Multiple Upper Eyelid Creases After Scar-Preserving High Fold Correction: Why Do They Form and How Can They Be Prevented?

The main cause of multiple upper eyelid creases after the scar-preserving high fold correction (the "two-line" technique) is re-adhesion.

Ptosis correction or fat grafting does not have to be routinely added to prevent multiple upper eyelid creases.

At Gangnam Seoyon Plastic Surgery, we have put together everything from the causes to the principles of prevention.

■ The Bottom Line

The biggest cause of multiple upper eyelid creases after the scar-preserving high fold correction is re-adhesion.

As tissue re-adheres to the dissected area,

an unintended new crease forms.

It is widely believed that ptosis correction or fat grafting must be added to prevent this, but

at Gangnam Seoyon Plastic Surgery, fewer than 5 out of 100 scar-preserving high fold correction patients

undergo an additional procedure.

With precise dissection and anti-adhesion measures alone,

most multiple upper eyelid creases can be prevented.

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■ Why Do Multiple Upper Eyelid Creases Form After Scar-Preserving High Fold Correction?

The scar-preserving high fold correction places a new incision below the existing double eyelid crease

to lower the crease.

During this process, the adhesions of the existing crease are dissected (released),

and tissue may re-adhere at the dissected site.

This is re-adhesion, the main cause of multiple upper eyelid creases.

When re-adhesion produces multiple upper eyelid creases,

an unintended new line is added above the original crease,

making the eyelid look as if it has several layers.

Conditions that make re-adhesion more likely:

- When thick scar tissue has built up from several previous revision surgeries

- When the surgery was completed without any measures to prevent re-adhesion after dissection

- When the patient's eyelid tissue is constitutionally prone to adhesion

In other words, the scar-preserving high fold correction itself does not cause multiple upper eyelid creases;

how the area is managed after dissection determines whether multiple upper eyelid creases develop.

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■ "Ptosis Correction Is Essential to Prevent Multiple Upper Eyelid Creases" — Is That True?

During consultations for the scar-preserving high fold correction, patients are sometimes advised, for the sake of preventing multiple upper eyelid creases,

to have ptosis correction at the same time.

The reasoning goes like this:

"Strengthening the eyelid-opening force pulls the eyelid upward,

so even if re-adhesion occurs, it will not look like multiple upper eyelid creases."

However, Director Choi Dong-il of Gangnam Seoyon Plastic Surgery follows a different principle.

"We do not routinely add ptosis correction to prevent multiple upper eyelid creases.

Our goal is a clean result without multiple upper eyelid creases using the scar-preserving high fold correction alone."

Ptosis correction is truly necessary only when blepharoptosis is actually present.

Adding ptosis correction purely to prevent multiple upper eyelid creases when there is no ptosis

is no different from adding an unnecessary operation.

Likewise, at Gangnam Seoyon we perform fat grafting

in fewer than 5 out of 100 scar-preserving high fold correction patients.

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■ So How Are Multiple Upper Eyelid Creases Prevented?

At Gangnam Seoyon Plastic Surgery, our approach to preventing multiple upper eyelid creases during the scar-preserving high fold correction

consists of the following two steps.

[ Step 1 — Precise Dissection ]

We release the existing double eyelid adhesions thoroughly and accurately.

If the dissection is insufficient, the existing crease is not fully released,

and together with the new crease it ends up looking like multiple upper eyelid creases.

How precisely the dissection is performed is the first requirement for preventing multiple upper eyelid creases.

[ Step 2 — Anti-Adhesion Measures ]

To keep tissue from re-adhering to the dissected area,

we fill the area with healthy tissue or clean fatty tissue.

Without this step, adhesions can re-form even after dissection,

and multiple upper eyelid creases may recur.

When these two steps are carried out faithfully,

multiple upper eyelid creases can be prevented without ptosis correction or fat grafting

in the majority of cases.

