Why creating a high double eyelid fold is better than a creating a low fold and excising skin

Asian patients with pre-existing low double eyelid fold may experience upper eyelid skin hooding that makes their double eyelid old appear smaller or non-existent. In this situation, we have two options. One is to simply cut the excess upper eyelid skin and leave the natural double eyelid fold alone. The other option is to make a higher fold and excise minimal amount of skin. One would assume that the first option of excising upper excess skin is better because it is simple and one would not need to touch the natural double eyelid fold. However, this is only true in cases where the natural double eyelid fold is high. We see rarely see this in young Asian patients because if they had naturally high double eyelid crease, then upper eyelid hooding would not occur. This is because higher double eyelid fold has the following characteristics: 1. Skin above the high double eyelid fold is a thicker brow skin. 2.Thicker brow skin is less likely to stretch and sag than thinner skin. 3. The relatively greater distance between the high double eyelid fold vs eyelid margin buys more time before the upper eyelid skin obstructs the eyelid margin shape. We will discuss this concept in detail in a later blog. So going back to small fold, the smaller fold has a relatively shorter distance between the double eyelid fold and the eyelid margin. Thus, the upper eyelid skin will hood at a faster rate.

Looking at double eyelid fold from an aesthetic perspective, a higher fold looks better because when one excise upper eyelid skin, one is in essence bringing down the thicker brow skin and shortening the distance between the eye and the brow. Of course we do not want to create unattractive, excessively high fold that looks unnatural. There is a fine line where an optimal fold will create the best aesthetic result. When one goes in for a consultation with a plastic surgeon, the surgeon will demonstrate the optimal fold height and the ranges.

Therefore in terms of economics of longevity (not having to do further surgery for a longer period of time) and aesthetics, a higher double eyelid fold creation is the better choice.

In the next blog, we will discuss why a higher double eyelid fold is not often created if it is a better option.