Let me walk through how we approach removing a double-eyelid crease. Why would anyone want their crease removed? In male patients, particularly when the crease sits high, the eye can look mismatched with the rest of the face. Some men come in saying their crease makes them look too oily, or makes their gaze too intense. There is a way to fully eliminate a crease, but I do not recommend it. Even people without a visible double-eyelid crease usually have a faint line on careful inspection.
So what happens if we surgically eliminate the line entirely?
The better approach is to keep the line technically present but render it invisible, as in this patient. The technique is based on slides I presented at the KSPRS spring meeting in 2017.
It also forms the basis of a paper of mine that has been accepted for publication in Aesthetic Plastic Surgery (the ASAPS journal).
I do not think it is wise to chase a no-fold appearance by aggressively excising skin right above the lash line or by deliberately producing a scar. That is not what the natural anatomy looks like.