Double eyelid surgery is a procedure that helps adjust the appearance of the eyelid crease to suit the structure of the face. However, in some cases, the crease may be too high after surgery, the fold may be deep and resemble a “clam-shell” eye, the eyes may look droopy, or the patient may have difficulty opening their eyes. This can make the appearance of the eyes differ from what was expected and, in some cases, may affect eyelid function.
Revision Double Eyelid Surgery (Revision Upper Blepharoplasty) is one approach to addressing problems after previous double eyelid surgery. An ophthalmologist specializing in oculoplastic and reconstructive surgery will assess the eyelid structure, crease position, scar tissue from the previous surgery, and function of the eyelid-lifting muscles in order to plan treatment tailored to each patient.
However, revising a previously operated double eyelid may be more complex than the initial surgery because the tissues and eyelid structures may have changed. A thorough assessment should therefore be performed before deciding on treatment.
Key Takeaway
- A high or deep eyelid crease, or one that resembles a clam shell, may result from the crease position and tissue adhesions being too high after the previous surgery.
- Droopy-looking eyes after double eyelid surgery may be related to the function of the eyelid-lifting muscles, scar tissue, an excessively high crease, or other conditions that require examination to determine the cause.
- Revision double eyelid surgery may involve releasing scar tissue, adjusting the crease level, repositioning tissue, or correcting the eyelid-lifting muscles, depending on the indication.
- Not everyone who has had double eyelid surgery needs revision, especially while the wound is still healing and the crease may continue to change.
- The goal of treatment is not only to improve the appearance of the crease, but also to consider eye opening, eye closure, vision, and the safety of the ocular surface.
What Is Double Eyelid Revision? Why Do Some People Need Repeat Surgery?
Double eyelid revision, or Revision Upper Blepharoplasty, is surgery to correct abnormalities or unsatisfactory results from previous upper eyelid surgery. These may affect appearance, eyelid function, or both.
Reasons some patients may consider revision surgery include:
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- The crease is too high relative to the structure of the eyes and face.
- The eyelid crease is deep, making the eyes look harsh or unnatural.
- The creases on the two sides are noticeably uneven.
- There is scar tissue or tissue tethering from the previous surgery.
- The patient cannot open the eyes fully or has a droopy-eyed appearance.
- There is scarring or an abnormality of the eyelid skin.
- The crease shape does not suit the structure of the face.
These problems may result from several factors, and their cause cannot be determined from appearance alone. An assessment by a specialist ophthalmologist is therefore important.
What Causes a High, Deep Crease That Resembles a Clam Shell?
An unnaturally high and deep eyelid crease is one of the problems that may occur after double eyelid surgery, particularly when the crease is positioned too high or the tissue is excessively tethered.
1. The Crease Is Too High
Positioning the crease too high relative to the eyelid structure may make it prominent and inconsistent with the natural appearance of the eyes. Some patients may feel that their eyes look harsh or older, or do not suit their face shape.
2. Scar Tissue from Previous Surgery
After surgery, the body forms scar tissue to repair the operated area. If the tissue adheres or pulls in an unsuitable position, the crease may appear deep or the eyelid shape may become abnormal.
3. Changes in Eyelid Tissue
The previous surgery may have removed some skin, fat, or other tissue, affecting the thickness, elasticity, and shape of the eyelid. If too little tissue remains, further revision may be more limited.
4. Abnormal Function of the Eyelid-Lifting Muscles
Some patients may also have abnormal function of the eyelid-lifting muscles, making it difficult to open the eyes fully or causing a droopy-eyed appearance. This condition must be distinguished from a high crease because the treatment approaches differ.
Are Droopy-Looking Eyes After Double Eyelid Surgery Caused by Weak Eye Muscles?
Droopy-looking eyes after double eyelid surgery may be caused by abnormal function of the eyelid-lifting muscles, but muscle weakness is not the cause in every case. Possible causes include:
- Pre-existing or acquired ptosis
- Changes to or injury of structures associated with the eyelid-lifting muscles
- Scar tissue that interferes with eyelid movement
- Postoperative swelling during recovery
- Certain neurological or muscular disorders
- An excessively high crease
People with droopy-looking eyes may notice that they cannot open their eyes fully, need to raise their eyebrows to open their eyes, or feel that the two eyes do not open equally. If ptosis is also present, surgery to revise the crease alone may not resolve all the problems. The doctor must also assess the function of the eyelid-lifting muscles.
