Gangnam Seoyon Plastic Surgery explains severe multiple folds — the condition in which the line settles into several overlapping creases after double eyelid surgery — covering four causes and the principles behind correcting them.
Have you had double eyelid surgery, only to find that over time the line looks not like one crease but two or three overlapping ones every time you open your eyes?
Many people tell us that every time they look in the mirror they wonder "is this normal?", and that even with makeup the creases overlap untidily and make the eyes look heavy. Medically this is called severe multiple folds, and the longer it is left, the thicker the line tends to become — in many cases it will not return to a natural state without ptosis correction or revision surgery.
Today, drawing on revision cases for severe multiple folds, we will go through the features of each cause and the principles behind correcting them.
■ What are severe multiple folds?
Severe multiple folds describes a state in which unintended extra creases form above the double eyelid line, so that instead of one smooth line you see several overlapping ones.
This is different from creases that overlap temporarily because of swelling. If the line continues to settle into several creases even after the swelling has completely gone down, there is a high chance it is severe multiple folds caused by tissue adhesion.
■ Why do severe multiple folds occur?
Pinpointing the cause accurately is what makes the result natural. The four representative causes identified at Gangnam Seoyon are as follows.
1) Adhesion after revision surgery such as the scar-preserving high fold correction (the "two-line" technique) or eyelid retraction surgery
If the tissue at the revision site adheres more than it should while healing, a new crease forms above the original line.
2) A congenital tendency to multiple folds
Some people are born with a skin structure that naturally forms several layers of creases; creating a natural double eyelid line in these cases requires precise design.
3) Thin skin with almost no tissue
When the skin and fat layers are thin, there is little support for the line, which creates conditions in which extra creases easily form above it.
4) The fold loosening as ptosis correction wears off
Here, as the effect of ptosis correction weakens over time, the line loosens along with it and comes to look like multiple folds.
■ When should severe multiple folds be operated on?
Revision is usually performed around six months after the first surgery. That is because it typically takes about six months for the scar tissue that remains hard to soften.
However, if the symptoms are severe enough to interfere with daily life, the procedure is sometimes carried out after consultation regardless of timing.
■ Gangnam Seoyon's principle for correcting severe multiple folds — three steps
Gangnam Seoyon Plastic Surgery works on the principle of handling the tissue responsible with precision, without forcing additional procedures.
STEP 1. Clean release of the adhesion
The adhered tissue causing the multiple folds is precisely separated.
STEP 2. Preventing re-adhesion
Areas where re-adhesion could occur are filled with normal tissue and clean fat tissue, lowering the chance of recurrence.
STEP 3. Fat grafting only when necessary
Fat grafting is performed only in a limited way, and only where volume is insufficient.
Gangnam Seoyon Plastic Surgery explains that "resolving it cleanly through release and prevention of re-adhesion alone, while avoiding accompanying procedures such as ptosis correction or fat grafting as much as possible, is Gangnam Seoyon's own know-how." In practice, more cases are resolved without any accompanying procedure than with one.
■ Frequently asked questions (FAQ)
Q. When can I have revision surgery for severe multiple folds?
A. For most patients, around six months after the first surgery is the appropriate time. However, if the symptoms are severe and interfere with daily life, it is sometimes performed regardless of timing.
Q. Do I have to have ptosis correction or fat grafting at the same time?
A. In most cases it is not necessary. The principle is to resolve the problem with release and prevention of re-adhesion alone; accompanying procedures are performed only in a limited way, when genuinely required.
Q. Will multiple folds form again even after revision surgery?
A. Because the area is filled with normal tissue and fat tissue to prevent re-adhesion, the chance of recurrence can be minimised. That said, there may be differences depending on the individual's healing capacity.
Q. How long does recovery take?
A. Sutures are removed after 5–7 days, and you can return to daily life after 3–7 days. The natural result usually settles at around the 3–6 month mark.
■ In closing
If your double eyelid line looks like several overlapping creases, it is best to first suspect severe multiple folds rather than simple swelling. Since the approach differs according to the cause, we recommend having an accurate diagnosis.
At Gangnam Seoyon Plastic Surgery, director Dr. Choi Dong-il, with 23 years of experience, personally handles everything from the consultation to the operation, working on the principle of precise revision matched to the cause, without forcing accompanying procedures.
※ After surgery, side effects such as bleeding, infection and inflammation may occur depending on the individual, and results and recovery periods may vary from person to person, so please be sure to proceed only after a thorough consultation with a specialist.
