Double eyelid hooding for deep set eyes

In patients with deep set eyes, there is a cliff effect that makes the upper brow skin to hood down faster than patients with protruding eyes. This physical difference is very important in double eyelid surgery and deciding how high the double eyelid fold or double eyelid crease should be. Think of a cliff. The upper brow skin in a deep set eyes does not have any support from the eyeball below. Therefore, the upper brow skin above the double eyelid fold tends to hood or drop down. This in comparison to protruding eyes, where the upper brow skin above the double eyelid fold does not hood down as much as the protruding eyeball support the upper eyelid skin from dropping or hooding.

There are two ways to compensate for the upper brow skin hooding down and making the double eyelid fold size look smaller than the desired size in deep set eyes. One is to make the double eyelid fold higher or larger. The other option is to cut out more skin above the double eyelid fold or double eyelid crease. Between the two options, it is aesthetically more favorable to make the double eyelid fold higher than to cut out more skin. This is because removing more eyelid skin will bring the thick brow skin down when the incision is closed. When the entire brow skin and brow is brought down, it further gives a puffy appearance to the eyelid. And for female patients, bringing the brow down will give a more masculine and heavy effect to the eyes rather than feminine, lighter, and refreshed appearance.

Therefore, for deep set eyes, it is important to make the double eyelid fold higher than protruding eyes when designing a double eyelid fold or double eyelid crease.