Multiple upper eyelid creases after surgery, congenital extra lines, and skin sagging from aging —
the cause of eyelid creasing must be identified first to choose the right correction.
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■ The Bottom Line
How eyelid creases are treated depends entirely on what is causing them.
Eyelid skin that has sagged with aging,
and unintended multiple upper eyelid creases that have formed from adhesions after surgery,
may look alike, but they need different corrections.
In particular, when several lines form on the upper eyelid after double eyelid surgery —
so-called 'severe multiple upper eyelid creases' — the cause must be identified precisely,
and treatment should center on dissection to release the adhesions.
Without adjunctive procedures such as ptosis correction or fat grafting,
many cases can be resolved with adhesion release and re-adhesion prevention alone.
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■ What Types of Eyelid Creases Are There?
Eyelid creases fall into two broad categories.
Telling them apart accurately is the starting point for treatment.
[ Aging type — creases caused by sagging eyelid skin ]
From the 40s to 60s onward, the eyelid skin loses elasticity and sags downward,
hooding over the eye or forming creases.
It often comes with a blocked field of vision or eyes that look smaller.
In these cases, upper blepharoplasty (excision of eyelid skin) or
a sub-brow lift is considered.
[ Multiple upper eyelid creases — unintended extra lines on the eyelid ]
After double eyelid surgery, above the original double eyelid fold,
unintended extra lines form and the eyelid looks layered.
This is called 'multiple upper eyelid creases' or, in severe cases, 'severe multiple upper eyelid creases.'
The key is not to stretch the eyelid skin or add volume,
but to release the adherent tissue.
The rest of this article focuses on multiple upper eyelid creases, and on correcting severe multiple upper eyelid creases in particular.
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■ What Are Severe Multiple Upper Eyelid Creases?
Severe multiple upper eyelid creases describe a condition in which, above the double eyelid fold,
additional unintended creases form.
With several lines visible at once, the eyes look untidy,
and some patients also feel tightness or a foreign-body sensation in the eyelid.
The eyelid is made of very thin, delicate tissue,
so surgery, inflammation, or adhesions can easily create unintended lines.
Severe multiple upper eyelid creases are not just a cosmetic concern;
in severe cases, they can even affect the ability to open the eyes.
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■ Why Do Severe Multiple Upper Eyelid Creases Develop? — 4 Causes
Severe multiple upper eyelid creases can have many causes,
and pinpointing the cause is the starting point for planning the correction.
① Adhesions after revision surgery
Revision procedures such as the scar-preserving high fold correction (the "two-line" technique) for a thick double eyelid, or Eyelid Retraction Surgery:
after such eye revision surgery, adhesive tissue forms at the operated site
and unintended new lines develop.
This is the most common cause in patients who have had revision surgery.
② The double eyelid fold loosening along with a loosening ptosis correction
After ptosis correction (blepharoptosis repair) has been combined with double eyelid surgery,
once the ptosis correction starts to loosen, the double eyelid fold also becomes unstable,
and multiple upper eyelid creases develop.
In this case, correcting the multiple upper eyelid creases and revising the ptosis correction should be considered together.
③ Very thin skin with almost no underlying tissue
When the eyelid skin is very thin and lacks fat tissue,
lines form easily with even minor irritation or adhesion.
People born with little eyelid tissue also fall into this group.
④ Congenital multiple upper eyelid creases
Multiple lines are present on the eyelid from the start, with no history of surgery.
They appear when the skin is congenitally thin or when the attachment between the eyelid skin and the deeper tissue
has an atypical pattern.
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■ Treating Severe Multiple Upper Eyelid Creases — 3 Steps
Correcting severe multiple upper eyelid creases is not simply a matter of creating a new fold.
The key is removing the adhesions and treating the area so they do not re-form.
[ STEP 1 ] Adhesion release
The abnormal adhesive tissue that is causing the multiple upper eyelid creases
is cleanly dissected (released).
How precisely this is done directly affects the result.
[ STEP 2 ] Re-adhesion prevention
After release, to keep adhesions from re-forming at the same site,
the area is filled with normal tissue or clean fat tissue.
If the adhesions are only released without re-adhesion prevention, multiple upper eyelid creases can come back in the same place.
[ STEP 3 ] Fat grafting only when needed
Fat grafting is added only when a lack of volume is contributing to the multiple upper eyelid creases.
In most cases, STEPS 1–2 alone are enough to correct the problem, without fat grafting.
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■ Are Ptosis Correction and Fat Grafting Always Necessary?
