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Ptosis Surgery: Why Making the Crease Higher Does Not Always Improve Eye Opening

The Common Misconception

Many patients believe that creating a higher eyelid crease
will make the eyes look more open.

At first glance, this may seem true.

A higher crease can create the impression of a larger, more defined eye.

However, this does not always reflect actual improvement in eyelid function.

Crease Height and Eye Opening Are Not the Same

The height of the eyelid crease
does not determine how well the eye opens.

Eye opening is primarily controlled by the levator muscle
and its interaction with surrounding structures.

The crease, on the other hand, is a surface feature.

Changing it does not necessarily improve function.

When a Higher Crease Becomes a Problem

Increasing the crease height without proper structural consideration
can lead to:

• excessive tension
• unnatural fold formation
• incomplete eyelid closure
• instability over time

In these cases, the eye may appear more open initially,
but the result does not remain stable.

The Illusion of Improvement

A higher crease can create a temporary visual effect
that mimics improved eye opening.

But this is often an illusion.

If the underlying cause of ptosis is not addressed,
the apparent improvement will not hold over time.

Function Must Guide the Decision

Ptosis correction is not about creating a more noticeable crease.

It is about restoring proper eyelid movement.

When the decision is based on appearance alone,
the result becomes less predictable.

When it is based on function,
the outcome is more stable.

What Defines an Appropriate Crease

An appropriate crease is not the highest possible crease.

It is the crease that aligns with:

• the patient’s anatomy
• muscle function
• structural balance

This ensures that the result is both natural and stable.

The Role of Surgical Judgment

The decision to adjust crease height
must be made in the context of overall eyelid function.

In many cases, lowering or maintaining the existing crease
produces a better long-term outcome
than attempting to raise it.

Internal References

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