In case 1, I discussed asymmetrical double eyelids (skin creases) caused by unequal markings. In this case, the patient has equal markings but the amount of skin removed were unequal.
A 60 year-old woman complained that her double eyelids were uneven and wanted revision. Examinion revealed the skin creases are of equal heights but there was loose skin of the upper eyelids. The cause in this case was unequal removal of the upper eyelid skin with more being taken from the left than the right. The excess skin on the right eye then covered part of the double eyelids making it look lower. The problem was easily rectified by removing the excess skin in the right eye as shown below.
Asymmetrical double eyelids.
The right one appeared lower.
The double eyelids (skin creases) were more or less
the same height but the right double eyelid is
covered by excess skin (arrows).
Two weeks after revision. The excess skin on the right
eyelid was removed and the double eyelids now
The right way to prevent unequal double eyelids (skin creases) is to mark the double eyelid the same height and then removing the same amount of excess skin. The height of the double eyelids should be checked from time to time during the operation so that any uneveness can be addressed perioperatively (see pictures below).
Equal markings of the height of the double eyelids and
the amount of skin are keys to preventing
uneven double eyelids.