In short. A crease set too high reads as hollow and staring, one set too low leaves skin to fold again. Why the line follows your own lid rather than a borrowed photograph.
Key points
- Ask to be shown the proposed line in a mirror while you are sitting up.
- The relationship between the brow and the lid changes when you lie down, so a line drawn on a face lying flat is drawn against different anatomy.
- If the mark is made after sedation, ask for it to be confirmed with you before the operation begins.
The crease is the line where the lid folds when the eye opens. It is not a mark drawn on the surface: it is created by anchoring the skin to the lifting mechanism beneath it, and the height at which that anchor is placed is one of the few decisions in this operation that is genuinely a choice.
What the height does to the lid
A crease placed higher than the lid can hold pulls skin upward and leaves the tissue above it looking thin, which reads as hollow and staring. The eye appears surprised rather than rested, and the effect is difficult to disguise because it is present at rest. A crease placed lower than the natural one leaves skin below the fold to hang over the lashes again, which is the problem the operation was meant to solve.
Where the height comes from
The figure follows the lid rather than a preference. The surgeon looks at where the existing crease sits, how much firm tissue lies between it and the lashes, how thick the lid skin is, and where the brow sits above it. A lid with a short distance between lash line and brow holds a lower crease, and one with thin skin and a long lid holds a slightly higher one.
The marking is a conversation, and you should be awake for it
Ask to be shown the proposed line in a mirror while you are sitting up. The relationship between the brow and the lid changes when you lie down, so a line drawn on a face lying flat is drawn against different anatomy. If the mark is made after sedation, ask for it to be confirmed with you before the operation begins.
Why the two sides are not always marked the same
Most lids are not symmetrical to begin with: the brow on one side sits differently, the lid margin is often a fraction lower on one side, and the skin thickness varies. One side may be marked slightly differently on purpose so that the two lids match in the mirror, which is a different aim from making the two marks identical.
Who should make the decision
The surgeon who has measured the lid, with the patient in front of them. A service that offers a standard crease, or one chosen from a photograph of somebody else, is offering a shape rather than a plan. The measurement is taken once, and everything about how the lid looks afterwards follows from it.
Claims to treat with suspicion
- That a particular crease fashion can be applied to any lid that asks for it.
- That a higher crease always looks more awake or more open.
- That the line settles exactly where it is drawn on the day.
What the crease means over the first months, and when it can honestly be judged, is set out in The First Month After Upper Eyelid Surgery, Week by Week. How a crease set too high is revised is covered in Too Much Skin Removed: The Hollow Upper Lid.
Frequently asked questions
Who decides the crease height, and when?
The surgeon measures it and the patient agrees it, with both looking at the same lid. It should be marked with you sitting upright and awake, because a face lying flat changes the relationship between the brow and the lid. A crease decided while you are already sedated is a crease decided without you.
Why does the crease look too high in the first weeks?
Because the lid is swollen and the skin is still held by the healing of the fixation. The crease settles downward over the first three to six weeks as that resolves, which is why judging the height at two weeks is unreliable in either direction and why a revision is not planned in that window.
Can the crease height be changed later if I do not like it?
It can be revised, and it is not a simple adjustment. Lowering a crease that was set too high may require releasing the fixation and finding skin that is still available, and raising one that was set too low takes more skin away. Both are easier to avoid than to correct, which is why the marking is worth arguing about.
Risks & Limitations
- The amount of skin removed decides how completely the lid closes. Too much and the eye is exposed at night and the surface becomes dry and gritty, and skin that has been taken cannot be stretched back.
- The dry eye question decides candidacy here more than any question about appearance. The skin being removed is part of what spreads moisture over the eye, so an eye that is already gritty on waking or needs drops through the day has less margin to spend.
- A brow lift and a repair of the muscle that raises the lid are different operations, not variations of this one. Removing skin does not lift a brow or widen the eye opening, and it can make either finding worse.
- The crease is set from the anatomy of your own lid. A crease placed higher than the lid can hold reads as hollow and staring, and over-resection produces a sunken upper lid that cannot simply be filled back with skin.
- The two sides settle at different speeds and the difference narrows over three to six months, so the crease sits higher than its final position in the early weeks. The lid is judged across a year, and the scar matures and fades towards the crease over six to twelve months without disappearing.
When to Seek Care
- Any change in vision, including blurring or a patch of lost sight — seek emergency care immediately.
- An eye that is painful and gritty with a discharge, or a lid that does not close at all.
- Increasing swelling or pain after the first few days rather than settling, spreading redness, warmth or fever.
- Bleeding from the incision that does not stop with gentle pressure, or a wound that opens.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- International Society of Aesthetic Plastic Surgery (ISAPS) — global 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.