Upper eyelid Incision too high. Any suggestions?

Question

When I went in for my consultation same day surgery I told the surgeon what I wanted. He used a metal paper clip and measured my eyes it was placed high, so I asked him if that was how high it would be - he didn't say much just showed me a purple sharpie and drew on my eyelid he asked me if that was ok. Honestly, I really dont know what he did. My surgeon just now told me my crease were 10mm! What I want to know is will the height go down as it heal or am I going to have revision to fix this??

Kenneth D. Steinsapir, MD · Answer

For those of you out there considering double fold surgery, it is essential that your surgeon actually knows something about double fold surgery and Asian eyelids.  These creases are much too high.  I see this situation all too often.  In the next few weeks the appearance will soften. You need to heal about 6 months before having a revisional surgery in my opinion.  It is likely that you can be improved.  While it is challenging to lower the apparent height of the upper eyelid crease, it is not impossible.  I am attaching a link for a free copy of my ebook that has a discussion of this issue and examples of how these situations can be improved.  Please try not to beat yourself up for this situation.  It is very difficult to know who to trust.  Your surgeon probably thinks they did a great job.  Remember it is not your fault this happened and there is help out there but it is highly improbable that someone in your community will be able to fix this.  If you become clinical depressed because of your appearance, I strongly recommend working with a mental health professional during this time to address your strong feelings if they are keeping you from working and socializing.

Andrew Campbell, MD · Answer

10mm seems pretty high for you, but the lid crease does typically drop as it heals. Only time will tell if it will drop enough to be satisfactory to you. Otherwise, a minor revision should help.Andrew Campbell, M.D.Facial Plastic SpecialistQuintessa Aesthetic Centers

John Michael Thomassen, MD · Answer

This will improve with time. It may appear excessively long but as swelling resolves it will diminish.  Ten mm of pretarsal show is about average for women and in your case once it decreases with resolution of swelling, it should be fine.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and photo. The incisions look slightly high, but considering you are only 6 days post op, it is too early to judge results. Wait 2-3 months and then repost your photos please. This will make it easier to evaluate your pitenresults.Good luck.

John A. Standefer Jr., MD, FACS · Answer

Thank you for your inquiry. Rest assured that your eyelid appearance will improve greatly as the swelling goes down. The problem with the height of the incision appears to be a lack of communication.  There is a vast difference in the height of an Asian vs. a Western eyelid crease. While many Asians want a more Western eyelid, most want to preserve their heritage. The height of the Western eyelid is closer to the 10mm that you mentioned while the Asian crease is closer to the 7-9 mm. There is a difference in the single vs. the double eyelid as well. Additionally, there are differences in desires of some on the shape of the epicanthal folds of skin in the nasal end of the incisions. Goals for all of these issues need to be discussed pre-operatively so that both patient and surgeon are on the same page. Give the scars time to heal and the swelling to resolve and then discuss with your surgeon what if any revision needs to be made.John Standefer MD

Upper eyelid Incision too high. Any suggestions?

Answers (5)

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