From the buried suture method to the scar-excision fold correction (the "one-line" technique) and the scar-preserving high fold correction (the "two-line" technique).
The right method depends on the condition of your eyes.
Gangnam Seoyon Plastic Surgery has put together an overview of every option and how to choose between them.
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■ The Short Answer
There are three main ways to lower a double eyelid fold.
They are buried suture removal, the scar-excision fold correction, and the scar-preserving high fold correction.
Which method is right for you depends on how your current fold was created,
how much spare skin you have, and how much you want to lower the fold.
The most important factor is the amount of skin.
If you have enough spare skin, you have more options;
if skin is insufficient, the scar-preserving high fold correction is essentially the only option.
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■ What Are the Options?
The approach to lowering a double eyelid fold depends on what is creating your current fold.
If the fold was made with the buried suture method, suture removal is the first option to consider.
Removing the buried sutures often makes the fold disappear or sit lower.
However, if a long time has passed since surgery, adhesions may have formed,
so the fold may not disappear completely even after the sutures are removed.
In that case, further correction with an incisional approach is considered.
If the fold was made with the incisional method, the scar-excision fold correction or the scar-preserving high fold correction is considered.
The scar-excision fold correction removes the strip of skin between the new line and the existing line, including the previous incision line.
The fold line comes out clean and well defined, and the risk of multiple upper eyelid creases is relatively low.
However, because it involves excising skin, it is only possible when there is enough spare skin.
If it is forced when skin is insufficient, the eyes may not close fully —
a problem known as lagophthalmos — so caution is needed.
The scar-preserving high fold correction leaves the existing incision line untouched and places a new incision below it.
Because no skin is removed, it can be used even when spare skin is limited,
and it is advantageous when substantial lowering is desired.
Its drawback is two lines of scarring, but these become naturally concealed over time.
Re-adhesion can create multiple upper eyelid creases, so the procedure should be performed by an experienced surgeon.
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■ Methods Compared at a Glance
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■ Which Method Is Right for Me?
The key to choosing a method is the amount of skin and what is creating your current fold.
Some of this is hard to judge yourself, but the following criteria can serve as a guide.
If you had the buried suture method and it was not long ago, suture removal can be considered first.
On the other hand, if more than a year has passed since surgery, adhesions may have formed and suture removal alone may not be enough.
If you had the incisional method and feel some slack when you gently pull on your eyelid skin,
the scar-excision fold correction may be considered.
However, if there is little spare skin or you want to lower the fold considerably,
the scar-preserving high fold correction is the realistic choice.
How many millimeters you want to lower the fold also matters.
If you only want slight lowering, there are various options,
but when substantial lowering is needed, the scar-preserving high fold correction is more suitable.
In many cases, these criteria alone are not enough for an accurate assessment.
The amount of eyelid skin is hard to gauge yourself,
and the condition of the internal tissue varies depending on the previous surgical method.
An in-person examination is the most accurate way to assess your current condition.
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■ Gangnam Seoyon Plastic Surgery's Approach
Director Choi Dong-il of Gangnam Seoyon Plastic Surgery has lectured on lowering thick double eyelid folds
at academic conferences on numerous occasions.
At Gangnam Seoyon, we follow set principles when performing fold-lowering surgery.
First, the method is chosen according to the amount of skin and the condition of the eyes.
We do not automatically recommend the scar-preserving high fold correction, nor do we insist on the scar-excision fold correction.
After directly assessing the patient's current spare skin, previous surgical method, and desired degree of correction,
we choose the most suitable method.
Second, we do not recommend unnecessary additional procedures.
Some clinics routinely recommend ptosis correction or fat grafting alongside the scar-preserving high fold correction to prevent multiple upper eyelid creases,
but at Gangnam Seoyon, fat grafting is added in
fewer than 5 out of every 100 patients.
Our principle is to resolve the problem with dissection and anti-readhesion measures alone.
Consultations can be booked by phone (02-535-8889) or through our KakaoTalk channel.
Using the similar-case search on knsy.co.kr,
you can review before-and-after cases of eyes similar to yours before your visit, which can be helpful.
Clinic hours are 09:30–18:30 on weekdays and 09:30–16:30 on Saturdays.
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■ Frequently Asked Questions
Q1. What are the options for lowering a double eyelid fold?
A. There are three main options. If your surgery used the buried suture method, suture removal is considered;
if it used the incisional method, the scar-excision fold correction or the scar-preserving high fold correction is considered.
Which method is suitable depends on the amount of spare skin, the previous surgical method,
and the desired degree of correction.
Q2. Which is better: the scar-excision fold correction or the scar-preserving high fold correction?
A. Neither can be said to be definitively better.
If there is enough spare skin, the scar-excision fold correction is suitable;
if skin is insufficient or you want substantial lowering, the scar-preserving high fold correction is suitable.
Because the two methods have different pros and cons, assessing the amount of skin comes first.
Q3. I had the buried suture method. What should I do to lower the fold?
A. Suture removal is considered first.
The shorter the time since surgery, the more likely the fold is to lower or disappear after the sutures are removed.
If more than a year has passed since surgery, adhesions may have formed and suture removal alone may not be enough;
in that case, additional incisional correction is considered.
Q4. I've heard the scar-preserving high fold correction leaves two lines of scarring. Are they very noticeable?
A. Both the existing scar and the new incision line lie on the inner side of the crease, where the double eyelid fold tucks in.
When the eyes are open, they are hidden within the fold, and their color fades over time.
In many cases they are hard to notice at a normal everyday distance,
but this can vary with individual skin characteristics and the course of healing.
Q5. When is the best time to have fold-lowering surgery?
A. We generally recommend waiting at least 6 months after the previous surgery, once the tissue has stabilized.
This is because dissection is easier once the scar tissue has softened.
However, if symptoms are severe or cause significant inconvenience in daily life,
you can come in for a consultation sooner.
Q6. How long does recovery take after double eyelid lowering surgery?
A. Stitches are typically removed after 4–12 days, and patients usually return to daily activities after 3–7 days.
The final result can be assessed after 3–6 months.
This varies from person to person depending on the extent and method of surgery.
Q7. Can the fold become high again after it is lowered?
A. If re-adhesion occurs, the lowered fold can rise again or multiple upper eyelid creases can form.
Anti-readhesion measures must be carried out together with dissection to minimize this.
Tissue conditions become more complex with each additional revision,
so careful planning of the first lowering surgery is important.
Q8. Is lowering a fold different from removing a double eyelid?
A. Yes, they are different.
Lowering redesigns the fold at a lower position than the current one,
whereas removing a double eyelid makes the fold itself no longer visible.
The approach depends on the result you want.
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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 an in-person 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)
Clinical Adjunct Professor, Department of Plastic Surgery, Korea University College of Medicine
Academic Committee Chair, Eye Plastic Surgery Study Group, Korean Society of Plastic and Reconstructive Surgeons
Clinical 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
Information and Communications Committee Member and Public Relations Committee Member, Korean Society for Aesthetic Plastic Surgery
Regular Member, Eye Plastic Surgery Study Group, Korean Society of Plastic and Reconstructive Surgeons
Former General Affairs Director, 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.