Friday, June 24, 2011

Doctor, why does (do) my double eyelid(s) disappear?

Most patients are happy with the results of double eyelid surgery which make their eyes bigger and more animated. Unfortunately, in a significant proportion of patients these double eyelid may disappear with time causing them to seek help for restoring the double eyelid. 

Some patients whose surgically created double eyelids
disappear, loosen or fade.

Diagrams showing two main ways of creating double eyelids.

The main reason for the disappearance of the double eyelid is the loss of the attachment between the levator muscle (or tarsal plate in the suture technique) and the skin. The factors for this loss may be divided into surgeon factor and patient factor. In the case of the surgeon factor, the main one include:

a. Failure to choose the appropriate method for double eyelid creation. Essentially, double eyelid can be created by the suture technique or the incision technique. Suture technique is suitable for eyes with thin skin without puffiness (resulting from fat) and if this technique were used in eyes with puffy eyelids, the failure is high.
b. Failure to clear the appropriate amount of tissue between the skin and the levator muscle. In the incision technique, the tissues (orbicularis muscle and fatty tissue) between the skin and the levator muscle should be adequately cleared to allow proper adhesion between the structures. Failure to do this will result in loosening of the adhesion.
Diagrams showing loosening of the adhesion between the skin
and the muscle after the suture technique.

Diagrams showing detachment of the skin from the
 underlying muscle after incision technique.

In the case of the patient's factors, the main ones are:

a. Excessive postoperative swelling. The patient must follow the doctors' instruction to control the swelling by using medications and ice pack. In Failure to do can result in excessive and prolonged swelling that affect the adhesion between the skin and the levator muscle. This applies to both the suture and incision techniques.
b. Failure to take care of the lids. Excessive rubbing of the eyelids can also loosen the adhesion and this should be avoided.

In the next blog, I shall mention how I restore the double eyelids in these patients.


  1. Thanks for sharing this dr chua! I've been searching the reason for this phenomena for long time. Can i ask u a question? I'm a 19 years old male chinese naturally born with parallel double eyelid crease. is it possible for me to have excess lid skin on the upper eyelid at my age? this is because i noticed that my crease has become less prominent than before.

  2. The skin creases can become less prominent for a variety of reasons in addition to excess skin such as swelling of the upper eyelid (from inflammation or infection) or increase fat deposit. If you are concerned about this, I suggest you consult an oculoplastic surgeon nearest to you or you may email me a picture of your upper face for a free online consultation at Please send me two pictures without flash one with eyes looking straight and one with eyes looking down.

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  4. thank you for your reply! But I think you will be the only doctor that I trust for consultant if I ever want to undergo blepharoplasty. May I know where your working place so that I can consult you face to face if I can go. My email is