In our last blog, we discussed why naturally appearing high double eyelid fold looks better than a small double eyelid fold. The key phrase is “naturally appearing” because unnatural high fold is often seen and does not look pleasing. Patients often tell me that they specifically informed the plastic surgeon that they did not want a high fold but it occurred. So why? The main cause of high unnatural high fold is due to eyelid muscle not being able to tolerate the fold height. This condition is called eyelid ptosis. Eyelid ptosis has various degrees in terms of severity. It ranges from mild, moderate, to severe. Often, we see severe form and diagnosis as ptosis. However, in double eyelid surgery, mild form is often not recognized by the surgeon. This is because ptosis is simply defined as weakness of eyelid elevating muscle that leads to decrease in the amount the iris (the color aspect of the eye) shown. However in double eyelid surgery, the skin is surgically connected to the eyelid elevating muscle—the levator aponeurosis. So in case of patients with pre-existing mild ptosis, double eyelid fold formation will induce more weight on the eyelid. The mildly weak eyelid muscle now cannot tolerate the connection of the skin, muscle, and the soft tissue of the eyelid, thus, the lid does not elevate optimally. This weak eyelid elevation leads to undesired high fold as the eyelid descends at rest. Another phenomenon that is seen is a puffy double eyelid fold with high double eyelid formation.
Of course the other reason the unnaturally high fold occurs is because the plastic surgeon intentionally made the fold too high. It is imperative that the plastic surgeon and the patient determine the optimal double eyelid fold height that the patient’s eyelid muscle can tolerate in order to avoid unnaturally appearing high double eyelid fold.
In the next blog, we will discuss why is eyelid ptosis so commonly seen in Asians with monolids (without double eyelid folds)?
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