Upper blepharoplasty eye crease question?

Hi, Can where the eye creases be altered, for example during upper blepharoplasty? Will the lid crease automatically where the incision was made or will the crease occur where it should be naturally? Thanks in advance. Regards Lisa

Doctor Answers 3

A very sophisticated question!

The upper eyelid crease is the lowest line of attachment between the skin and the levator aponeurosis-the fascial expansion of the tendon for the levator palpebrae superioris muscle that opens the upper eyelid.  When a skin excision is made in the upper eyelid, the lowest incision generally becomes the upper eyelid crease.  Some surgeons look for an existing crease to make the crease incision.  As a rule, this typically leaves the upper eyelid crease too high.  For example a natural crease found at 9 mm, when used as the crease will heal at a height of 10.5 to 12 mm.  

This is due to a not widely appreciated tendency of these creases to heal at a higher position.  Laxity of the eyelid skin and underlying orbicularis muscle needs to be considered in making this crease incision.  Crepey upper eyelid platform skin can be corrected by laying out the eyelid platform skin and muscle on a slight stretch when designing the location of the upper eyelid crease.  This snugging up of the platform skin and muscle is important because this gives a female eyelid a place to hold eyelid make up.  

Making the crease too high can leave the upper eyelid hollow and surgical in appearance.  If the surgeon chooses an existing crease line at 10 mm, the upper eyelid crease can ultimately heal at 12 to 13 mm.  For this reason, very experienced eyelid surgeons will avoid using an existing natural crease and put the incision lower.  

I commonly will place the incision at 7.5 mm for a caucasian women and somewhat lower in Asian men and women.  Generally this will mean that the natural crease is removed as part of the skin excision or the lid will be forced to break in a way that hides the existing natural crease. You did not ask about how much skin is excised with upper eyelid surgery.  For some reason, surgeons are overly focused on how little skin they can leave between the eyebrow and the upper eyelid lashes and still have the eye close.  The result is too much skin is removed from the upper eyelid.  A much more natural approach is to use the one taken with designing Asian eyelid surgery where one focuses on deciding how much of the eyelid platform to expose below the upper eyelid fold.  This preserves the upper eyelid fold, rather than remove it with surgery.

I would be very careful in Europe because it seems very hard to find a surgeon who truly understands these issues. 

If this subject is interesting to you, you can find much more on the subject on my website.  You can also find examples of very subtle and natural upper anchor blepharoplasty surgery results on my website.


Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Eye Crease Positioning During Blepharoplasty

Yes of course they can be altered when you mark the patient pre-operatively.  In fact, it is better to mark the crease lower in most cases to make the eyelid look more youthful and fuller.  Consult your Board Certified plastic surgeon with expertise in eyelid surgery.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 50 reviews

Upper blepharoplasty eye crease

In most circumstances of upper blepharoplasty, the incision is made in the existing eye crease.  There are maneuvers that can be done to alter the position of the crease if needed though.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.