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Today we would like to take a closer look at the scar-preserving high fold correction (the "two-line" technique).
Some patients come in and then wonder what the scar-preserving high fold correction actually is,
and some come in wanting the scar-preserving high fold correction without really knowing what it involves.
A lot of the information online was not explained by a doctor, so it is often inaccurate, and that is why we would like to explain this first.
First we will explain what the scar-preserving high fold correction is, why it is done, and the various possibilities such as side effects that can arise when it is performed.
To correct a high double-eyelid fold, you take the existing line and set a new line below it,
then cut out the strip in between to remove the scar and release the adhesion, creating a new line and lowering the fold.
That way the double-eyelid scar becomes invisible and the line can be lowered.
This is commonly called the one-line technique.
The scar-preserving high fold correction is a surgical method that releases the adhesion of the existing double eyelid and creates a new fold line below the existing one, lowering the height of the fold.
More precisely, it can be described as double-eyelid revision surgery that preserves the existing incision-line scar.
The scar-preserving high fold correction lowers the height of the fold without excising the scar, so people who lack spare skin use this method to lower the height of the line.
Rather than cutting away skin, when there is an existing scar like this, a new incision line is made below it and only the adhesion is released.
The scar-preserving high fold correction is a process that, without cutting away skin, creates a new incision line below the existing scar and releases only the adhesion.
You might think, 'Wait, doesn't that leave two lines of scarring?'
But as long as the adhesion of the existing scar is released well, only one line is visible and the old scar becomes faint.
So why is the scar-preserving high fold correction performed?
As in the picture above, if you cut out the scar, skin is lost.
That can leave you short of skin,
so in cases where even the scar has to be put to use, the scar-preserving high fold correction (which does not cut out the scar) must be performed.
#Cases where the fold is so high that the double eyelid does not fold
A double eyelid is only a double eyelid when it folds.
As the diagram above shows, the skin has to lift and fold upward for a double eyelid to form.
A double eyelid is created only when the skin below the eyelashes folds upward and inward.
So what happens if there is only an incision line and it does not fold?
As with this patient, if there is only an incision scar and the skin does not fold, there is no double eyelid, just a scar, like this.
This naturally looks unnatural, and in such cases the line must be lowered using the scar-preserving high fold correction.
In this patient's case, there is currently some spare skin, but the double-eyelid fold sits too high.
Cutting out the strip between the newly created fold line and the scar would leave too little skin, so this is a case where the scar-preserving high fold correction is required.
#Cases where the line is lowered as much as possible to hide the double eyelid from view
This is a case where the line needs to be hidden and lowered as much as possible.
In these cases, the skin has to be draped over the fold so that the double eyelid is not visible.
It is used when making the double eyelid almost invisible, as in men.
This shows the appearance before surgery and on day 10 after surgery.
This shows the appearance at 6 months after the scar-preserving high fold correction.
#Cases where the fold is so high that it looks overdone
These photos show the appearance before the scar-preserving high fold correction and about one year afterward.
This shows the eyes closed about one year after surgery.
The faint line above is the old scar, and the slightly darker line below is the scar from the scar-preserving high fold correction.
In this case, the scar-preserving high fold correction lowered the right eye's line, and because the side nearer the nose looked slightly sleepy, eye-shape (ptosis) correction was performed at the same time.
Here is another case.
This patient was unhappy with an outer-line double eyelid and wanted to lower it to about an in-out fold.
#Is eye-shape (ptosis) correction essential?
Some patients ask whether eye-shape correction has to be done during the scar-preserving high fold correction.
For a patient who looks sleepy, as in the photo above, it can be done, but it is of course not mandatory.
If a triple fold develops, the surgery can be considered a failure.
This most commonly happens when re-adhesion occurs at the site of the original double-eyelid fold.
This is an example of a triple fold. This person did not have the scar-preserving high fold correction, but to show it as an example,
a triple fold is when the eyelid folds once more, like an extra double eyelid, above the existing fold line.
If the scar-preserving high fold correction fails, the line folds once more at the site of the old scar, like this.
There are several ways to prevent this.
The scar-preserving high fold correction is done when spare skin is lacking, but there still has to be at least some spare skin; the eyes should at least be able to close for it to be worth attempting.
Also, at least 6 months must have passed since the last surgery, and the longer the interval, the higher the success rate.
In addition, with revision surgery, once the area is opened there are so many unexpected variables that the success rate is higher only when an experienced surgeon operates safely, so please consult a board-certified plastic surgeon to confirm whether this is the right method for you, and consider it carefully.
You can find more detailed information in the video below.
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