How to Turn Tapered Lids with Multiple Folds into Uniform Lids with Parallel Folds? (photo)

I have uneven, tapered lids with different, multiple folds underneath my eye creases. I want to change my lids to a uniform and even parallel eye crease, but I am not sure which procedures are necessary for the results I want. At the very least, I would like to get rid of the multiple folds beneath my crease, while retaining my tapered lids. I would appreciate any medical advice on the procedures I should consider. I am also curious as to why my eyelids fold as they do now. Thank you!

Doctor Answers 6

Correcting Asian eyelid shape

Thank you for your question about changing the shape of your eyelids.

  • Your eyelid shape is from lack of attachment of a deep muscle called the levator palpebrae to the eyelid skin.
  • The multiple folds are from unwanted muscle attachments lower on the lid. 
  • Surgery creates a parallel fold by attaching the levator palpebrae muscle to the skin and releasing unwanted attachments - called an Asian eyelid correction. Hope this helps!

Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Improving multiple creases

Mulitple creases in the upper lid skin are often an indication that attachments of the main crease are loose in a sense. By surgically creating  a tighter more deeply attached main crease this often puts the skin on a stretch and improves the variable multiple creases below. I have found that the anchor technique where the oribularis muscle is attached with permanent sutures to the levator muscle often improves these folds more that the standard skin attachment double eyelid procedure. I dont recomend the simple suture technique for this as it does not produce enough skin tightening.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Multiple eyelid folds

Many people have multiple upper eyelid folds because there is no solid attachment between the skin and the mechanism that raises the eyelid.  About 50% of Asians have a nice fold (double lid) while the other 50% has no fold, incomplete, or multiple folds.  In your case, an operation calle Asian blepharoplasty (double eyelid operation) would give you one distinct fold with your same taper.  Seek a consultation with a surgeon who does this type of surgery on a regular basis.  I hope this helps.

Clyde H. Ishii, MD, FACS
Honolulu Plastic Surgeon
4.3 out of 5 stars 4 reviews

Crease reformation surgery

You will benefit from lid crease reformation blepharoplasty with a small ellipse of skin excision. Reinforcing the skin attachements to the underlying levator muscle will help achieve this.

Make sure you find a surgeon with good experience with Asian Blepharoplasty.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 36 reviews

Actually, so-call supratarsal fixation will cause your crease to be too high.

Each redundant crease represents at attachment between the skin and the levator aponeurosis.  An open incisional surgery is need with removal of skin below the new crease is needed.  Properly done this places the skin of the eyelid platform on a slight stretch which supports the upper eyelid lashes.  The crease needs to made low.  Looking at your photos the height is likely to be about 5.5 mm above the eyelashes.  Regarding tapered vs parallel double fold, this is really a question about taking your inside fold to an outside fold.  I do not recommend this.  The reason is that the epicanthoplasty needed for this can also leave visible scaring on the face.  Generally it is not worth taking this risk.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Incisional upper blepharoplasty with supratarsal fixation

There is a muscle in your upper eyelid called the levator which has dermal (skin) attachments.  These connections between the muscle and the skin form the crease.  When there is excess skin, or when the attachments are weak, there can be some variation from a single, definied crease to having no fold, or multiple, poorly-defined folds.

An incisional blepharoplasty with supratarsal fixation will remove any excess skin, and recreate a strong connection between the muscle and the skin to recreate a single, parallel fold.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.