Non-existent Crease Years After Blepharoplasty

I had a blepharoplasty performed on my right eye about four years ago. I noticed after the swelling had gone down, the lid seemed to double crease resulting in my right eye looking a bit wider than my left, but at least with a crease so it didn't bother me much. But, in the past couple of weeks I've noticed that this has ceased and that the lid simply folds over resulting in no visible crease, just a fat pad over my eye. Is this normal four years after surgery? Can it be remedied?

Doctor Answers 7

Normal aging process

It sounds like the patient is just having a normal aging process regarding the upper lids. The eyelids are not going to change four years after the previous surgery. Fat can be removed from the upper eyelids, and a natural crease can be created along the natural fold of the upper lid if the patient so desires, to match the opposite eyelid.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Sutures creating fold during Blepharoplasty may not have held

I agree with most of the posts and think that the sutures creating the fold are no longer helping to maintain it and that the lid may have to be redone if you want to have the earlier result.  Go to original doc or someone who specializes in this procedure.


Richard D. Gentile, MD
Youngstown Facial Plastic Surgeon
4.4 out of 5 stars 36 reviews

Corrective surgery is needed to get the double eyelid fold back.

If you want the look of the double-eyelid fold, you will need to have a corrective surgery. Make sure you go to a surgeon that performs this procedure often, get references, and see lots of pictures to make sure that you and your surgeon are on the same page as far as the result you are seeking. The preference of most of my patients, for example, is to have a natural-looking, thin but distinct fold. When done correctly, the surgery should last for many years.

Good Luck!

Thomas T. Nguyen, MD
Orange County Plastic Surgeon
3.9 out of 5 stars 19 reviews

A revisional surgery is needed

Dear Zootgirl,

The double fold surgery creates a fold in the eyelid and exposes the eyelid platform. The key to create a lasting distinct upper eyelid fold is the exposure of the anterior levator aponeurosis, the tendon of the muscle that raises the upper eyelid, in the upper eyelid and suturing the platform skin to this tendon.

By doing this carefully, not only is the crease formed but the upper eyelid lashes are also supported (think perky). This is the so-called anchor blepharoplasty.

It is important to make the upper eyelid incision relatively low and preserve fat in the upper eyelid fold to maintain an asian eyelid-the surgery is absolutely not about Westernizing the eyelid. The crease formed in this fashion tends to be permanent.

Other double fold methods such as Pang sutures often result in a loss of the fold in time. Since you were not completely happy with your original procedure, I would recommend that you find a new surgeon. It should be some one who does a lot of asian eyelids and whose work you are familiar with or some one who has done a number of your friends.

If this does not help you can look on the ASOPRS website for an eye plastic surgeon in your area but just confirm that they do Asian eyelid surgery.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Best to talk to your original surgeon

It is hard to tell from your picture. However, it is possible that the original repair is loosening. Also if your brow level has been affected, by Botox or other treatment, it can effect the dynamics of the lids by compressing more tissue into a smaller space. Regardless, it is probably best for you to follow up with your original surgeon. Good luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 77 reviews

Suture for the fold in Asian Blepharoplasty can pull out

The sutures used to produce a double fold in the Asian blepharoplasty can pull out in time.

This is not harmful. If you are happy with the appearance, I would do nothing.

Relapse of double lid surgery

I assume that you had an operation to create a so-called double eyelid. There are many methods to achieve this but some have a higher rate of relapse with loss of this double crease. You should discuss the technique with your original surgeon or seek a second opinion. You can certainly have another surgery to recreate the crease. Methods that use an incision rather than just sutures usually last longer.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 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.