Important Precaution If ptosis develops suddenly, particularly with double vision, a severe headache, abnormal pupils, or weakness, seek urgent medical evaluation. Do not assume it is a result of previous double eyelid surgery.
What Are the Options for Revising Previous Double Eyelid Surgery?
There is no single revision technique that is suitable for every patient, because each person’s problem and eyelid structure are different. An ophthalmologist specializing in oculoplastic and reconstructive surgery may consider the following approaches:
1. Correcting Abnormal Function of the Eyelid-Lifting Muscles
If examination shows that the patient has ptosis due to abnormal function of the eyelid-lifting muscles, the doctor may consider surgery to correct the relevant structures and help adjust eyelid position and eye opening. The surgical approach depends on the cause and strength of the eyelid-lifting muscles.
2. Adjusting the Crease to an Appropriate Level
If the original crease is too high, the doctor may consider repositioning it to better suit the structure of the eyes and face. However, lowering the crease may be more complex if there are significant adhesions from scar tissue or previous surgery, or if there is insufficient eyelid skin.
3. Releasing Scar Tissue and Scarring
The doctor may consider releasing or loosening scar tissue that is pulling on the tissues, as well as treating scar tissue where necessary. The goal is to reduce abnormal tethering and facilitate adjustment of the crease to an appropriate position.
4. Repositioning Eyelid Tissue
In some cases, tissue may need to be rearranged or repositioned to reduce the depth of the crease or address changes in the tissue following the previous surgery. If there is insufficient tissue, additional reconstructive methods may be considered as indicated. Not every patient needs every step of revision. The technique selected depends on the examination findings and the doctor’s treatment plan.
Example Before and AfterPtosis Revision Surgery by Dr. Fonthip Na Pombejara (Dr. Fon)
Example Before and AfterPtosis Revision Surgeryby Dr. Yongyot Tuachob (Dr. Big)
What Does the Doctor Assess Before Double Eyelid Revision?
In some cases, revision double eyelid surgery is more complex than the initial procedure because both the original structure and changes from previous surgery must be considered. The ophthalmologist may assess the following important factors:
| What Is Assessed | Importance to Treatment |
| Original crease level | Assesses the crease position and its suitability for the structure of the face |
| Eyelid-lifting muscles | Checks for ptosis and the ability to open the eyes |
| Scar tissue and scarring | Assesses tethering and limitations resulting from the previous surgery |
| Amount of skin and tissue | Determines whether there is sufficient tissue for revision |
| Eye symmetry | Assesses eyelid levels and differences between the two sides |
| Eye closure and dry eye | Assesses the risk of incomplete eye closure and ocular surface problems |
| Previous surgical history | Informs surgical planning and risk assessment |
A thorough examination helps the doctor establish appropriate treatment goals and explain the limitations of possible outcomes to the patient.
How Long Is the Recovery After Double Eyelid Revision?
After revision double eyelid surgery, patients may experience swelling, bruising, tightness, or discomfort around the eyelids. The severity and recovery time vary according to the complexity of the surgery and the condition of the existing tissue.
First 1–2 Weeks
- Swelling and bruising around the eyelids may occur.
- The crease may not yet have settled into its final shape.
- Care for the wound and use medication as directed by the doctor.
- Attend follow-up appointments as scheduled.
Several Weeks to Several Months
Swelling and tissue tightness usually subside gradually, while the scar and crease position may continue to change. Recovery may take longer if there is significant scar tissue or if multiple structures have been revised.
The result after only 1 week is not the final outcome because the wound and tissues are still healing. The crease should therefore be assessed at a time the doctor considers appropriate.
If I Am Unhappy With My Double Eyelid Surgery, How Long Should I Wait Before Revision?
In general, if there are no complications requiring urgent correction, the doctor will usually consider waiting for the tissues and wound from the previous surgery to heal first. In many cases, this may take approximately 3–6 months or longer. The appropriate timing depends on factors such as:
- Time elapsed since the previous surgery
- Severity of the scar tissue
- Any remaining swelling and inflammation
- Problems with opening or closing the eyes
- Complications that require treatment
If the eyes cannot close completely and the cornea is at risk of injury, or if there is severe eye pain or abnormal vision, see an ophthalmologist without waiting for this period to pass.
