Type of Crease in Upper Blepharoplasty?

Hi, I'm considering upper blephroplasty, but concerned about looking like Cher...high crease. I've always had fullness in my lid area above my eye and only want to recreate my old eyes by eliminating the excess skin but retaining the full area. Is there only one type/way of doing a blephropasty (crease height) or is there some terminology for making sure my doctor fully understands that my eyes were always fuller and didn't have that high crease look I see so often? Many thanks!!!

Doctor Answers 16

It is critical to preserve the natural fullness of the upper eyelid fold.

Dear Ask

It is critical to have a very clear understanding with your potential surgeon.  Many surgeons feel it is their job to remove skin, muscle and fat.  The textbooks describe the placement of the upper eyelid incision at too high a position (in some cases as high as 10 mm).  This is a factor in overexicision of the upper eyelid fold.  Many eyelid surgeons are poorly trained and do not know how to reliably expose the levator aponeurosis or perform anchor blepharoplasty which helps address eye lash ptosis and provides a reliable and well defined upper eyelid crease.  By preserving upper fold fullness and defining eyelid details, it is possible to preserve and enhance upper eyelid structure in a way that does not suggest that you have had eyelid surgery.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Upper blepharoplasty

I understand your concern.  Years ago, the idea of blepharoplasty was to remove too much fat from the upper eyelids, which gave it a hollow appearance with "high" crease.   It is best to preserve all, or most, of the fat in the upper eyelids, which would give the youthful appearance you desire.  The incision itself is fairly standard, about 10mm above the lashes.

Dr Taban

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Upper eye lid surgery

A conservative approach to the upper eye lid is a good thing. Sometimes upper eyelids can look hollow if overdone.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Natural Upper Blepharoplasty

There are many ways to do an Upper Blepharoplasty. The old, “standard” way was to remove fat from the area as well as extra skin. This created a deep-set eye but gave a hollower look. I have almost stopped removing fat from the upper lids, but, instead, remove only the excess skin. Occasionally, I will, even, add fat. Before selecting the position of the lower incision, I look at where the natural crease is. You need to discuss your desires with whomever you see. If they insist on removing all the fat or do not seem to be listening to your desires, see someone else.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Upper lid crease

In the caucasian eyelid, the incision is placed in the supratarsa crease> this is where the muscle of the eye inserts into the skin and therefore retracts when the eye is opened. If no crease can be easily found, the incision should be 8-13 millimeters above the lash line.

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Lids should look full after upper blepharoplasty.


This is an excellent observation.  Young attractive eyes have full upper eyelids.  Plastic surgeons have tended to ignore this until very recently, and a lot of women after Blepharoplasty have had a hollow look with high creases.

But we are becoming more sophisticated.  For most patients, the right thing to do is to remove skin only (and conservatively), and to place the scars low on the eyelids.  More and more plastic surgeons are now doing this type of surgery.

So just ask to see a lot of before and after pictures.  You will see very quickly what your particular surgeon does.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Avoiding the "hollow" look

In years past, surgeons would excise upper eyelid muscle and fat when doing an upper eyelid blepharoplasty.  We have since realized that at patients age, this would lead to a hollow, high crease look in patients. Nowadays, most surgeons have realized that this is not an ideal appearance, and that a full looking eyelid is actually a more youthful appearance.

So in relaying you desires to your surgeon, make sure you indicate that you want to avoid the hollow look, and that he/she should remove only skin, and leave fat and muscle behind to give you the "full apearance" that you are looking for.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Lid crease in upper blepharoplasty

There are very definitely multiple approaches to upper blepharoplasty, and ways specifically to avoid an elevated crease and deep hollowing of the lid.  These include a lower incision placement, avoiding orbicularis muscle resection and minimizing the removal of fat from the upper lid.  Be certain that whomever you select as a surgeon is especially skilled in eyelid surgery.  A consultation with a member of the ASOPRS  (ophthalmic plastic surgery society) is recommended.

Alan B. Brackup, MD, FACS
Philadelphia Oculoplastic Surgeon
5.0 out of 5 stars 29 reviews

Placement of Upper Eyelid Crease after Blepharoplasty

The position of the upper eyelid crease is an important part of the upper eyelid procedure. The final placement of the incision can change the look of the eye, giving a patient a deep set upper eyelid versus a more closed look. It is very important for the patient to share their particular likes and dislikes with the surgeon. If the surgeon is not interested in your goals and desires to proceed with their goals-go interview another surgeon.

 The placement of the crease is important in many different cultures, Asian, Irish, northern European, etc. Placing a high crease in these patients who have never had this before, will generally give them a very different look. A computer imager, photos of eyes in magazines, and other patient photos are all good communication tools.

If a patient has a long upper eyelid crease, it could be a sign of the upper eyelid muscle beginning to weaken causing the upper eyelid to droop. The surgeon should evaluate you for this condition and if present recommend the appropriate treatment.

Brian Maloney, MD, FACS
Atlanta Facial Plastic Surgeon
4.7 out of 5 stars 30 reviews

Crease in Upper Blepharoplasty

Absolutely this is possible.  This can be achieved, provided that your surgeon is experienced in blepharoplasty surgery.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 128 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.