Correcting Multiple Eyelid Folds (feat. Triple Folds After Revision Blepharoplasty)

Correcting Multiple Eyelid Folds (feat. Triple Folds After Revision Blepharoplasty)

This post is about addressing multiple eyelid creases.

This patient was referred to our clinic by a director at another hospital.

I am grateful to the colleague who responsibly referred this patient to us. Everyone has their own area of expertise, and I promised to do my absolute best for this patient.​

The upper eyelid lacks volume, and multiple folds are visible.

There are various causes for this condition:

First, specific adhesions. If tissue damage occurs and unwanted adhesions form, that area becomes sunken, leading to multiple folds.

Second, a lack of volume. This happens when too much tissue was removed from the upper eyelid, or if there is a congenital lack of fat or a thin orbicularis oculi muscle.

In such cases, triple folds can occur.

Third, damage to the levator muscle. Adhesions forming at the site of the damaged muscle can cause this issue.

Surgery is performed accordingly.

The principle of the surgery is to thoroughly release the adhesions and ensure they do not reform.

In this patient’s case, there were adhesions and slight damage to a portion of the levator muscle due to a previous revision surgery.

While it didn’t hinder the ability to open the eyes, it made the area prone to adhesions and multiple folds.

Furthermore, the double eyelid crease was at risk of loosening.

The success of the surgery can be determined immediately afterward.

Immediately after surgery, multiple folds should not be present. If they do appear right away, it is usually for two reasons: first, the adhesions were not properly dissected.

Second, it could be a lack of volume in the upper eye area due to a lack of swelling. This is rare and requires experienced clinical judgment.​

If you look at the video, this is the appearance when the stitches were removed. Do you see an extra line folding above the double eyelid line?

In these cases, patients can become very anxious, wondering, ‘Did something go wrong again?’ or ‘Was the surgery a failure?’

Let me explain why this happens.

After surgery, swelling below the incision line lasts longer than the swelling above it.

In other words, the upper swelling subsides first, making the area below the incision relatively firmer.

When the eye opens, this firm area pushes against the upper part, causing a fold.

This improves over time, but only the surgeon knows for sure. If the surgeon determines that fat repositioning and grafting were performed perfectly during surgery, the patient must wait. Patients should not panic.

However, early revision is necessary in the following case: if the eye folds only at the top with almost no sensation of folding at the actual incision line, early correction is required. Please refer to the blog post below.

Case Study: Early Correction and Early Revision of Double Eyelids : Naver Blog (naver.com)

This patient waited as I requested, and here is the appearance at the 2-month follow-up.

Looking closely, you can see it has improved significantly compared to before.

This is the appearance at 6 months.

The multiple folds have completely disappeared.

For ‘malignant’ multiple eyelid folds, various techniques must be used to prevent recurrence, and the patient must be patient. It can be distressing when results aren’t immediate after a revision surgery, but trusting your surgeon and following instructions will lead to a good outcome.

However, if early correction is indeed necessary, you must consult with your surgeon and proceed immediately.

Since patients cannot make this judgment themselves, you must consult an expert. A non-expert will not be able to determine whether early correction is needed or if it can be left alone, which could lead to missing the ‘golden time’ for correction.