Hi, I have had a blepharoplasty for lash ptosis 2 years ago. The crease or incision on my right eye was made 3 mm higher than the left. Now the bridge area or skin under my crease is too expansive compared to the left. I really want to lower the crease, not raise the left. My opthamologist says that she doesn't recommend any operation because lowering the crease is taboo... Please help me with a solution, I am desperate. Too many doctors saying its too hard, is there any way?
Crease Too High 2 Years After Blepharoplasty. What Can I Do?
Doctor Answers 8
This can be impossible to do unless you have enough excess skin in that lid equal to the length you need to move the scar down. This would be determined by an exam from an expert. Otherwise, there really is nothing you can do. Once in a while, the incisions are made exactly equal but because of healing differences and scar tissue, they wind up at different levels so this is not necessarily a mistake on the pat of your surgeon.
The placement of a high crease in blepharoplasty is difficult to correct unless you have redundant skin. This is why it is important to seek out a Board Certified Plastic Surgeon or a plastic surgeon with expertise in blepharoplasty. Also, one should place the crease lower than higher because it is easier to camouflage and also gives the illusion of a fuller lid.
the difficulty in lowering the crease is that there has to be enough excess skin equal to that of amount downward migration of the crease that is required . If you do not have more excess skin than the difference in the crease height that needs to be reduced, then attempting to move the crease down could cause you to end up not being able to close your eyelid and letting the cornea get dried from over exposure. Hard to say without seeing you in person.
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Depending on your situation, the crease may be lowered. The visible crease depends not only on how high above the tarsus dermal connecting fibers extend, but also upon how much skin and fat are above that point, above the actual location of the orbitopalpebral crease. If you have a very deep supratarsal fold and no skin excess to work with, may be more difficult to lower. Sometimes, outer lamella just scars higher and becomes adherent on one side, but not the other. Because you have a desirable result on one side, but not the other, I think it may be possible to correct, and if the appearance really bothers you, probably worth the attempt. It is a straightforward office procedure.
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Photographs of the lids in forward and down looking gaze would have been very important to advise you. In unoperated Caucasiants the eyelid crease is the result of insertion of part of the muscle system which lifts the lid. This insertion is not present in Orientals giving rise to some of the differences seen between these ethnic groups. Ideally, the crease is 10-12mm from the lash line and assuming there are no other factors involved a skilled Opthalmic surgeon should be able to revise your crease and lower it by placing the skin stitches in such a way that the scar will tether the crease lower. I would get a second opinion.
Peter A Aldea, MD
This is a very tough question to answer without seeing you in person. In general though, it is very difficult to lower a crease.
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We just don't have a means of reliably doing it. There is an expression: measure twice cut once. That is how one avoids this situation. What are your options? Well a photo would be very helpful. Since you did not upload a photos, let me generally discuss this topic. This items may or may not apply to you. 1) Is the eyelid with the longer appearing platfrom ptotic or droopy compared to the other side? Raising the eyelid with the longer platform is generally the ideal way of making a real difference. 2) Could the side with the lower crease benefit from having the crease elevated to the height of the other side? This is a straight forward proposition if you know what you are doing. However, most people in this situation find that they would prefer to have the higher crease lowered than have two creases that are higher then they would like. 3) Are the crease covered by any upper eyelid fold? Too many times the original surgeon not only messed up the creases but they also took every bit of upper eyelid spare skin and then some. If there is a fold, the side with the too high crease might be improved by placing filler in the upper eyelid above the crease. A more radial alernative would be to place an inplant on the orbital floor to push the orbital contents forward. Most people in this situation are not interested in orbital surgery. Finally, the eyelid can be opened up and fat grafts can be placed in a effort to lower the crease. How good is this option? Because the take and effect of the grafts is highly unpredictable this is essentially an impossible approach reserved for severe deformities where there are no other options. I would place the chance of this method working in the 10% range and that only after many reoperations.
What is best for you? Only a personal consultation will determine that.
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A lot will depend on your exam. See an experienced eyelid surgeon who can give you an opinion of whether it is possible or not. It is possible in certain circumstances.
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.
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