Correcting Multiple Folds into a Single Line: Triple Eyelids Caused by Eyelid Loosening

Correcting multiple lines into a single line in triple eyelids caused by double eyelid loosening.

I would like to post about this specific condition today.

Let me explain with an example. This patient had undergone incisional ptosis correction and upper eyelid fat repositioning (?) several years ago.

However, immediately after the first surgery, multiple folds began to form, creating what is known as triple eyelids or multi-layered eyelids.

She underwent another revision surgery a year before visiting our clinic, but the issue remained unresolved.

In the photo, the lower part is the original incision line, but the fold is occurring in an unwanted area above it.

Please refer to the video.

The patient seemed to have consulted many clinics. She visited our clinic for multiple consultations and made her decision very carefully.

Other clinics strongly recommended fat grafting, but personally, I am not a fan of injecting fat into the upper eyelids.

While general fat grafting is fine, I am particularly cautious about the upper eyelid area.

That said, upper eyelid fat grafting can yield good results if done skillfully, and I do perform it in quite a few cases myself.

The reasons I generally avoid it are:

1. If the patient gains weight later, the grafted fat also increases in volume.

2. Many cases can be resolved through fat repositioning and ptosis correction alone (depending on the surgeon’s specific technique).

However, since I also achieve good results when I do perform fat grafting, if I recommend it, please consider it necessary. In patients with these types of multiple folds, fat grafting is only required in about 10% of cases.

This is the appearance immediately after surgery. We deliberated on whether to include fat grafting, but for this patient, we decided to proceed without it for now.

Appearance after stitch removal (1 week post-op).

Until the one-month mark, the area is still settling due to swelling and scarring, so cases like this require continuous monitoring.

The eyes may temporarily look smaller, scars may protrude, or the line may appear higher than intended.

At one month, a faint line is visible above the double eyelid. This is the old fold line appearing slightly like a wrinkle as the swelling subsides. However, as the swelling continues to decrease and the scar tissue settles, the line will lower and the wrinkle will begin to disappear.

Finally, at the 3-month mark... She visited for a follow-up before the Chuseok holiday. The small upper wrinkle has vanished, the line has lowered as swelling subsided, and the eyes look slightly larger.

This patient did not undergo additional ptosis correction.

I was very grateful for her kind words wishing me a happy holiday as she left. I look forward to seeing her again in another three months in even better condition.

Comparing the before and after, you can see that the mucosal exposure (eyelid flipping) on the right side (left side of the photo) has also been improved.

Please also refer to previous related content.

https://blog.naver.com/medicdoctor/222157893648

Frequently Asked Questions

Is fat grafting on the upper eyelid absolutely necessary for triple eyelid revision surgery?

No, it is not absolutely necessary. Upper eyelid fat grafting can have the side effect of gaining fat in that area with weight gain, so it is only recommended for about 10% of patients who truly need it. In many cases, fat repositioning alone can resolve the issue.

How long is the recovery period after multiple eyelid fold correction surgery?

Generally, stitches are removed one week after surgery, and the period up to one month is when swelling and scars settle. After about three months, the swelling subsides, the line naturally lowers, and fine wrinkles disappear.

Is it normal to see a slight old double eyelid fold line one month after surgery?

Yes, it is a normal part of the recovery process. One month after surgery, as the swelling subsides, the previously folded line may appear as a fine wrinkle. However, as time passes, more swelling goes down, and the scar stabilizes, these wrinkles gradually disappear.

Should blepharoptosis correction be performed together with triple eyelid correction?

No, it depends on the patient's condition. The patient in the example case successfully corrected multiple lines into a single line without additional blepharoptosis correction surgery. It should be decided after consultation with a specialist.