There are two types of fold loss in double eyelid surgery. One is from a suture or non-incision double eyelid surgery. The other type of fold loss is from open or incision double eyelid surgery.
When fold loss occurs from a suture technique or non-incision double eyelid surgery, it is because the surgery itself is relying on the suture to create the double eyelid fold rather than an incision adhesion. Therefore, with wear and tear / over time, the sutures rips away from the eyelid tissue. Thus, the holding power of the suture is diminished and therefore, fold loss occurs. When one is deciding to have a suture technique double eyelid surgery, fold loss over time should be expected in the future.
In an open or incision technique double eyelid surgery, fold loss can also occur. Many people think that an open or incision technique double eyelid surgery will lead to a permanent double eyelid fold for the rest of their lives. However, there are patients who also lose the fold. The most common reason why a person will lose a fold in an open or incision technique double eyelid surgery is a weak eyelid muscle function. When an eyelid does not lift properly, then an invagination does not occur and therefore, a fold adhesion does not set within 6 months postoperatively. And when this adhesion does not occur, then one is relying on a suture to create the fold which is not anything different than a suture, non-incision technique. Suture by itself is not strong enough to withstand the ten thousand eye movements per day that one’s eye blinks. So over time, the fold loosens. Another reason the double eyelid fold loosens after an open or incision technique double eyelid surgery is that the fold is made too loosely. Many patients do not want a deep fold and therefore it is a fine balance of creating enough tension to create a gentle natural appearing fold without creating an overly deep fold. When this tension is inadequate, a double eyelid fold can loosen.
In the next blog, we will determine how long should the suture technique double eyelid surgerylast.