Some people assume that surgery for severe multiple upper eyelid creases must always include ptosis correction or fat grafting,
but in most cases, that is not true.
Ptosis correction is occasionally needed, but most of the time it is not.
Fat grafting is likewise occasionally needed, but most of the time it is not.
The principle is a clean correction with adhesion release and re-adhesion prevention alone.
Unnecessary adjunctive procedures can put extra strain on the tissue
and complicate recovery.
Whether an adjunctive procedure is really needed should be decided at the preoperative assessment.
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■ When Can Severe Multiple Upper Eyelid Creases Be Corrected?
In general, the right time for correction is six months after the primary surgery.
This is because scar tissue that hardened after surgery
usually takes six months or more to soften.
By then, the dissection tends to be easier.
However, if the multiple upper eyelid creases are very severe
or are interfering with the ability to open the eyes,
surgery is sometimes done early, without waiting six months.
Timing should be decided with a specialist, based on how severe the current symptoms are and how much discomfort they cause.
Because early correction must be done within three weeks of surgery at the latest,
you should see a specialist for an examination as soon as possible.
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■ Procedure Details and Recovery
* The window for suture removal is wide because
it varies a great deal between individuals depending on the extent of surgery and the suturing method.
* The final result can only be judged accurately after 3–6 months.
Before then, it is important not to draw early conclusions from swelling or changes in the fold.
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■ Frequently Asked Questions (FAQ)
Q1. What options are there for improving eyelid creases — surgery or non-surgical procedures?
A. Sagging eyelid skin caused by aging is often corrected with upper blepharoplasty (skin excision).
Multiple upper eyelid creases that develop after surgery (severe multiple upper eyelid creases) call for an approach built around adhesion release and re-adhesion prevention,
which means a surgical approach is needed.
Lasers and non-surgical procedures have limits when it comes to correcting severe multiple upper eyelid creases.
Q2. I have several lines on my eyelids after double eyelid surgery. Are these multiple upper eyelid creases?
A. If unintended creases have formed above the double eyelid fold
and the eyelid looks layered, multiple upper eyelid creases may be suspected.
Swelling right after surgery can temporarily look like several lines,
so an accurate assessment is only possible once the swelling has settled, at least 3–6 months later.
Q3. Are ptosis correction or fat grafting essential for correcting severe multiple upper eyelid creases?
A. In most cases, they are not needed.
Correction is often possible with adhesion release and re-adhesion prevention alone,
and the principle is to add ptosis correction or fat grafting only when truly necessary.
Unnecessary adjunctive procedures can complicate recovery.
Q4. Can severe multiple upper eyelid creases come back after correction?
A. If re-adhesion occurs after release, multiple upper eyelid creases can form again.
To prevent this, normal tissue or clean fat tissue is used
to fill the released area as re-adhesion prevention, done during the same operation.
However, results may vary with each person's healing capacity and tissue characteristics.
Q5. I developed multiple upper eyelid creases after revision surgery. When can I have them corrected?
A. In general, six months after the primary surgery is the right time.
By then, the scar tissue has softened, which makes the dissection easier.
However, if symptoms are very severe or interfere with daily life,
surgery is sometimes done without waiting six months.
Q6. Can congenital multiple upper eyelid creases also be corrected?
A. Yes, they can.
Congenital multiple upper eyelid creases are often caused by the attachment between the eyelid skin and the underlying tissue
having an atypical pattern.
The approach is similar to that used for multiple upper eyelid creases caused by surgery,
but because the skin is often thin with little tissue, careful surgical planning is required.
Q7. How long is recovery after correction of severe multiple upper eyelid creases?
A. Sutures are removed 4–12 days after surgery.
Most people return to daily activities after 3–7 days,
and the final result can be seen after 3–6 months.
This may vary with individual healing speed and the extent of surgery.
Q8. My multiple upper eyelid creases are severe. Do I need incisional revision surgery, or will a simple procedure do?
A. It depends on how severe the multiple upper eyelid creases are and what is causing them.
When adhesions are the cause, non-surgical procedures cannot fix the underlying problem,
and a surgical approach that includes adhesion release is often required.
The severity of symptoms, previous surgical history, and condition of the eyelid tissue must be examined in person
before the right method can be chosen.
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* This article is intended to provide general information,
and correction methods and results may differ depending on each person's eyelid condition and surgical history.
Please decide how to improve your eyelid creases only after an in-person consultation with a specialist.
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The photographs in this post were taken under identical conditions with the patient's prior consent.
In addition, side effects such as bleeding, infection, and inflammation may occur after plastic surgery or procedures depending on the individual, so caution is required.