How Do I Choose the Height of a Double Eyelid Fold?

Dr. Kenneth Kim, a board certified plastic surgeon who specializes in Korean aesthetic surgery will discuss how to choose an ideal double eyelid fold height.  Choosing the height of a double eyelid fold has a lot to do with various factors such as the patients’ eye anatomy, the size of their eyes, eyelid function, their personality, their preference, and their overall facial shape.  We will address each one of these factors.

Eye anatomy, in terms of whether their eyes are positioned in (enophthalmos) or eyes are positioned out (exophthalmos), is quite important in deciding a double eyelid fold height.  Enophthalmic eyes are positioned deeply relative to their eyelid skin and their surrounding orbital bone.  In these patients, having a relatively high double eyelid fold will lessen their chance of their eyelid skin drooping as they age. In addition, because their eyes are deeply set, having a larger fold make them look more open and refreshed.  Yet, in patients with exophthalmic eyes where their eyes are protruding, the double eyelid fold should be set relatively low.  There are two reasons for this.  One reason is mechanically, the high fold will tend to loosen in these patients as they age.  Second, a high fold will accentuate their protruding eyes and will make them look more aggressive and intense.

Another factor in choosing a double eyelid fold height is how big or small a patient’s eyes are before the surgery.  Double eyelid fold height should be proportional to their eye size.  If the eyes are small, then the fold should also be relatively small.  If the eyes are large, then the double eyelid fold should be larger to balance the fold height to eye size.

The third factor to consider is eyelid muscle function.  This is very subtle yet vital in determining double eyelid fold height.  It is subtle because most patients have difficulty understanding why eyelid muscle function will dictate double eyelid fold height.  The two anatomic factors above (eye globe position and size of their eyes) can be seen and patients may already have certain thoughts regarding them.  Yet, eyelid muscle function must be tested by the plastic surgeon when determining the double eyelid fold height.  Patients fall under the following categories of eyelid muscle function.  One category is excellent to normal eyelid muscle function.  These patients may have a high fold and will often look good with a relatively high double eyelid fold.  However, patients with mildly weak eyelid muscle function will need a slightly lower double eyelid fold height.  The reason is that when the eye elevating function is weak, their eyelid muscle cannot tolerate a high fold with all the weight that comes with a high double eyelid fold.  One exception is that they undergo 3DST® or ptosis surgery.  In patients with moderate to severe weak eyelid muscle function (moderate to severe eyelid ptosis), both the patient and the plastic surgeon will need to determine how much ptosis correction is going to be performed to enlarge the eyes and then determine the double eyelid fold height.

The next factor to consider is the patient’s personality.  Patients with an outgoing personality, who like to wear a good amount of make up, often prefer to have a higher fold. And patients with a shy personality, who do not frequently wear makeup, will prefer a smaller double eyelid fold height.  The plastic surgeon should see how the patient wears their makeup and what kind of double eyelid fold height would look good with and without makeup.  These factors should be considered and discussed when choosing a double eyelid fold height.

Lastly, the plastic surgeon should look at the patient’s overall face and determine an ideal double eyelid fold height that will make the person look natural and optimize their eye and overall facial beauty.  This ideal fold height should be discussed with the patients and the patients should also express their desires.  Fold height, if chosen incorrectly, looks awkward and unnatural.  The surgeon should test various fold heights with the patients and choose a correct fold height that will function most dynamically and appear most natural and beautiful.  If a patient’s double eyelid fold height preference is different from the surgeon’s ideal, then the plastic surgeon should consider the patient’s wish and see how the desired fold height can be accommodated.  Ultimately, the surgeon and the patient must agree on the ideal double eyelid fold height.  When both come to an agreement based on all the factors mentioned above, an ideal double eyelid fold height is determined.