Aesthetic Plastic Surgery

, Volume 43, Issue 1, pp 139–146 | Cite as

Lowering of the High Eyelid Crease in Revision Upper Eyelid Surgery

  • Stephanie M. Young
  • Yoon-Duck KimEmail author
  • Jeong Hee Kim
  • Stephanie S. Lang
  • Kyung In Woo
Original Article Oculoplastic



High placement of the lid crease is a common complication in upper eyelid surgery. Correction of the high crease by revision surgery is challenging and has not been well-reported.


This is a retrospective interventional study of patients who underwent revision eyelid surgery with lowering of the lid crease from 2008 to 2016 at a tertiary institution. Main outcome measures were pretarsal show (PTS) distance, lid crease symmetry, margin reflex distance 1 (MRD1), and lid height symmetry. Lid crease symmetry was graded as symmetrical, mild asymmetry (PTS difference ≤ 0.5 mm), moderate asymmetry (PTS difference > 0.5 mm but ≤ 1 mm), or obvious asymmetry (PTS difference > 1 mm). Lid height symmetry was graded as symmetrical, mild asymmetry (MRD1 difference ≤ 1 mm), moderate asymmetry (MRD1 difference > 1 mm but ≤ 2 mm), or obvious asymmetry (MRD1 difference > 2 mm).


There were a total of 69 patients and 100 eyes. The majority (n = 42, 60.9%) of patients were females. The mean age was 38.3 ± 17.3 years, and mean follow-up was 16 months. Mean PTS decreased from 3.1 mm pre-surgery to 2.0 mm 2 years post-surgery. The proportion of patients with moderate or severe lid crease asymmetry decreased from 81.1% pre-surgery to 6.7% 2 years post-surgery. The mean MRD1 difference decreased from 1.54 mm pre-surgery to 0.23 mm 1 year post-surgery. The proportion of patients with moderate or severe lid height asymmetry improved from 64.5% preoperatively to 4.5% 1 year postoperatively.


Revision eyelid surgery to correct a high crease is a challenging procedure. We present a technique that is effective in correcting the high lid crease, while simultaneously improving the lid height and lid crease symmetry.

Level of Evidence IV

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Blepharoplasty Eyelid surgery Revision blepharoplasty High crease Oculoplastics 


Authors Contribution

All authors have made substantial contributions to the (1) conception of the work, (2) the acquisition, analysis or interpretation of data, (3) drafting the work or revising it critically for important intellectual content, and (4) final approval of the version published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The manuscript has been read and approved by all the authors, and the requirements for authorship as stated above have been met.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  • Stephanie M. Young
    • 1
  • Yoon-Duck Kim
    • 2
    Email author
  • Jeong Hee Kim
    • 2
  • Stephanie S. Lang
    • 3
  • Kyung In Woo
    • 2
  1. 1.Department of OphthalmologyNational University HospitalSingaporeSingapore
  2. 2.Department of Ophthalmology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
  3. 3.Clinical AuditSingapore National Eye CentreSingaporeSingapore

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