- Failure to clear adequate amount of tissue between the skin and the levator muscle. This can interfer with correct adhesion between the structures.
- Inadquate anchoring of tissue between the orbicularis/skin and the levator muscle. There should be adequate area of contact between these tissues or the skin creases can easily disappear with time.
- Excessive postoperative swelling. Prolonged swelling will affect the adhesion between theskin and the levator muscle.
- Failure to take care of the lids. Excessive rubbing of the eyelids can loosen the adhesion.
This patient presented with asymmetrical double eyelids. The left double eyelid is well-formed but that of the right one is shallow. This
is due to inadequate adhesion between the levator and the skin.
There are several ways of recreating the adhesion: either by incision or suture technique. With the incision technique, the skin crease need to be incised along its length and the tissues resutured, however, this can create significant post-operative swelling in lid that had had surgery before. I opted for the suture technique and the post-operative result appeared satisfactory at two weeks.