Double-Eyelid Revision Scars Look Natural When They Follow the Skin’s Texture

When counseling patients about double-eyelid revision surgery, I often meet people who are concerned not simply about the height or shape of the double-eyelid crease, but about issues such as

“the crease appears bent,”

“a diagonal wrinkle forms toward the inner corner,”

“the scar is noticeable when I close my eyes.”

This case involved a woman in her late 50s who had previously undergone upper blepharoplasty (middle-aged double-eyelid surgery and incisional double-eyelid surgery).

Middle-aged double-eyelid surgery review. Middle-aged eye surgery review. Upper blepharoplasty review. This is a real model who consented to the disclosure of the images.

Inner-eye wrinkles. Diagonal eye wrinkles. Middle-aged double-eyelid surgery review. Middle-aged double-eyelid surgery. This is a real model who consented to the disclosure of the images.

Before surgery, the double-eyelid crease did not continue smoothly but instead appeared bent in the middle.

Diagonal wrinkles were also present toward the inner corner of the eye.

In such cases, simply performing double-eyelid surgery again may not be sufficient.

It is important to first understand why these issues developed.

There are directions in which the skin on our face repeatedly folds and moves.

These are called Skin Tension Lines. When this direction is taken into account during skin incision or suturing, the scar may be relatively less noticeable, while natural skin movement can also be maintained.

Skin tension lines of the face. Source: Plastic Surgery Keys. Skin tension lines of the upper eyelid. RSTL. Skin tension line.

The upper eyelid is no exception.

The eyelids also have directions in which the skin texture and wrinkles form, so it is important to consider these Skin Tension Lines when creating a double-eyelid crease.

If a double-eyelid crease is created in a position or at an angle that does not match the skin’s natural direction,

it may look fine when the eyes are open, but the scar may become more noticeable when the eyes are closed,

diagonal wrinkles may form as the skin toward the inner corner twists,

or the crease may appear bent rather than smooth.

• Before and after revision eye surgery in a woman in her late 50s, and the scar maturation process -

For this revision surgery, the design took into account both the direction of skin tension and the condition of the existing tissue.

The double-eyelid crease was formed along the natural line where the skin folds, and suturing was performed while carefully adjusting the tension of the tissue.

Before and after middle-aged double-eyelid surgery. Middle-aged double-eyelid surgery review. This is a real model who consented to the disclosure of the images.

At five months after surgery, the previously bent double-eyelid crease had changed into a rounder, more natural curve.

Double-eyelid surgery scar. Incisional double-eyelid surgery scar. Double-eyelid revision scar. This is a real model who consented to the disclosure of the images.

The scar was also not very noticeable when the eyes were closed. Because the sutures followed the skin texture, the diagonal wrinkles toward the inner corner that had been visible before surgery also appeared improved.

However, scars after double-eyelid surgery do not become fully established immediately after the procedure.

Recovery process after middle-aged double-eyelid surgery. One month after middle-aged double-eyelid surgery. Recovery process after middle-aged eye surgery. This is a real model who consented to the disclosure of the images.

Double-eyelid scar. Double-eyelid surgery scar. Scar maturation process. Before and after double-eyelid scars. This is a real model who consented to the disclosure of the images.

Many people become most concerned around three to four weeks after surgery.

This is because the scar area may appear slightly red, feel bumpy to the touch, or make the crease feel firm during this period.

However, in most cases, this is part of the natural process of scar formation and healing.

Scar tissue undergoes a maturation process over time. The initially firm tissue gradually softens, and the reddish color also changes to become closer to the color of the surrounding skin.

In particular, because the eyelids have abundant blood circulation and thin skin, scars often change relatively naturally over time.

Double-eyelid revision surgery is not simply a procedure to recreate the crease. It is closer to a process of understanding the direction in which the skin naturally moves and the characteristics of the tissue, then restoring harmony between them.

Although the changes to the eyes may seem small, taking careful account of the direction in which the skin folds and the tension lines can lead to a more natural and stable result.

Middle-aged double-eyelid surgery review. Before and after middle-aged double-eyelid surgery. This is a real model who consented to the disclosure of the images.

Double-eyelid scar revision. Double-eyelid surgery scar. Before and after double-eyelid surgery scars. Double-eyelid surgery scar review. This is a real model who consented to the disclosure of the images.