Triple Folds After Crease Loss — Consolidating Multiple Lines into a Single Crease
Topic for today.
An example case. This patient had had an incisional ptosis correction several years ago, with a fat-repositioning procedure on the upper lid.
From the immediate post-op period, multiple folds developed and her lid took on a triple-fold ("three-fold") appearance.
She had a revision a year before coming in to us, but the result did not improve.
On the photo, the lower line is the original incision; the upper fold caught in a place where she did not want a crease.
Video for reference.
She had clearly done a lot of consultation. She came in for several visits before deciding to proceed.
Other clinics had pushed for fat grafting, but I personally avoid placing fat above the eye.
General fat grafting elsewhere on the face is fine; placing fat above the eye is the part I am cautious about.
When upper-lid fat grafting is done well, it produces a good result, and I do place fat above the eye when the case calls for it.
My reasons for being cautious:
1. If the patient gains weight later, the grafted fat gains with them.
2. In many cases, fat repositioning combined with ptosis correction is enough on its own (this depends on the surgical approach).
That said, when I do recommend fat grafting, the result is usually good — so if I am the one suggesting it, please do go ahead. In multiple-fold patients like this one, I recommend fat grafting in around 10% of cases.
Immediately post-op. I considered fat grafting and decided against it for this patient.
After suture removal (one week post-op).
Through about one month, swelling and scar maturation are still in flux, and a case like this needs ongoing monitoring.
The eye can read smaller, the scar can ridge up, and the line can read higher temporarily.
At one month, you can see a faint line just above the crease — a remnant of the old fold, becoming visible as swelling resolves. It softens further as swelling goes down and the scar settles, and the line itself drops.
Three months in. She came in just before the Chuseok holiday — the faint upper line is gone, the swelling is down, the crease has dropped, and the eye opens slightly more.
She did not have ptosis correction this time.
On her way out she wished us a good Chuseok. A small thing, but appreciated. I look forward to seeing her three months from now in good shape.
Before and after. The mucosal show on her right eye (the left side of the photo) has also improved.
Some earlier posts on the topic for reference.