Section: Other Challenges
Reverse Double Eyelid Surgery
"Reverse double eyelid surgery" is a procedure that has received recent attention. Unfortunately, the operation is not designed to undo the effect of previous crease surgery and so the name can be misleading.
Also called "monolid surgery" or even "single eyelid surgery," reverse double eyelid surgery is instead a straightforward procedure to soften or eliminate the appearance of an overly noticeable eyelid crease but only in the setting of a condition known as "eyelid ptosis."
Ptosis is the technical term for upper eyelid droopiness. If the platform of tissue just above the lashes (that is, the tissue platform on which eye shadow is normally applied) is hanging too low due to a weakness or tear in the internal lifting mechanism, the eyelid can appear as if a "natural" crease is present.
In cases where a patient with ptosis happens not to like the look of either the droopiness or the associated creases, both problems can be eliminated by repairing the anatomical defect causing the ptosis. Once the lid can open to a normal height, the platform of tissue mentioned above retracts back under the overlying skin and the double eyelid seems to disappear. The procedure only works when the ptosis is mild. In patients with severe droopiness, there is no appearance of a crease, and so this really isn't an issue.
Of course, the obvious limitation of this operation is that one must have an abnromal drooping eyelid (ptosis) accounting for the appearance of the crease. Otherwise, there's nothing to lift. Lifting a lid in the absence of ptosis can cause major problems: a look of staring (eyelid retraction) or difficulty fully closing the eye (lagophthalmos).
So, what about a patient who was born with single eyelids, later underwent an incisional operation to create double eyelids, and then several years later decided to try to return to his or her former state? The procedure described above will not help.
Then what instead can help in such cases? Unfortunately, nothing that's simple or very reliable. Once eyelid tissue has been removed, it can only be restored by grafting (skin and fat can be grafted; muscle cannot).
But what if a patient had his or her crease created using the non-incisional or "suture" technique without tissue removal? Then there's at least a chance that the surgical creases can be softened or eliminated by removal of the sutures. However, even this sort of repair is not fully predictable because of the presence of stubborn internal adhesions that form during the first six months.
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