and unnatural

The surgeon told me he placed the crease at 9mm, took off 5mm of skin and left 15mm of

skin between the eyebrow and the crease. He also said the final result would look like

the third picture. However, it seems that the crease is halfway between my eyebrow and

eyelashes. Also, my eyelids are gauging inwards and there is absolutely no drooping of the

skin over the crease. I am worried about whether the crease is too high and whether there will

be enough skin left to droop over the crease.

Thank you for your question!

You submitted some photos and you stated in your question that it is about 7 days after

your eyelid surgery. You also gave some details about the 9 mm height and the amount of skin

that was removed as well as the amount of skin that's between the brow and the crease.

So you have a lot of very good information. I'm glad that you are able to discuss with

your surgeon. And your concern is that the crease is too high and there may be not enough

skin to fold over. So let's now explore this a little bit. First, let's start first about

what your expectations were after your surgery.

It's routine in my practice, as a cosmetic oculofacial plastic surgeon for 20 years,

I do a lot of Asian eyelid surgery, I've written about it and I'm definitely familiar with

the different methods and techniques. But one of the things that I always discuss with

my patients and there's a good chance that your surgeon discussed with you was that the

initial swelling after eyelid surgery typically makes the crease look very high. Now of course,

there is variability. Some people swell more than others. But to understand that the space

between the eyelid and the crease called the pretarsal area, this area can swell tremendously.

You see the very nature of this type of surgery is there is a suturing whether it's non-incisional

or incisional to the skin to the levator skin or the muscle that sounds like the world elevator

but without the letter "e", the levator muscle, the muscle that lifts the eyelid. What essentially

it does is it almost acts like a tourniquet in a way to cause to swelling to stay in a

very limited space and expand and when it expands, it makes the crease look high. So

anticipate that after the 7 days has passed, every week, that swelling will change. And

that true eyelid surgery healing, even though you can have functional healing within a week

then go back to work, is still 6 months to a year. And so understanding that, appreciate

that it takes a lot of time to really understand what your final result will be.

Now as far as predicting whether the skin will fold over, understanding that we don't

have the benefit of the preoperative photo and also understanding that if you make your

decision based on finding a surgeon who has a lot of experience with Asian eyelid surgery,

you can be confident that the doctor anticipated that in order to create a crease that a certain

amount overlap to create a natural double fold would be necessary. There is an art to

doing this. This art is also adjusted depending on the patient's skin type, thickness, the

age, the degree of fat volume, there are many factors that are taken into consideration

that certainly makes Asian eyelid surgery a challenge.

With that being understood, it is not most likely, you're not going to get a prediction

of the overlap until the swelling comes down. It's seems intuitive that as the swelling

goes down, the skin that would likely overlap would kind of sink in place and be more in

position. When we do our Asian eyelid surgery or surgeries such as ptosis surgery, we will

sometimes allow the patients to wake up a little bit so we can see them open their eyes

and we can see how things look. But typically, by doing the measurements and planning ahead,

we can consistently get a nice result.

So I would advise that you continue communicating with your doctor and allow the time to pass.

You are not going to be able to do anything interventional anytime soon without disrupting

the natural healing process. And of course, the communication with your doctor will help

you feel better about your anticipated recovery time. So I wish you the best of luck, I hope

that was helpful and thank you for your question!