Case Study: Eyelid Retraction and Double-Line Lowering (Extremely High Crease)

Looking at this patient’s eyes, the left side is relatively fine, but the right side appears startled, as if the eye is opened too wide.

This is especially noticeable when magnified.

The white of the eye (sclera) is almost fully exposed.

When the eyes are closed, there is severe scarring and the crease is absurdly high—a so-called ‘sausage eyelid.’

In most cases, men prefer the double eyelid crease to be invisible, focusing only on the clarity of the eye itself. To achieve this, the crease must be lowered so that the upper skin can drape over and conceal it.

To explain further:

The area marked in red indicates where the skin should cover from the front to hide the double eyelid crease.

This patient lacked sufficient tissue in the upper eyelid and had severe scarring, making the risk of re-adhesion very high. To prevent this, various advanced techniques were required. I used a specialized material currently being researched with a professor at Korea University to act as an anti-adhesion barrier, along with fat repositioning.

Eyelid retraction surgery is particularly prone to re-adhesion because the levator palpebrae superioris muscle moves upward. Since this is highly technical, I will skip the finer details.

One week after surgery: The patient’s right eye (left side in the photo) shows a lowered crease and corrected retraction.

However, this is not the end. Re-adhesion typically occurs between 2 weeks and 2 months post-op. I anticipated this for this patient as well. In the photo above, you can see a faint hint of the original crease line.

Here is the progress at 1 month.

The patient mentioned that when he opens his eyes with more force, an extra layer folds above the crease.

Since I had anticipated this, I reassured the patient and explained that it would improve over time. This happens partly due to adhesion, but in this case, it was because of a slight hollow caused by a lack of volume in the upper area, combined with lingering swelling in the lower crease preventing it from tucking in properly.

Most patients who have undergone multiple surgeries experience immense stress regarding potential failure and may find it difficult to trust the process. Fortunately, this patient placed his trust in me.

At 3 months, the extra line no longer forms even when opening the eyes wide, as the swelling below the crease has subsided.

This is the final result at 6 months. The crease is successfully lowered, the retraction is corrected, and no triple folds occur.

To reiterate, these photos are of an actual patient and have not been edited with Photoshop; only basic screen capture was used for cropping.

Before surgery / 6 months post-surgery