmetic surgery.  However, knowledgable surgeons use many nuanced techniques to refine these surgeies.  That is what distinguishes the best eyelid surgery from mediocre eyelid surgery.  If your eyelids heal and there is an issue with crease symmetry, this can be corrected but it requires advanced techniques and it is improbable that your current surgeon will be able to provide this level of care.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Blepharoplasty: changing the position of the crease

Blepharoplasty is a surgery to improve the shape of the eyelid by addressing excess skin, herniating fat, or weakened structures. 

The position of the crease can be adjusted to a degree by the location of the incisions. An important detail to check is ptosis or lid drooping. A difference in the creases caused by ptosis cannot be improved with blepharoplasty. I would recommend following up with your surgeon and consulting with an eyelid specialists (oculoplastic surgeon). Safety comes first. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Upper Eyelid Creases

Thanks for the question.  The upper eyelid crease is a defined anatomical structure that is created by an attachment of the upper eyelid skin with the underlying levator aponeurosis which is a fascia that is attached to the muscle (levator) that raises the upper eyelid.  The position of this attachment can vary from one eyelid to the other resulting in asymmetrical creases.  This can be corrected at the time of upper eyelid surgery by releasing and recreating this attachment at the desired level.  Pictures would be helpful to assess whether or not this is relevant to your current concerns.

Changing eyelid crease

Changing your eyelid crease is possible but it depends.  If you had previous surgery, the incision can be adjusted either higher or lower, and made deeper.  This can improve symmetry, but there are likely other factors that make your eye and eyelid assymetric and I would discuss those concerns with your surgeon.  Finally you have to consider the risks of no improvement, or evening worsening the assymetry-- again something you should talk to your facial plastic surgeon about.

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 57 reviews

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.