When I see patients in revision consults, a recurring request is the sausage-eye look. There are many ways to lower a double-eyelid crease, and when the patient has skin to spare, lowering the line is straightforward. The harder cases are the ones where there simply is not enough skin to work with.
This was the cover slide from the lecture I gave on the topic.
A photo with Dr. Wong Chin Ho, a Singaporean colleague.
Looking like I am making a passionate point.
This was taken when I was chairing a separate session.
The technique I described leaves the existing crease in place and adds an incision below it to release the underlying adhesions.
Here is a real patient I operated on. She is only about 10 days post-op and still carries some swelling, but the eye looks bigger and the crease is clearly lower. She also had a lower canthoplasty, so the lower lid sits a bit further down for now and will rise slightly with time.
The conclusion of my talk: release the adhesions thoroughly, prevent re-adhesion, and time the surgery as late as you reasonably can. Those were the key points.