There are few reasons why double eyelid fold loss occurs after a suture technique double eyelid surgery.
If a patient has eyelid ptosis (weakness of eyelid elevating muscle), the fold loss will likely occur. And this is especially evident in patients with unilateral eyelid ptosis. In these patients, one will lose the fold on the side with the eyelid ptosis first. And when they think carefully about the side of the eye that swelled up more after the double eyelid surgery, it is the side with the eyelid ptosis. Even a subtle amount of eyelid ptosis will make a difference in postoperative swelling recovery and double eyelid fold loss occurrence.
2. Significant fat of thick skin.
In eyes with significant eyelid fat or thick skin, the double eyelid fold does not want to occur. This is because there is a signifcant mass that prevents eyelid from invaginating to create the double eyelid fold.
3. Loose eyelid skin
Eyelids with loose skin also tend to lose the double eyelid fold because the skin stretches too much. Too much skin stretching does not allow eyelid to invaginate toward the levator muscle. Hence, a permanent track from the skin to the deeper eyelid elevating muscle (levator muscle) does not occur. This will lead to double eyelid fold loss.
The way to correct these issues is to create a direct contact from the eyelid skin to the eyelid elevating muscle (levator muscle) via open double eyelid surgery or incisional double eyelid surgery.
A suture technique double eyelid surgery is a semi-direct contact between the skin to the eyelid elevating muscle, while an open technique double eyelid surgery is a direct contact to the eyelid elevating muscle. Therefore, in cases where the fold loss occurred from the suture technique double eyelid, an incisional technique double eyelid surgery or open double eyelid surgery will correct the fold loss.