There are two ways to lower a high, thick double eyelid fold: the scar-excising high fold correction (the "one-line" technique) and the scar-preserving high fold correction (the "two-line" technique).
Here at Gangnam Seoyon Plastic Surgery, we have outlined the differences between the two methods, the right candidates for each,
and the most common misconceptions.
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■ The Bottom Line
The scar-preserving high fold correction is a procedure that leaves the existing double eyelid incision scar uncut
and lowers the fold by making a new incision below it.
It is meticulous work: the adhesions at the existing scar are released
and the eyelid is redesigned so that it folds at the new line.
The key difference from the scar-excising high fold correction is whether or not the existing incision line is cut.
When there is enough spare skin, the scar-excising high fold correction may be considered;
when skin is insufficient or the fold needs to be lowered substantially, the scar-preserving high fold correction is chosen.
Having the scar-preserving high fold correction does not mean that ptosis correction or fat grafting must be performed at the same time.
At Gangnam Seoyon Plastic Surgery, fewer than 5 out of every 100 patients having the scar-preserving high fold correction
undergo a combined procedure.
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■ What Is Scar-Preserving High Fold Correction?
Put precisely, this procedure is
"lowering the fold without cutting through the existing double eyelid scar."
When the fold looks too high or too thick after double eyelid surgery,
the procedure releases the fold that has been creasing at the existing incision scar
and lowers the fold by creating a new incision line below it.
It is nicknamed "two-line" because the existing scar remains as one line,
and the new incision below it adds a second line.
In the final result, the eyelid folds at the new, lower line,
so that the old, higher line is covered.
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■ When Scar-Preserving High Fold Correction Is Needed
Here are the five cases in which we at Gangnam Seoyon Plastic Surgery consider high fold correction appropriate.
① When the double eyelid fold is too high and you want it lowered
The fold was set too high in a previous surgery,
or the natural double eyelid fold itself is excessively high relative to the eyebrow.
② When the fold is high and the scar is deep
Thick scar tissue has formed at the previous incision site,
so the fold looks high and, at the same time, feels stiff and unnatural.
③ When the fold is thick — so-called "sausage eyes"
The eyelid has become thick and droopy as a result of excessive removal of muscle or soft tissue.
The skin above the fold bulges out, giving the eyelid a sausage-like appearance.
④ When the fold is too high relative to the brow-to-eye distance
In proportion to the whole face, the space between the eyebrow and the double eyelid fold is too narrow.
Even when the fold height itself is not the issue, a fold that does not suit the facial proportions can be a candidate for correction.
⑤ When ptosis exposes the fold and makes it look high
As the eye-opening force weakens and the eyelid descends,
the fold is no longer hidden by the skin and becomes exposed, making it look high.
Lowering the fold alone without correcting the ptosis may not resolve the problem,
so an accurate preoperative diagnosis is essential.
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■ Scar-Excising vs. Scar-Preserving High Fold Correction — How Do the Methods Differ?
Methods for lowering a thick double eyelid fold fall broadly into two categories: the scar-excising high fold correction and the scar-preserving high fold correction.
Which method to choose depends on the amount of available skin and the condition of the eyelids.
[ Scar-Excising High Fold Correction — METHOD A ]
This method cuts directly through the existing incision line.
The skin between the new line and the existing line is excised,
and the fold is lowered in a way that removes the existing scar along with it.
Pros:
- The fold often comes out clean and well defined.
- Multiple upper eyelid creases are less likely to form than with the scar-preserving high fold correction.
- The surgical technique is relatively simple.
Cons:
- Because skin is excised, there must be enough spare skin.
- If skin is aggressively excised when there is not enough of it,
the result can be a double eyelid pushed to its limit that can no longer be corrected.
- Apart from patients who had a high fold when young and developed extra skin with age,
it is often difficult to apply.
[ Scar-Preserving High Fold Correction — METHOD B ]
This method leaves the existing incision line untouched and makes a new incision below it.