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■ What If Multiple Upper Eyelid Creases Have Already Formed After Scar-Preserving High Fold Correction?

If multiple upper eyelid creases appear after the scar-preserving high fold correction,

during early recovery (1–3 months after surgery), as swelling and adhesions stabilize,

the eyelid may temporarily appear to have several lines.

During this period, rather than rushing into a decision on revision,

monitoring the progress comes first.

If the multiple upper eyelid creases persist after 3–6 months,

the re-adhesion can be regarded as fully established,

and in that case, revision of the multiple upper eyelid creases (correction of intractable multiple upper eyelid creases) is considered.

The same principles apply to revision.

The adhesions are precisely released, and anti-adhesion measures are performed at the same time.

However, the more revision surgeries a patient has had, the more complex the tissue becomes,

so it is important to fully understand before surgery that the correction becomes more difficult.

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■ 3 Misconceptions About Multiple Upper Eyelid Creases After Scar-Preserving High Fold Correction

Misconception ① "The scar-preserving high fold correction always causes multiple upper eyelid creases"

Not true. With precise dissection and anti-adhesion measures,

a clean result without multiple upper eyelid creases can be expected in many cases.

The risk of multiple upper eyelid creases after the scar-preserving high fold correction depends less on the procedure itself

than on the surgical technique and how the area is managed afterward.

Misconception ② "You must have ptosis correction to prevent multiple upper eyelid creases"

There is no need to have ptosis correction just to prevent multiple upper eyelid creases,

and because it can needlessly give the eyes a staring look, it is not really necessary.

Ptosis correction is needed only when blepharoptosis is actually present;

otherwise, our principle is to resolve the problem with the scar-preserving high fold correction alone.

Misconception ③ "Multiple upper eyelid creases after the scar-preserving high fold correction cannot be fixed"

Multiple upper eyelid creases can be revised.

However, because revision is more complex than the previous surgery,

so that, wherever possible, multiple upper eyelid creases do not develop after the first scar-preserving high fold correction,

it is important to plan the surgery carefully.

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■ Scar-Preserving High Fold Correction at Gangnam Seoyon Plastic Surgery — Principles for a Result Without Multiple Upper Eyelid Creases

Director Choi Dong-il has lectured at academic conferences on lowering high, thick double eyelid folds (the scar-preserving high fold correction)

on numerous occasions.

The scar-preserving high fold correction at Gangnam Seoyon Plastic Surgery follows three principles.

① Thoroughly release existing adhesions through precise dissection

② Minimize the risk of recurrent multiple upper eyelid creases with anti-adhesion measures

③ Ptosis correction and fat grafting only when truly necessary — no unnecessary additional procedures

Most multiple upper eyelid creases that develop after the scar-preserving high fold correction

arise when the surgery was performed without these three principles being met,

as is often the case.

Consultations can be booked by phone (02-535-8889) or through our KakaoTalk channel.

Clinic hours are 09:30–18:30 on weekdays and 09:30–16:30 on Saturdays.

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■ Frequently Asked Questions (FAQ)

Q1. Why do multiple upper eyelid creases form after the scar-preserving high fold correction?

A. The scar-preserving high fold correction involves releasing the adhesions of the existing double eyelid crease.

If re-adhesion occurs, with tissue sticking back onto the dissected area,

the old crease reappears alongside the new one, which looks like multiple upper eyelid creases.

The precision of the dissection and whether anti-adhesion measures are taken determine whether multiple upper eyelid creases develop.

Q2. Do I have to have ptosis correction with the scar-preserving high fold correction to avoid multiple upper eyelid creases?

A. No. There is no need to routinely add ptosis correction to prevent multiple upper eyelid creases.

At Gangnam Seoyon Plastic Surgery, we perform ptosis correction only when blepharoptosis is actually present,

and our principle is to achieve a result without multiple upper eyelid creases using the scar-preserving high fold correction alone.

