— that is what this post is about.
This is part of what I presented at the 17th Academic Symposium of the Oculoplastic Research Society, Korean Society of Plastic and Reconstructive Surgeons, on July 5, 2026.
It covers how to keep multiple folds from forming while lowering a high crease, and how to treat cases where multiple folds — triple folds and the like — have already developed.
When the upper lid looks hollow, the hollowing can come from a number of different causes.
After a double-line revision (두줄따기), the most damaging problem is adhesion. In that case the adhesion has to be released and a barrier placed so it cannot re-form; without that, nothing improves.
When to Revise Multiple Folds After Double Eyelid Surgery
Multiple Folds After Failed Revisional Eyelid Surgery
These are the cases where the adhesion has to be released properly.
And there are also cases that come simply from a lack of volume.
Fat is harvested with a cannula, and then microfat is injected to fill the deficit.
After the surgery
Right after surgery you can already see the improvement. If multiple folds are still there immediately after surgery, it means the adhesion was not released at all.
This is one month after surgery. These are the creases caused by a lack of volume in the eyelid.
As a rule, about 50% of a fat graft survives.
But over-filling from the start is risky: if more of it takes than expected it can form lumps, and then you need another operation to remove the grafted fat.
So I deliberately under-fill and do a second session. This time, at the second session, I performed the fat graft together with an intradermal injection (Rituo).
The volume filled in right away, so the multiple folds improved.
Because these creases were not caused by adhesion, they improve quickly.
This is three months after surgery. The scar has not fully settled yet, but a good deal of volume has come in and the skin tissue looks a bit thicker.
The advantage of the intradermal injection (Rituo, Re2O) is that it makes up for the unevenness you can get when fat is placed shallowly in the skin layer — even placed superficially it spreads evenly without lumpiness and takes well.
It also requires no separate fat harvest and no sedation; a simple injection is all it takes.
That is all for today's post.