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Woman: I had incisional double eyelid surgery nine months ago and I'm thinking of a revision of my left eye. Are my expectations realistic? I have been experiencing problems with allergies and swelling and the crease in my left eye will temporarily disappear. Also, I don't feel fully satisfied with the appearance of the crease as it doesn't match my right eye. The crease is folding above the incision line. My surgeon has offered the suture method as a revision. I applied some eyelid tape along my incision line to stimulate what this might look like. Is this a realistic expectation or is there a chance of an undesirable result?

Dr. Amiya Prasad: Thank you for your question. In your question you submitted you asked about having undergone incisional Asian eyelid surgery approximately nine months prior and that you have a desire for a different type of eyelid crease. You mentioned that your doctor had suggested doing the suture method and you applied a tape that shows what your desired outcome is that you want. Your question is certainly a very reasonable question. The challenge of Asian eyelid surgery has to do with several factors when we're doing this type of procedure because no two surgeries are exactly the same. There are factors that include whether or not there's excess skin, whether or not skin the skin is thick or thin, whether or not there is fat present as well as the intraoperative issues such as the connection made between the skin and the levator muscle and how well that holds.

When you place a piece of tape on the eyelid margin, it actually forces the eyelid to crease inward. However, I would suggest that since the absence of a physical exam and not being able to tell what your skin quality is and whether or not this is something that your eyelid would cooperate with, I think that it is conceivable that with a non-incisional method or the suture technique that your surgeon suggested that it is possible to achieve this type of result. Now, this is with one basic condition. If there is a skin shortage, it is that when you close your eyes, if the eyelid skin pushes forward away from the underlying muscle then that crease is not likely to hold very well. If however with the tape in place and your eyes close well and your surgeon seems to feel that this is possible then it is probably worth pursuing. As long as there's no issue with excess skin which probably there is not, then a non-incisional approach or a suture method can create the necessary fixation that the eyelid skin requires in order to be able to fold in at a desirable height.

I think that the best case scenario now is to discuss this with your surgeon. If your surgeon feels comfortable and confident with doing this, I would say that this is a relatively low risk procedure in general since no skin is being removed, the eyelid is not being opened up fully. It's just the several little entry points along the desired crease level is placed and then the suture’s placed through those entry points to engage the levator muscle.

I think that is a pretty decent option in terms of trying to achieve that eyelid fold. Again, meet with your doctor and be clear about what the process will be like and what the likelihood of that desired outcome will be and then move forward.

I hope that was helpful. I wish you the best of luck. Thank you for your question.

Asian Eyelid Surgery Without an Incision Could Be a Worthwhile Alternative

Dr. Amiya Prasad details some of pre-operative and post-operative factors that can affect Asian eyelid surgery results and discusses why the non-incisional revision is a relatively low-risk option.