In short. The commonest reason patients seek a second eyelid operation, why the crease moves while swelling settles, and why the first answer is usually to wait.
Key points
- Asymmetry during healing is the rule rather than the exception.
- What turns it into a finding is persistence: a difference still present once the swelling has gone and the crease has settled on both sides.
- That judgement needs measurement at more than one visit rather than a single photograph.
A crease that sits too high, a crease that has disappeared, and two sides that do not match are the three complaints that bring most people back to a clinic after eyelid surgery. They are described together here because they share one feature: none of them can be judged until the eyelid has stopped changing.
Why the crease moves after surgery
The crease is not a structure. It is where the skin folds as it meets the tissue beneath it. Swelling inside the lid holds those layers apart, and as it resolves the skin settles downwards onto them. That is why a crease that looks far too high in the first month commonly descends, and why a fold that was fixed with a stitch can look settled early and then relax. The travel is usually downwards, over months.
A crease that has disappeared
When the fold fails to form, the lid is smooth where it used to have a line. That happens when the connection between the skin and the deeper tissue is not strong enough, or when the tissue that was meant to hold it was removed. It is not usually painful and it does not threaten the eye, which is why it is an appearance problem assessed on an appearance timetable.
What makes asymmetry a finding rather than a phase
Asymmetry during healing is the rule rather than the exception. What turns it into a finding is persistence: a difference still present once the swelling has gone and the crease has settled on both sides. That judgement needs measurement at more than one visit rather than a single photograph.
Why the first answer is usually to wait
A crease revised while the lid is still settling is revised against a moving target. The tissue is more scarred the second time and the skin available is less, so the operation carries more uncertainty and less margin than the first one did. Waiting is not inactivity; it is the only way to know what is actually being corrected.
What can be changed, and what cannot
Where the crease sits can often be adjusted, and a difference between the two sides can often be narrowed. What cannot be promised is symmetry, because the two lids heal independently and neither is a copy of the other. Nor can a crease be made to match one that someone else has, because the fold depends on the thickness of the skin, the position of the fat and the way the deeper tissue holds it. Those are anatomical facts and belong in the conversation before a plan, not after it.
Do not wait on these
- An eye that will not close, or that stays open during sleep.
- Eye pain, light hurting the eye, or a gritty feeling that worsens.
- A wound that is opening, or redness, heat, pus or fever around it.
The timetable that has to be respected before a crease is addressed is set out in How Long Before Eyelid Revision Can Be Considered. Where too much tissue was removed rather than the crease misplaced, the problem is described in When Too Much Skin or Fat Has Been Removed.
Frequently asked questions
Why would a crease that looked right at first change position?
Because the crease is where the skin folds as it meets the tissue beneath it, and swelling inside the lid holds those layers apart. As the swelling resolves the skin settles downwards onto them. Movement over months is the rule rather than the exception, which is why the position of a crease is judged late rather than early.
Can a crease that has disappeared be brought back?
Sometimes. Whether it can depends on why the fold has failed to form: a connection that was not strong enough, one that was released by swelling, or tissue that was removed and is no longer there. The assessment establishes which of those is present, and the answer for the third is different from the answer for the first two.
Will a revision make the two eyelids symmetric?
Symmetry cannot be promised. The two lids heal independently, most faces are asymmetric before any operation, and the fold depends on the thickness of the skin, the position of the fat and the way the deeper tissue holds it. A revision can often narrow a difference; it cannot make one lid a copy of the other.
Risks & Limitations
- An eye that cannot close, or that stays open during sleep, is the finding that matters most: the surface of the eye is at risk, and it is treated rather than watched.
- A revision works on tissue that has already been operated on, so there is less skin and fat available the second time and scarred tissue behaves differently from the tissue the first operation worked with.
- Eyelid surgery changes how completely the lid closes, so it can affect the surface of the eye. An eye that is already dry is a reason for caution and sometimes a reason not to operate.
- Symmetry cannot be promised. Most faces are asymmetric before surgery, the two lids heal independently, and the tissues continue to age after any operation.
When to Seek Care
- An eye that cannot be closed, or that stays open during sleep and is painful — seek emergency care now.
- Severe eye pain, a gritty feeling that keeps worsening, or light hurting the eye — seek emergency care now.
- Vision that does not clear on blinking, double vision, or any sudden loss of vision — seek emergency care now.
- A lower lid pulled away from the eye with constant watering, or blood collecting around the eye with tense painful swelling — seek urgent care.
- A wound that has opened, or spreading redness, heat, pus or fever — seek care the same day.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.