The adhesions of the existing double eyelid fold are released, and the eyelid is designed to fold at the new line.
Pros:
- It can be performed even when skin is insufficient.
- It is advantageous when you want the fold lowered substantially.
- Surgery can be repeated several times if needed.
Cons:
- It leaves two lines of scarring.
(the existing scar + the new incision line)
- Because it is influenced by the existing scar, readhesion can easily lead to multiple upper eyelid creases.
- Only experienced plastic surgeons can perform it safely.
Scar-Excising vs. Scar-Preserving High Fold Correction Comparison:
Director Choi Dong-il of Gangnam Seoyon Plastic Surgery has given numerous conference presentations on surgery to lower thick double eyelid folds,
including the scar-preserving high fold correction.
Which method is right for you is decided after we directly assess the amount of skin and the condition of the eyelids.
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■ 4 Misconceptions About Scar-Preserving High Fold Correction — The Answer to All Is NO
When people search for the scar-preserving high fold correction, vague worries about side effects often come up as well.
Here are the misconceptions we hear most often at Gangnam Seoyon Plastic Surgery.
Misconception ① "The scar-preserving high fold correction is a last resort"
→ Not true. If anything, the scar-excising high fold correction, which aggressively excises skin, may be the real last resort.
Once skin has been excised, no further correction is possible.
The scar-preserving high fold correction does not use up skin, so surgery can be repeated several times if needed.
Misconception ② "Ptosis correction is a must"
→ Not true. Ptosis correction is sometimes recommended to prevent multiple upper eyelid creases,
but routinely combining it is often unnecessary.
Resolving the problem with the scar-preserving high fold correction alone, without multiple upper eyelid creases, is both our principle and our expertise at Gangnam Seoyon.
Misconception ③ "Fat grafting is a must"
→ Not true. At Gangnam Seoyon Plastic Surgery, fat grafting is combined with the scar-preserving high fold correction
in fewer than 5 out of every 100 patients.
Even when fat grafting appears necessary, it often turns out not to be,
and unnecessary combined procedures can actually complicate recovery.
Misconception ④ "A step-off scar is inevitable"
→ Not true. As the fold is lowered, skin naturally drapes over the incision line,
and this is often mistaken for a step-off scar.
In fact, even in people who have never had surgery,
the same appearance can be seen when the fold is low.
This is a natural skin structure, not a scar.
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■ The Truth About Step-Off Scars
After the scar-preserving high fold correction, skin may drape slightly over the incision line.
This is sometimes called a step-off scar,
but in reality it is the same natural eyelid structure seen in people
who have never had double eyelid surgery and simply have a low fold.
The lower the fold, the more skin naturally covers the incision line — this is to be expected,
and regarding it as a side effect is a misconception.
However, it needs to be distinguished from a true step-off caused by scar tissue,
so it is best to have this checked during your preoperative consultation.
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■ Gangnam Seoyon Plastic Surgery's 3 Principles for Scar-Preserving High Fold Correction
When performing high fold correction at Gangnam Seoyon Plastic Surgery,
these are the three principles we follow.
① Precise diagnosis by an experienced board-certified plastic surgeon
Whether the scar-excising or the scar-preserving high fold correction is more suitable,
and whether a combined procedure is needed, is decided after directly examining the amount of skin and the condition of the eyelids.
② Customized design that considers eye shape, eyelid condition and the whole face
Rather than simply lowering the fold height,
we design a fold that suits each individual, taking into account the distance to the eyebrow and overall facial proportions.
③ Thorough planning + meticulous surgery to minimize tissue damage
The scar-preserving high fold correction is a precision operation performed directly beneath the existing scar tissue.
To prevent readhesion and create a natural fold without multiple upper eyelid creases,
we take an approach that minimizes tissue damage.
Director Choi Dong-il has lectured on lowering thick double eyelid folds (the scar-preserving high fold correction)
at academic conferences on numerous occasions.
