High fold correction must be considered in relation to ptosis surgery.
As discussed in our previous post,
high fold correction is closely related to ptosis surgery.
👉 Previous post:
Why High Folds Form—and How They Should Be Corrected
https://ahnsungminplasticsurgery.com/why-high-folds-form-and-how-they-should-be-corrected/
High fold correction is not a single, uniform procedure.
Before deciding how to correct a high fold,
there are two critical factors that must always be evaluated together.
1. Restoring comfortable eyelid opening through ptosis correction.
One of the most common reasons high folds persist or worsen
is compensatory effort caused by insufficient eyelid opening.
When ptosis is not adequately addressed,
the eye continues to rely on excessive muscular effort to open.
Over time, this force repeatedly pulls the crease upward,
making the fold thicker and more fixed.
In such cases,
lowering the crease alone does not solve the problem.
The fold often returns to its previous position or becomes unstable.
For this reason,
the first priority in high fold correction is ensuring
that the eye can open comfortably without excessive effort.
This mechanism was explained in detail in our previous post.
2. Lowering the crease at the level of the eyelid skin.
Not all high folds are driven purely by functional imbalance.
In some cases, even when ptosis is mild or adequately corrected,
the crease remains excessively high due to the existing skin and fixation pattern.
At this stage,
the key question is not how to lower the fold,
but where the original crease is positioned.
(Example of an excessively high preexisting crease)
When the original crease is positioned very high,
lowering it becomes technically demanding.
In theory,
excising the existing crease and redefining the fold
is often the cleanest and most effective approach.
However, when the crease is fixed too high,
there may be insufficient skin to safely excise it.
Simply releasing the crease and leaving it in place
can result in visible scarring or the formation of multiple folds.
Scarring must be discussed realistically.
As a plastic surgeon,
every effort is made to minimize scarring.
However, it is important to understand that
once a scar has formed,
it cannot simply return to normal skin.
This reality must be clearly understood
before proceeding with high fold correction.
One of the most common challenges in high fold revision
is that the original crease has been fixed too aggressively.
Even after correction,
the tissue often attempts to return to its previous position,
leading to unstable folds or the appearance of double creases.
Eyelid volume is another critical variable.
When eyelid fat is insufficient,
the eyelid may lack the natural weight
needed to settle into a stable position.
Instead of gently draping downward,
the eyelid can roll upward,
making high fold correction even more difficult.
In such cases,
results tend to be less predictable
and require particularly careful judgment.
In high fold correction, identifying the cause is everything.
High fold correction is not defined by the technique used.
It is defined by
why the fold became high,
what forces are acting on the eyelid,
and what condition the tissue is truly in.
When these factors are not accurately identified,
high fold correction often leads to another revision.
For this reason,
in high fold correction,
accurate cause analysis is not optional.
It is essential.
Seeing the Eye as a Whole, Not in Parts
A Clinic Dedicated to Eyelid Revision Surgery in Korea
Ahnsungmin Plastic Surgery