Patients often ask whether there is an ideal double eyelid fold or crease height. This is because the patient or the plastic surgeon can make a high double eyelid fold, medium double eyelid fold, and a low double eyelid fold with a metal wire applicator. At home, patients can also make a double eyelid fold with a tape or a glue. If a metal wire applicator or tape or a glue can make any size double eyelid fold, is there an ideal double eyelid fold height for surgery? The answer is yes. This is because the wire, tape, or a glue is different than surgery. A wire, tape or a glue superficially puts pressure on the skin to create a double eyelid crease. However, for surgery, the double eyelid fold occurs when there is a connection from the skin to the deeper layer of the eyelid known as the tarsus and levator aponeurosis.
A tarsus is a cartilaginous structure that gives firmness to the eyelid. Everyone has a different height and shape of the tarsus. When a double eyelid fold is attached to this upper layer of the tarsus, then a smooth, thin, and natural double eyelid fold occurs. However, if the double eyelid fold is attached higher than the tarsus such as the upper aspect of the levator aponeurosis, then a puffy double eyelid fold occurs. And if the double eyelid fold is made to the lower aspect of the tarsus, then a small, unattractive fold can occur. If the skin incision is made too low and the double eyelid fold is made to the upper aspect of the tarsus or the levator aponeurosis, then eyelash eversion can occur.
Interestingly, the eyelid skin that is transposing the tarsus is a very thin eyelid skin. And the junction between this thin eyelid skin and the medium size skin is at the exact upper aspect of the tarsus. Therefore, when the double eyelid fold is created at the junction, a perfect, smooth, and natural appearing double eyelid fold occurs.