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■ Procedure Information
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■ Frequently Asked Questions (FAQ)
Q1. What is the scar-preserving high fold correction?
A. The scar-preserving high fold correction is a procedure that leaves the existing double eyelid incision scar uncut
and lowers the fold by making a new incision below it.
The adhesions of the fold that had been creasing at the existing scar are released,
and the eyelid is designed to fold at a new, lower line.
Because this leaves two lines in total — the existing scar plus the new incision line — it is nicknamed the "two-line" technique.
Q2. Which is better: the scar-excising or the scar-preserving high fold correction?
A. Neither is better in every case;
the right method depends on the amount of skin and the condition of the eyelids.
If there is enough spare skin, the scar-excising high fold correction is suitable; if skin is insufficient or you want the fold lowered substantially, the scar-preserving high fold correction is suitable.
It is important to decide after a precise diagnosis.
Q3. Do multiple upper eyelid creases form after the scar-preserving high fold correction?
A. It is true that the scar-preserving high fold correction is prone to multiple upper eyelid creases caused by readhesion.
However, there is no need to routinely add ptosis correction or fat grafting to prevent multiple upper eyelid creases.
When the surgery is performed meticulously by an experienced surgical team,
multiple upper eyelid creases can often be prevented with the scar-preserving high fold correction alone, without any combined procedure.
Q4. Is a step-off scar unavoidable?
A. The skin draping over the incision line as the fold is lowered
is a natural phenomenon also seen in people with a low fold who have never had surgery.
It is a structural characteristic of the eyelid, not a scar, and is distinct from a step-off scar.
The more the fold is lowered, the more noticeable this can become.
Q5. Can revision surgery be done again after the scar-preserving high fold correction?
A. Yes. Because the scar-preserving high fold correction does not excise skin,
the skin is not used up, and surgery can be repeated several times if needed.
In contrast, the scar-excising high fold correction removes skin,
so repeating it can leave too little skin and make further correction difficult.
Q6. Can someone who had non-incisional (suture) double eyelid surgery have the scar-preserving high fold correction?
A. The scar-preserving high fold correction may be possible for patients who had non-incisional surgery.
However, with a suture-method double eyelid, removing the buried sutures first may be considered,
so we check the current condition of your eyelids at the preoperative consultation before deciding on the approach.
Q7. How long is the recovery period for the scar-preserving high fold correction?
A. Stitches are removed between 4 and 12 days after surgery,
and most patients return to daily activities after 3–7 days.
A natural result settles in at around 3–6 months.
The timing of stitch removal may vary depending on the extent of surgery.
Q8. How do I book a consultation for the scar-preserving high fold correction at Gangnam Seoyon Plastic Surgery?
A. You can book a consultation by phone (02-535-8889) or through our KakaoTalk channel.
Using the Find Similar Cases feature on knsy.co.kr,
you can review before-and-after cases of eyes similar to yours before your visit,
which allows for a more specific consultation.
Clinic hours: weekdays 09:30–18:30, Saturdays 09:30–16:30.
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* Side effects such as bleeding, infection and inflammation may occur after surgery depending on the individual,
and subjective satisfaction may vary from person to person.
An accurate diagnosis and surgical plan should always be determined 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 Academic Committee, Eye Plastic Surgery Research 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, Academic Committee, Korean Society of Plastic and Reconstructive Surgeons
Expert Reviewer, Editorial Committee, Korean Society for Aesthetic Plastic Surgery
Former Director of Finance and Current Director of Information, Korean Association of Plastic Surgeons
Member, Information & Communications Committee and Public Relations Committee, Korean Society for Aesthetic Plastic Surgery
Regular Member, Eye Plastic Surgery Research Group, Korean Society of Plastic and Reconstructive Surgeons
Former General Secretary, Eye Plastic Surgery Research Group, Korean Society of Plastic and Reconstructive Surgeons
Regular Member, Rhinoplasty Research 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.