One Eyelid Has Multiple Creases and the Other Does Not? (photo)

Question

One of my eyelids have multiple creases, and I guess the other is normal. I was wondering, what is the best way to fix this? Would it be better if I used eyelid tape on the normal eye to make the crease higher, or get the eyelid with multiple creases fixed? If I try to fix the one with multiple creases, how so? I've had this for a few years now, so I don't think it'll go away naturally. It really bothers me, especially since people look at the eyes when talking to each other.

Charles S. Lee, MD, FACS · Answer

Although the right eye is the one bothering you, the cause of the problem more likely lies in your left eye, which is slightly droopy. To maximize symmetry, both eyes should be corrected: the left eye opening muscle needs to be strengthened and a crease placed to match the opposite eye; and the right eye needs the multiple folds (probably loose fibers of the eyelid opening muscle) anchored down for a crisper fold to match the left eye.

A.J. Amadi, MD · Answer

Reconstructing a proper eyelid crease is a common procedure in asian eyelids. This can be done with  excision of small strip of skin and re-establishing the skin edge with the underlying muscle.

	Your best bet is consultation with an Oculoplastics surgeon, or a facial plastic surgeon with extensive experience in Asian blepharoplasty.

Kenneth D. Steinsapir, MD · Answer

Mochii 

	As you correctly intuit, the two eyes are different and both should be addressed surgically to give you an opportunity to have the best possible result.  The right upper eyelid has multiple folds because the skin of the eyelid platform is loose.  This can be addressed with a very precise anchor blepharoplasty.  The left upper eyelid has a better appearing double fold but the eyelid is heavy and if this is fixed without also performing double fold surgery, it will appear as if there is no double fold on this side.  A detailed consultation could address if the difference in appearance of the two sides is actually due to overaction of the frontalis on the right side due to the heavy upper eyelid on the left side (Herring's law).

Leo Kim, FRACS(Plast), MS(Plast), MBBS(Hons) · Answer

A few things about your photo- the first noticeable thing is uneven eyelids obvious to you and second one is the thickness of your skin +/- excess fat (this impacts the type of surgery you need) and third important fact for you is the relative position of your LOWER eyelid in relation to your eye. 
1) Uneven eyelids- relatively straight forward to correct, this asymmetry or unevenness is very common 2) Thickness of your skin+/- fat means you potentially need either an open approach or at least a partial open approach. If you have a closed suture technique it may 1) have higher chance of coming undone needing a second operation 2) not address the excess fat that need to be reduced so that you get less puffiness and "tired" look at the end and at the beginning of the day and 3) looking at your skin the thickness will make closed technique difficult too look natural and it all about making it look natural.
3) Your lower eyelid- why am I talking about your lower lid when you're worried about the upper eyelid (and I am NOT advocating you get your lower lids addressed) ? Because you may have what's called Morphologically Prone Eyes (and there's no way of knowing this whiteout a thorough examination and history so consult your local Specialist Plastic Surgeon) and those are special group of patients that need special attention whenever you operate anywhere near the eye/eyelid. I say this because the colour part of your eye appears to (within limitation of the photo) be away from your lower lid.
Wish you the best in your journey.
Dr Leo Kim, Specialist Plastic Surgeon in Sydney

Jeffrey M. Joseph, MD · Answer

The eyelid anatomy in those of asian descent is unique. So are the goals of surgery. Forming a low, natural crease, remove a small amount of skin, repositioning some of the eyelid fat, may all be options to help you reach your goal.

William Portuese, MD · Answer

One eyelid crease is lower than the other.  The left upper lid crease can be raised to match the opposite side with a unilateral blepharoplasty.

Chase Lay, MD · Answer

Morning Mochii,

	 

	I see this in my clinic about once a week.  This is not a unique issue and can be dealt with with upper eyelid surgery under local anesthesia.  Essentially your lid with the multiple creases has weak and multiple attachments to underlying anatomy where as the apposing is uniform.  
	A physical exam is required and surgery may be required on both eyes for good symmetry.  You're healing time would be about a week with 2 to 3 weeks for swelling to go down to the point they look even.  Here is a link and video that may be helpful.

	 

	I hope that was helpful.  

	 

	Chase Lay, MD

One Eyelid Has Multiple Creases and the Other Does Not? (photo)

Answers (7)