It is not uncommon to see older patients who had double eyelid surgery that looks unnatural. This unnatural look is so common that it is one of the first things I hear from older patients (what they do not want) when they come in for a consultation. There are three main reasons why this occurs. These unnatural double eyelids have a characteristic effect of visible double eyelid fold scar, puffy overlying eyelid lid skin, and sleepy or harsh appearance of the eye. There are 3 main reasons for these effects.
- Deep and noticeable double eyelid folds occur from creating a static fold. Static fold is a double eyelid fold that does not move with eye opening and closing. This is a traditional older technique that leaves a characteristic noticeable surgical double eyelid scars. This can be replaced with a dynamic fold or physiologic double eyelid fold creation.
- Puffy eyelid skin occurs because there is often hooding of the brow skin. Our upper eyelid is composed of thick brow skin (higher region of the upper eyelid) and thinner eyelid skin (lower region of the upper eyelid). With age, both the thick brow skin and the thin eyelid skin droops. If only double eyelid surgery is performed, then the thin eyelid skin is removed and some of the thick brow skin is also removed. Therefore, now the thick brow skin comes down and is at the junction of the double eyelid fold. This creates a significant depth discrepancy with the fold and the overlying upper skin. The upper eyelid skin looks full and puffy. One common mistake is to remove excess fat, thinking that this is from fat excess. Removing fat will lead to hollow out eyes with persistent puffy lateral (outer) eyelid skin. The treatment is to lift the brow through a brow lift.
- The third reason is that older patients often have eyelid ptosis. When a fold is created onto the eyes with already pre-existing ptosis, their eyelid muscle can’t handle the excess weight placed from the double eyelid and the ptosis worsen. They look even more tired or even mean as the upper part of iris (the color aspect of the eye) is covered by the eyelid. The double eyelid also looks full and swollen, as the eye elevating muscle cannot lift the eyelid. These patients can easily be corrected with a ptosis surgery.
I hope this helped with understanding why so many older patients have unnatural eyelids after surgery. As you can see, aged patients have many aging effects and these aging effects needs to be addressed and corrected in order to achieve a natural appearing result.
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