How is double eyelid revision done to make eyes bigger or smaller? Do you make an incision on the old crease?

Question

1) How is double eyelid revision done to make eyes bigger or smaller? 2) Do you make an incision on the old crease and suture it inside higher or lower, or do you have to cut out the old crease and make a new crease? 3) What about revision just for ptosis sake? Do you make an incision on the same crease or make a new crease?

Kenneth D. Steinsapir, MD · Answer

Making a double eyelid larger or smaller very much depends on what is actually going on with your eyelid. The upper eyelid crease can be lowered or raised. Generally revisions are needed because the original crease was make too high. The crease is lowered by cutting the new upper eyelid crease at the desired height and then moving the tendon inside the eyelid to the desired height. If there is ptosis, it is also corrected. A hard crease is made at this location using the anchor blepharoplasty method. Depending on the nature of the previous crease, the old scars may be removed or left in place and forces under the fold. The choice of this depends on the particulars the eyelid. Finally, often scaring of the orbital septum from the original surgery can mat down orbital fat. The scar can be broken down and  the fat mobilized to fill the fold. A detailed personal consultation is the first step. There is expert help for you.

Charles S. Lee, MD, FACS · Answer

In most cases, the old scar is cut out so that you will have a single scar. The most common cause of problems with crease size is subtle ptosis that was not addressed at the time of surgery - this usually leads to an over-sized fold. Correction of the ptosis will make the crease smaller. Very small creases are frequently caused by an overly-cautious approach to the crease size - in these cases, the old scar would be ignored and a new incision made at the desired height.

Jonathan Kulbersh, MD · Answer

Thank you for your question. Unfortunately, it is impossible to make specific recommendations on the technique that will work best for you without at least a photo or two, or better yet - an in-person consultation. The technique used will depend on factors like where your crease is currently situated and the results you are hoping to achieve. In some cases, the original crease is in a good position. Other times, it must be recreated in a more aesthetically pleasing location. Ptosis can also be corrected, although it also depends on where the original crease is located as to whether the incision will be placed in the crease or a different location. 
The most important factor to consider when preparing for double eyelid surgery is to work with a board-certified plastic surgeon with expertise in Asian blepharoplasty. An experienced surgeon will carefully create all incisions so they will be safely hidden in the natural creases of the eye. You can also rest assured your surgery will be safe and produce an optimal outcome when you work with the best surgeon for the job.

Hugo Higa, MD · Answer

Hi,Addressing your questions:1) How is double eyelid revision done to make eyes bigger or smaller? Generally double eyelid surgery is performed to give the "impression" of a larger eye.  The distance between the upper lid and lower lid margins (aka palpebral fissure) remain the same as if the double crease were not created.    If ptosis surgery is performed along with the lid crease formation and/or the surgery is performed to primarily remove skin, then the palpebral fissure maybe enlarged.  2) Do you make an incision on the old crease and suture it inside higher or lower, or do you have to cut out the old crease and make a new crease? If the old crease is at desired height then it can be used.  If the crease is too low, then a higher crease can be formed.  If the crease is too high, then the lower crease is created.  Scarring can be encountered when performing this surgery so it is important to either leave enough upper lid skin to drape over the crease if the previous crease was too low.  If the crease was too high, careful skin removal is imperative.  This is done to allow the skin above the previously higher crease to cover it.3) What about revision just for ptosis sake? Do you make an incision on the same crease or make a new crease?If the crease is at the desired height, then it's fine to make the incision at this site.  If not, then it's fine to change the height.  Crease height doesn't affect ptosis repair results.Hope this helps

Curtis Perry, MD · Answer

Sometimes the placement of the new crease is where the original crease is. Other times it is farther back. It all depends on who much lid show the patient wants..

How is double eyelid revision done to make eyes bigger or smaller? Do you make an incision on the old crease?

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