The Eyelid Crease, and it’s cousin, The Eyelid Fold, can be the most important element of a patient’s face. It can be the dominant feature of facial ethnic identity.
And some times the crease is just gone. How? What makes the crease?
The eyelid crease is formed by the attachment of the levator palpebrae muscle, the main elevator of the eyelid. This muscle sends a fine web of tendons into the skin of the upper eyelid. Without this web, the skin would flop over the edge of the upper lid when the muscle lifts that lid…. as in the left eye depicted below:
A simplistic examination might conclude that the left eye just has a ton of extra eyelid skin above it… But in reality, there is the exact same amount of skin on each side.
By the way, I fixed this problem in the office in about 20 minutes Friday. It requires extra attention to reforming the connections between the eyelid skin and the deep underlying levator muscle. This is the same sort of attention that is required when forming a lasting crease in Asian blepharoplasty. Once the lid crease was set, the skin fold (which hangs over the crease, as you can see in the right eye above) was similar to the other side.
By the way, I’ll knock on some wood and say that loss of the lid crease is something that is very rare in my patients, because I address is explicitly in all patients.