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Section: Complications

Upper Asian Eyelid Crease
Revision Shown Start to Finish

This patient was unhappy with both upper hollowness and asymmetry following incisional double eyelid surgery performed elsewhere as well as ptosis (or eyelid droopiness).

The left crease is too high and semilunar in shape as it approaches the nose (top arrow) and does not match the desired crease on the right side. Such an outcome is typically associated with excessive fat removal.

Lowering a crease is difficult and requires undoing the results of the original surgery, buffering the internal scar with fat to prevent reformation and restore volume, and recreating a new crease.

In this case, donor fat was obtained from the slight excess present in the patient's left lower orbit (lower arrow). The incision was made on the inside of the lid to avoid creation of an external scar.

Note that smaller imbalances following double eyelid surgery are the norm rather than the exception. Crease revision is an invasive and challenging operation and should not be undertaken unless the asymmetry is a substantial bother to the patient.

The principles illustrated below are applicable to both Asian and non-Asian patients.

1. Skin incision is placed just below the existing scar in the nasal two-thirds of the eyelid No skin is removed.

2. Dissection reveals retained internal sutures (small black dots)

3. Higher dissection reveals deficiency of normal fat

4. An incision placed on the inside of the lower eyelid exposes the site from which donor fat will be obtained

5. Fat graft from lower eyelid is shown in the recipient bed. It is later splayed apart to create a thin but wide zone of buffering and sewn into proper position to erase the previous surgical crease.

6. Crease shape assessed prior to suturing of the wound

7. Entry wound closed. After healing, the skin just above the scar will drape to cover the incision.

(patient also underwent bilateral ptosis repair)



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Frank Meronk, Jr., M.D.
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