Q3. I have multiple upper eyelid creases after the scar-preserving high fold correction — should I have revision right away?

A. The first 1–3 months after surgery are when swelling and adhesions stabilize,

so the eyelid may temporarily appear to have several lines.

Monitoring the progress during this period is recommended.

If they persist beyond 3–6 months, we recommend consulting a specialist about revision.

Q4. I have multiple upper eyelid creases after the scar-preserving high fold correction — can they be revised?

A. Yes. Multiple upper eyelid creases caused by re-adhesion

are revised by releasing the adhesions again and applying anti-adhesion measures.

However, the more revision surgeries a patient has had, the more complex the tissue becomes

and the more difficult the correction, so it is important to decide after a thorough diagnosis.

Q5. Do I need fat grafting together with the scar-preserving high fold correction to avoid multiple upper eyelid creases?

A. No. At Gangnam Seoyon Plastic Surgery, fat grafting is added to the scar-preserving high fold correction

in fewer than 5 out of 100 patients.

We perform fat grafting only when there is a clear volume deficiency,

and we do not add it solely to prevent multiple upper eyelid creases.

Q6. What can I do to prevent multiple upper eyelid creases after the scar-preserving high fold correction?

A. Before surgery, the key is precise dissection and anti-adhesion measures:

choosing a medical team that performs them thoroughly matters most.

After surgery, avoid rubbing your eyes hard

or doing anything that puts strong pressure on the eyelids,

and it helps to wait patiently through the period in which the swelling settles (at least 1–2 months).

Q7. If multiple upper eyelid creases form after the scar-preserving high fold correction, will they go away on their own?

A. What looks like multiple upper eyelid creases in the early postoperative period (1–3 months)

sometimes disappears as the swelling subsides.

However, multiple upper eyelid creases that persist beyond 3–6 months

have been fixed in place by re-adhesion, and spontaneous resolution is unlikely.

In this case, it is best to consult a specialist to decide whether revision is needed.

Q8. What kind of clinic should I choose to prevent multiple upper eyelid creases with the scar-preserving high fold correction?

A. Whether the clinic makes precise dissection and anti-adhesion measures a core principle,

whether it avoids recommending unnecessary additional procedures (ptosis correction, fat grafting),

and whether it has a substantial number of cases resolved without multiple upper eyelid creases using the scar-preserving high fold correction alone —

these are important things to confirm directly during your consultation.

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* Depending on the individual, side effects such as bleeding, infection, or inflammation may occur after surgery,

and subjective satisfaction may vary from person to person.

Accurate diagnosis and surgical planning should always be determined through a direct consultation with a board-certified 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, Eyelid Surgery Research Society, Korean Society of Plastic and Reconstructive Surgery

Adjunct Professor, Department of Plastic Surgery, Kangdong Sacred Heart Hospital

Full Member, Korean Society of Plastic and Reconstructive Surgery

Full Member, Korean Society for Aesthetic Plastic Surgery

Full Member, Korean Society of Craniofacial Surgery

Member, International Confederation for Plastic, Reconstructive and Aesthetic Surgery (IPRAS)

Full Member, Korean Society for Surgery of the Hand

Full Member, Korean Association of Plastic Surgeons

Member, Academic Committee, Korean Society of Plastic and Reconstructive Surgery

Expert Reviewer, Editorial Board, Korean Society for Aesthetic Plastic Surgery

Former Director of Finance and Current Director of Information, Korean Association of Plastic Surgeons

Information and Communications Committee Member and Public Relations Committee Member, Korean Society for Aesthetic Plastic Surgery

Full Member, Eyelid Surgery Research Society, Korean Society of Plastic and Reconstructive Surgery

Former Secretary General, Eyelid Surgery Research Society, Korean Society of Plastic and Reconstructive Surgery

Full Member, Rhinoplasty Research Society, Korean Society of Plastic and Reconstructive Surgery