If your double eyelid looks thick and puffy after surgery, the first step is to determine whether it is swelling or a sausage eyelid.
The right solution depends on the cause and on how much time has passed since surgery.
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■ The Bottom Line
After double eyelid surgery, a crease that looks thick and puffy, like a sausage,
generally falls into one of two categories.
One is residual swelling that has not yet resolved; the other is a true sausage eyelid.
If you are within three months of surgery, swelling is the most likely cause.
If the crease still looks thick and heavy after 3–6 months,
a sausage eyelid should be suspected.
The main causes of a sausage eyelid are
a crease set too high, eyelid fat that was not adequately removed,
excessive adhesion formation, and damage to the orbicularis oculi muscle.
Depending on the cause, the appropriate approach may be observation, an additional procedure, or revision surgery.
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■ What Is a Sausage Eyelid?
A sausage eyelid describes a condition after double eyelid surgery in which the crease, instead of folding into a fine, well-defined line,
looks thick and bulging.
The name comes from the way the eyelid looks, as if a sausage had been laid on top of it.
Characteristic features:
- The eyelid tissue above the crease looks noticeably thick
- When the eyes are open, the area above the crease bulges outward
- It may be accompanied by a heavy or congested feeling around the eyes
- The eyelids look puffy or bulky overall
- In some cases, the eyes look even smaller than before surgery
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■ The Most Important First Question: Is It Swelling or a Sausage Eyelid?
This is the first point where many patients get confused.
If you do not distinguish between the two, you may miss the right time to intervene
or, conversely, decide on revision surgery too early.
[ When It Is Most Likely Still Swelling ]
- You are within three months of surgery
- It looks puffier when you wake up and improves somewhat as the day goes on
- You notice gradual changes from day to day or week to week
- It looks thicker when you are tired or have not slept well
- It gets worse after eating salty food or drinking alcohol
[ When a Sausage Eyelid Should Be Suspected ]
- There is little to no change in thickness 3–6 months after surgery
- It stays consistently thick, with no difference between morning and evening
- It does not improve even after adequate rest
- The eyes look smaller or heavier than they did before surgery
- The tissue above the crease feels firm and hardened
How to tell them apart (summary):
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■ 3 Causes of a Sausage Eyelid
If it is judged to be a sausage eyelid rather than swelling,
the next step is to identify what is causing it.
The solution differs depending on the cause.
① Crease Set Too High
The higher the double eyelid crease, the more eyelid tissue accumulates above it.
When the crease is set high, at 8 mm or more,
this often makes the tissue above it look thick.
In this case, the key solution is a revision that lowers the crease: the scar-preserving high fold correction (the "two-line" technique).
② Excessive Adhesion Formation
The double eyelid crease is fixed too firmly beneath the skin,
which pulls the tissue above the crease downward so that it bunches up.
When the eyes open, the area above the crease does not fold in but bulges out thickly.
Surgery to release the excessive adhesions and readjust the fixation is required.
③ Thickened Tissue from Orbicularis Oculi Damage
If the orbicularis oculi muscle, which encircles the eyelid, is damaged during surgery
or excessively resected, the tissue around the muscle can become abnormally thick.
This is the most difficult type to correct and requires a meticulous approach.
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■ How to Fix a Thick Double Eyelid: A 3-Step Approach
[ Step 1: Observation, Up to 6 Months After Surgery ]
The first six months after surgery are when the tissue stabilizes.
During this period, the thickness may decrease naturally as the swelling subsides.
What helps during the observation period:
- Reduce salt intake (to ease swelling)
- Get plenty of sleep and keep your head elevated
- Avoid alcohol and strenuous exercise
- Use a scar-softening agent if one has been prescribed
However, if the thickness has not decreased after six months, revision should be seriously considered.
[ Step 2: Considering Non-Surgical Treatment (Limited Options) ]
In some cases, steroid injections (triamcinolone) or similar treatments
can be tried to partially reduce hypertrophic adhesion tissue.
However, they do not work for every sausage eyelid,
and whether they are appropriate must be judged based on the cause and the condition of the tissue.
Only a limited number of cases can be resolved with non-surgical treatment alone.
[ Step 3: Revision Surgery, Tailored to the Cause ]
Most sausage eyelids are corrected with revision surgery.
The surgical method depends on the cause.
Crease set too high → lowering the crease (the scar-preserving high fold correction, incision redesign)
Residual fat → additional fat removal
Excessive adhesion → adhesion release + anti-readhesion measures
Orbicularis oculi damage → meticulous dissection and tissue rearrangement
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■ When Can Revision Be Performed?
As a rule, the right time for revision is 6 months to 1 year after surgery.
Only after this point is the tissue stable enough
for the dissection to be performed with greater precision.
However, earlier correction may be considered in the following cases:
- The thick crease is obstructing vision
- There is a problem with eye-opening function
- There is also significant asymmetry
Because the timing of revision depends on the current condition of the tissue and the severity of the symptoms,
it is important to decide after a thorough consultation with your plastic surgeon.