What Are the Risks of Double Eyelid Revision?
Although revision double eyelid surgery may improve certain problems, patients should understand the risks before deciding to proceed. These include:
- Swelling, bruising, bleeding, or infection
- Uneven creases between the two eyes
- New scar tissue or scarring
- The crease remains high or deep, or its shape does not meet expectations
- Abnormal eye opening or closure
- Dry eye or irritation of the ocular surface
- Injury to the cornea or related structures
- Some patients may need additional treatment or surgery
People who have had multiple surgeries or have little tissue remaining may have greater limitations on revision. They should consult a doctor to appropriately assess the benefits, risks, and achievable outcomes.
Who Should Consult an Ophthalmologist About Double Eyelid Revision?
People with the following features may consider an evaluation:
- They have had double eyelid surgery and find that the crease is abnormally high or deep.
- The crease resembles a clam shell.
- The creases on the two sides are uneven.
- They have droopy-looking eyes or cannot open their eyes fully.
- Scar tissue or scarring is pulling on the eyelid.
- They feel that the crease shape does not suit the structure of their face.
- They have difficulty closing their eyes or experience eye irritation after surgery.
Consulting a doctor does not mean that every patient needs repeat surgery. It is an assessment to identify the cause and choose an appropriate approach to care.
Double eyelid revision with an ophthalmologist specializing in oculoplastic and reconstructive surgery Revision of previously operated double eyelids requires consideration of more than appearance, because the eyelids are involved in opening and closing the eyes, protecting the ocular surface, and vision.
Ophthalmologists specializing in oculoplastic and reconstructive surgery (Oculoplastic and Reconstructive Surgery) are experienced in assessing abnormalities of the eyelids and structures around the eyes, including both function and appearance.
Treatment planning must therefore take into account the patient’s preferences, the original eyelid structure, safety, and limitations resulting from the previous surgery.
FAQ Frequently Asked Questions
Q : I have had double eyelid surgery, and the crease is too high. Can it be corrected?
A: Revision may be considered in some cases. The doctor will assess the crease position, scar tissue, amount of tissue, and eyelid structure to determine whether the crease level can be adjusted. The outcome depends on each person’s tissue condition.
Q : If the crease is deep and resembles a clam shell, does everyone need revision surgery?
A: Not necessarily. If the surgery was recent, the crease may still change as swelling subsides and the wound heals. However, if a deep crease or tissue tethering persists, the doctor may consider treatment based on the cause.
Q : Are droopy-looking eyes after double eyelid surgery caused by weak eye muscles?
A: This is possible, but it is not the cause in every case. Droopy-looking eyes may result from ptosis, scar tissue, swelling, or other abnormalities. The function of the eyelid-lifting muscles must be examined to determine the cause.
Q : Is double eyelid revision more painful than the first surgery?
A: The level of pain varies according to the technique and complexity of the surgery. The doctor will plan anesthesia and postoperative care to suit each patient.
Q : Can the eyes look natural again after double eyelid revision?
A: Surgery may help improve the crease shape, but there is no guarantee that the eyes will return to how they looked before the first surgery or become perfectly symmetrical because of limitations from scar tissue and existing tissue.
Q : Can double eyelid surgery be revised after multiple previous operations?
A: Some patients may still be considered for revision surgery, but scar tissue, the amount of tissue, eyelid function, and risks must be carefully assessed because multiple surgeries may make treatment more complex.
Revision of Previously Performed Double Eyelid Surgery Requires Identifying the Underlying Cause
A high or deep crease, a crease that resembles a clam shell, or droopy-looking eyes after double eyelid surgery may result from an abnormal crease position, scar tissue, changes in the tissue, or the function of the eyelid-lifting muscles. Each cause requires a different treatment approach.
Double eyelid revision is therefore not simply about creating a new crease. It must also take into account eyelid function, eye opening and closure, and the health of the ocular surface, alongside an appropriate appearance.
People who have had double eyelid surgery and have problems with the crease shape or opening their eyes can be evaluated by an ophthalmologist specializing in oculoplastic and reconstructive surgery to identify the cause and plan treatment tailored to each patient.
Consult an ophthalmologist specializing in
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