Prior natural fold vs. new double eyelid fold

In patients with natural double eyelid fold or double eyelid crease, they are concerned about their natural double eyelid fold will be affected by the new surgically created double eyelid fold. One may wonder why one would have a new surgically created fold if a patient already has a natural double eyelid fold? That is because the patient’s natural double eyelid fold can be too small, too large, or there can be hooding from overlying excess skin or have eyelid ptosis.

If the natural double eyelid fold is too small, then creating a larger or higher double eyelid will not negatively affect the lower double fold. And the prior lower double eyelid fold will not negatively affect the higher double eyelid fold. That is because people will only notice the higher fold. However, for patients with a natural high double eyelid fold, the newly created lower double eyelid fold tension has to be greater than that of a high natural double eyelid fold. It is often unnecessary to release the prior high natural double eyelid fold in these cases as the natural double eyelid fold tension is weak. If the high double eyelid fold was created surgically, then a more extensive dual plane dissection has to be performed to fully release the upper double eyelid fold.

In a case where we are staying with the patient’s natural double eyelid fold height, then, prior to closing the incision after excising excess skin or correcting eyelid ptosis, it is important to recreate the double eyelid fold. If the double eyelid fold is not recreated, then the double eyelid fold will look weak and uneven.