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■ What to Check Before Revision
If you are considering revision of a sausage eyelid,
be sure to confirm the following during your consultation.
- Has the cause of the thick appearance been accurately identified?
(Is the main cause crease height, fat, adhesion, or muscle?)
- Can it be resolved simply by lowering the crease, or is a more extensive correction needed?
- How extensive will the scarring be after revision?
- Has the chance of the eyelid becoming thick again after revision been explained?
- Does the surgeon review your previous surgical records before planning the approach?
Sausage eyelid revision is often more complex than the primary surgery,
so it is important to identify the cause accurately and decide after a thorough consultation with an experienced surgeon.
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■ Frequently Asked Questions (FAQ)
Q1. Is every double eyelid that looks thick after surgery a sausage eyelid?
A. No. If you are within three months of surgery, it is most likely swelling.
Swelling after double eyelid surgery gradually subsides over time.
If there is little change in thickness after 3–6 months and it stays thick all the time,
it can be considered a sausage eyelid.
Q2. Does a sausage eyelid improve naturally over time?
A. If swelling is the cause, it often improves considerably by around six months.
However, if the crease is too high, fat remains, or there is excessive adhesion,
it will not get better on its own with time.
If there is no improvement after six months, revision should be considered.
Q3. What is the most common cause of a sausage eyelid?
A. The most common cause is a crease set too high.
The higher the crease, the more tissue accumulates above it,
which makes the eyelid look thick.
The second most common cause is eyelid fat that was not adequately removed.
Q4. Can a thick double eyelid be fixed without surgery?
A. At the swelling stage, it can sometimes improve with observation and lifestyle adjustments.
However, once it has set into a sausage eyelid, definitive correction with non-surgical treatment alone
is difficult in most cases.
Steroid injections and similar treatments are sometimes used as adjuncts,
but their indications and effects are limited, and revision surgery is often necessary.
Q5. I developed a sausage eyelid after the non-incisional method. Do I need an incisional revision?
A. If a sausage eyelid develops after the non-incisional (suture) method,
removing the buried sutures to release the crease is considered first.
In some cases, removing the sutures resolves the thick crease.
However, if suture removal alone does not solve the problem,
an incisional revision that adjusts both the crease height and the fat is needed.
Q6. Can a sausage eyelid come back after revision surgery?
A. If the cause is accurately identified and corrected during revision,
the same problem is less likely to recur.
However, depending on individual tissue characteristics and the possibility of readhesion,
recurrence cannot be completely ruled out.
To prevent recurrence, it is important to reset the crease height, remove fat,
and apply anti-readhesion measures together.
Q7. When is the best time for sausage eyelid revision?
A. Generally, 6 months to 1 year after the first surgery is recommended.
This is because dissection and revision can be performed more precisely once the tissue has stabilized.
However, if the functional discomfort is severe, earlier revision may be considered,
and the timing should be decided in consultation with a specialist.
Q8. Will lowering the crease fix a sausage eyelid?
A. If a crease that is too high is the main cause,
a revision that lowers the crease (the scar-preserving high fold correction) often improves the thick appearance.
However, if fat remains or there is excessive adhesion,
lowering the crease alone may not be enough,
and fat removal and adhesion release may also be needed.
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* This article is intended to provide general information,
and causes and solutions may differ depending on each individual's postoperative course and eyelid condition.
Whether and how to revise a sausage eyelid should always be decided through an in-person consultation with a specialist.
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Director Choi Dong-il
Board-Certified Plastic Surgeon
Current: Chief Director, Gangnam Seoyon Plastic Surgery (2015–present)
Former: Director, BK Plastic Surgery (2011–2013)
Former: Director, Regen Plastic Surgery (2013–2015)
Adjunct Professor, Department of Plastic Surgery, Korea University College of Medicine
Chair of the Scientific Committee, Eye Plastic Surgery Study Group, Korean Society of Plastic and Reconstructive Surgeons
Adjunct Professor, Department of Plastic Surgery, Kangdong Sacred Heart Hospital
Regular Member, Korean Society of Plastic and Reconstructive Surgeons
Regular Member, Korean Society for Aesthetic Plastic Surgery
Regular Member, Korean Society of Craniofacial Surgery
Member, International Confederation for Plastic, Reconstructive and Aesthetic Surgery (IPRAS)
Regular Member, Korean Society for Surgery of the Hand
Regular Member, Korean Association of Plastic Surgeons
Member, Scientific Committee, Korean Society of Plastic and Reconstructive Surgeons
Expert Reviewer, Editorial Board, Korean Society for Aesthetic Plastic Surgery
Former Director of Finance and Current Director of Information, Korean Association of Plastic Surgeons
Member, Information and Communications Committee and Public Relations Committee, Korean Society for Aesthetic Plastic Surgery
Regular Member, Eye Plastic Surgery Study Group, Korean Society of Plastic and Reconstructive Surgeons
Former General Secretary, Eye Plastic Surgery Study Group, Korean Society of Plastic and Reconstructive Surgeons
Regular Member, Rhinoplasty Study Group, Korean Society of Plastic and Reconstructive Surgeons
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.