Double Eyelid & Eyebrow
Double Eyelid Surgery
This page discusses some of the considerations of someone contemplating double eyelid & eyebrow surgery.
- They were born without an upper eyelid crease.
- They had a double eyelid that has gradually disappeared.
- To convert multiple creases on the upper lid to a single crease.
Upper Eyelid & Eyebrow
Effect of the Eyebrow on the double eyelid
As we age the skin of the upper eyelid above the eye crease becomes lax and falls over the crease. This makes the double eyelid “disappear”. The skin at the outer corners of the eyelids droops more than the inner corners (red arrow). This makes the eyes look hooded.
This appearance cannot be corrected by just excising extra skin at the corners of the eyelids because the problem is the drooping of the eyebrows. Metaphorically, constantly excising the skin is like shortening a pair of trousers without attempting to wear a belt.
What happens if extra skin is excised?
A browlift is difficult to “sell” and therefore, the patient will go to another clinic to try their luck if they are told that they need a brow lift. The next clinic will promise to remove extra skin, but this will only shorten the distance between the eyebrow and eyelash margin, and there will still be a fold of skin at the outer corners (red arrow).
The AI generated photo demonstrates the result of attempting to “lift” the eyelid by removing a larger amount skin. The eye is rounded in shaped due to the retracted upper lid (blue arrow) and there is still a fold of skin at the outer corner. When the eye is too retracted (shortened), the eye may not close adequately, causing dry eyes.
A double eyelid or supra tarsal crease is formed by the attachment of skin to the muscle that pulls open the eyelid. When it is absent, it needs to be created by stitching the skin to the muscle with through-and-through sutures. This procedure is easy to “sell” because it claims to be “incisionless”.
To correct an eyelid with excess skin, the suture has to be placed in an unnaturally high position to allow the skin to drape over it. This would usually create an unnaturally high fold, giving a sleepy look.
If the upper eyelid has a lot of fat between the skin and muscle, the suture may not hold very well, and the crease will not last very long.
Inspire of the claims, this method is not incisionless. Most surgeons make a series of small stab wounds to bury the suture.
This method works for eyelids without too much fat and excess skin. Otherwise, a proper blepharoplasty still produces a better result. Here is a YouTube video on this topic.
If you are having difficulty deciding between a suture or proper Blepharoplasty, choose the proper one because the results are more consistent, long-lasting and reliable.
What normal upper eyelids and eyebrows look like
Normal Eyes are elliptical (upper photo). The upper lid should overlap the limbus by 1 – 2mm. The lower lid should just touch the limbus (black round part of the eye). The young eyebrow his higher up, not near the eyelashes.
You would not want to end up with rounded eyes as shown in the lower photo.
Remember: what sells is not necessarily good. If there is a doubt what surgery to choose, always choose the natural looking result.