Extra line after double eyelid surgery. Is this normal? (Photo)

Thank you for your question. You submitted a single photo and state you underwent Asian upper eyelid surgery about 4 weeks earlier, and are worried about an additional crease or fold  pointing towards your nose, so you want to know if this is normal.
I can share with you my perspective about your situation in this stage as Asian eyelid surgery is a significant part of my practice. Patients come to us from around the world for this type of surgery, both primary and revision surgery. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Asian eyelid surgery is a practice focus for us, and I can basically give you an understanding I suspect your surgeon also shared with you.
Asian eyelid surgery in principle is about creating a connection,whether it’s non-incisional or incisional, between the skin and a muscle called a levator aponeurosis, or the levator palpebrae muscle. Stitches are placed to make that connection between the eyelid and the new crease, and this is an area where a lot of fluid can collect. What I see in your photo is swelling, which affects the skin from the margin to the crease, and above the crease. What is unique in Asian eyelid surgery is this swelling can persist for months. It goes down slowly, but it can be significant enough to affect the area and the appearance, so it does require time.
Based on this appearance, it looks like your doctor did a nasally tapered crease. That’s important because it was designed to stop just short of the epicanthal fold, so it’s not likely there’s much tension that would be pulling the eyelid skin parallel to the epicanthal fold. There are two  basic types of creases in Asian eyelid surgery: the nasally tapered crease, and the parallel crease. As this most likely is a nasally tapered crease, I suspect this fold is more of a result of tension and swelling. As the tension and swelling diminishes, and the area matures, it’s likely to be less significant.
It’s important you understand the stages of wound healing. Although we are very proud of helping our patients get back to work as early as a week after surgery, it is still important to understand that the body goes through very specific stages of healing. The first month is the proliferative stage where a lot of collagen is produced, a lot of blood supply, and a lot of activity that causes swelling. It’s understandable to be concerned, but I think you have to allow this area to heal for several months, so allow at least 3-6 months.
It’s very important you speak to your doctor about this. In our practice, we see our patients fairly frequently, particularly after Asian eyelid surgery. In the first few months, we see a patient like yourself every month just to monitor the process, see how the swelling is resolving, give guidance about how things are going, and show the progress so you get a better sense of how, even though it doesn’t look like a lot of change over time, there is significant change. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Assuming you have had surgery performed by a Board Certified Facial Plastic or Oculoplastic  surgeon, you have nothing to worry about.  It is not unusual to have  some degree of persisting swelling lasting 3 to 6 months following surgery to the upper eyelids-this mild edema and swelling can cause all sorts of transient wrinkles and creases that over the twelve months following surgery will gradually resolve.  Some individuals who have had not only an upper eyelid crease formed, but who have also had a modest to extensive amount of skin resected at the same time-may indeed have some changes to the eyelid skin surface realized as new minor creasing or wrinkles-discuss this with your talented surgeon to see where this might lead.  At four weeks your symmetry and initial eyelid appearance looks fantastic-lucky you for choosing such a great surgeon !!

This is common when a parallel crease is surgically created in a person who naturally has a tapered crease or a pronounced epicanthal fold.  It should become more subtle after the swelling subsides (usually wait till at least 6 months).  Otherwise, some patients would choose to undergo medial epicanthoplasty to soften the epicanthal folds.