Botox or surgery for shifting eyelid crease? (Photo)

Thank you Luna bella for posting your question here.I will start by saying that my answer is based on the limited information and pictures provided , for a more bespoke plan please consult with your plastic surgeon in person.
From the limited information provided , you do appear to have ptosis this can happen from a number of reasons but just based on the pictures and your symptoms it is likely that it is the result of "levator dehiscence" it happens when the levator muscle (eyelid muscle) separates from it's insertion site. this will change your crease and lead to eyelid drooping, so the eyebrow will try to compensate for the droop by elevating. This issue is usually corrected through surgery .
I hope this helps, best of luck!

I would try injecting 2-3 units of Botox above the brow arch to lower the eyebrow. This should lower the crease as well. I would try that before considering surgery.

Thank you for your detailed question and photo. What you’re describing—a shifting or newly formed triple eyelid crease, is quite common and often related to muscle imbalance, eyebrow elevation, skin laxity, or subtle changes in fat distribution. This can result in an asymmetric or unstable eyelid fold, especially during blinking or facial movement.

To achieve a permanent result you would benefit from an upper lid Blepharoplasty. In these procedures the surgeon is able to remove any excess skin or fat that causes the extra flap or crease to the eyelid.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It sounds like you're experiencing some changes in your eyelid crease that can be concerning. Botox can be effective in relaxing the muscles around the eyebrow and eyelid, potentially helping to lower the eyebrow and create a more defined crease. However, the results can vary based on individual anatomy and the underlying cause of the issue. I suggest trying Botox as a first step, it might be a good option to see if it provides the desired improvement without jumping straight to surgery. If you don’t see the results you want or if the issue persists, then considering surgery may be the next step. I hope this helps and best of luck!

The reason for that is that we simply to not train our eyelid plastic surgeons with sufficient understanding of internal eyelid anatomy for them to understand why your eyelid is doing this. You Have upper eyelid ptosis with a compensatory eyebrow elevation. Freezing the forehead with Botox will drop the affected eyebrow but it won't fix the upper eyelid ptosis. You eyelid has multiple creases because you have a central levator disinsertion with retraction of the levator aponeurosis and preaponeurotic fat pad. The subbrow fat pad, which also contributes volume to the upper eyelid fold, is also elevated out of position by the compensatory eyebrow elevation. The fix is to repair the aponeurotic disinsertion. During a detailed consultation, I would also assess your upper eyelid ptosis, assess you risk of Herring' law ptosis. A discussion needs to be had regarding your preferences for fold shape, platform show, and lid margin height. To not get talked into posterior approach ptosis surgery. This does not address your issues. Do not get talked into filler or grafted fat to add volume to the upper eyelid fold. Your eyes can be your best feature.

Though an in person evaluation is best, based on the photos it appears you would benefit from an upper blepharoplasty. This surgery removes excess skin and can improve symmetry of the upper lids. Botox may give you some improvement, but surgery would be more notable and permanent.

In general, adjustment of the upper eyelid crease is performed using surgery to create scar in a location that is desired and connecting the deeper structures to the eye lid skin at that precise location. The creation of the natural supratarsal crease is often done in pediatric, post traumatic, senile, and asian eyelid procedures.
Botox on the other hand weakens muscle function temporarily and the consequence is less tone and lowering of the skin that was elevated by that muscle in its normal function.
Trust your face with a craniofacial surgeon!