Multiple Eyelid Folds After Repeated Surgeries

After double eyelid surgery, some patients experience multiple folds forming on the upper eyelids. Ideally, a well-designed double eyelid should have a single, smooth crease. However, when the eyelid skin is thin or the eyes are prominent, the eyelid may fold like an accordion when opening the eyes, resulting in multiple creases instead of one clean line.

In revision cases, the scars from previous double eyelid surgeries can also fold and become visible, creating the appearance of layered or overlapping creases. When surgery is repeated multiple times, internal tissues may become hardened or tightly adhered due to scarring. These adhesions prevent the eyelid from moving naturally, leading to unstable and unnatural multiple folds rather than a soft, integrated crease.

Evaluating the Eyelid Based on the Open-Eye Crease

The condition of the double eyelid is evaluated based on the crease visible when the eyes are open. Clinically, eyelids are often described as having a deep crease, a large crease, a thick crease, or no visible crease at all. A natural and stable double eyelid does not show the surgical line directly on the eyelid when the eyes are open. Instead, the most ideal crease forms naturally as the upper eyelid skin gently descends and settles over the eye.

Main Causes of Multiple Eyelid Folds After Surgery

The most common causes of multiple eyelid folds include an incorrectly designed crease line, creating a new crease higher than the original while ignoring the existing line, and repeated surgeries that result in internal adhesions and excessive scar tissue. Each of these factors disrupts the normal movement of the eyelid, making it difficult to achieve a single, harmonious crease.

A Complex Revision Case

The patient shown below is a rare and complex case in which scars from four previous eyelid surgeries were all clearly visible. In a normal double eyelid, the scar line is only noticeable when the eyes are closed. When the eyes open, the crease naturally rolls inward and becomes part of the eyelid contour. If the scar line remains visible while the eyes are open, it indicates that the internal eyelid tissues were not properly released or reorganized during prior surgeries.

Such cases require a highly detailed understanding of eyelid anatomy and extensive experience in revision surgery to restore a natural, stable eyelid crease.

Revision Case at Ahnsungmin Plastic Surgery

This patient was a case in which ptosis had not been properly corrected, and only the double eyelid crease had been made larger. As a result, when the eyes were opened, all of the previous surgical crease lines were exposed, preventing a natural eye appearance.

After observing the patient’s eye-opening habit, it was found that because the ptosis was severe, the patient used the forehead muscles to open the eyes. This caused the eyebrows to lift upward, making all existing crease lines visible. Therefore, to resolve the most fundamental cause, eyelid contour correction surgery was performed together.

Severe Adhesions After Multiple Surgeries

Because scars from previous surgeries remained within the eyelid, the patient had severe internal adhesions. This case involved a fifth eyelid revision surgery, and the patient had been experiencing social difficulties due to an unnatural and harsh eye appearance.

Among revision surgeries, this case was considered exceptionally complex, requiring a significantly higher level of surgical difficulty, time, and cost compared to standard revision procedures.

During surgery, all adhesion tissues were meticulously released through an incision. However, due to limited skin laxity between the eyebrow and the eyelid, it was not possible to remove all scar tissue completely. Instead, the focus was placed on carefully releasing the bound tissues and skin as much as possible and reorganizing them into a single, stable eyelid crease, achieving a natural and balanced result.

Why Eyelid Revision Surgery Is So Challenging

Eyelid revision surgery is one of the most difficult procedures even for experienced plastic surgeons.
There is no standardized formula or single correct method—outcomes vary depending on each patient’s condition, previous surgical history, eyelid anatomy, and the degree of tissue damage.

Only a surgeon with extensive experience in complex revision cases and refined surgical judgment can determine the most appropriate and safe approach.

In addition, all surgical procedures must follow a proper sequence. Poorly performed surgeries cannot be fully corrected overnight.
Eyelid surgery is not about following trends, but about understanding the current condition of the eyes and proceeding with a carefully planned, step-by-step approach. When performed correctly, natural and satisfying results can be achieved.

Ahnsungmin Plastic Surgery

Ahnsungmin Plastic Surgery is a specialized clinic dedicated to eyelid revision surgery.
Under the expertise of Dr. Ahnsungmin, we provide customized surgical plans focused on achieving stable, natural, and long-lasting results, even in the most complex revision cases.

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