Why do extra creases appear after double eyelid surgery?
Multiple folds form when loose skin above the fixed line buckles or an old crease re-adheres — some settle with swelling, others need release.
A clean single fold depends on the skin above the line draping smoothly. When that skin is loose, thin, or previously creased, it can buckle into a second or third line — a pattern sometimes called a triple fold. Early multiple creases are common while swelling distorts the drape, and many resolve on their own.
When a crease needs treatment
A crease that persists after swelling resolves usually means the old adhesion re-formed or hollowness above the lid lets skin fold. Treatment matches the cause: releasing the unwanted adhesion, adding filler or fat to a hollow upper lid, or revising the fixation line.
Distinguishing a temporary buckle from a re-adhered crease takes an examination of skin thickness, hollowing, and old scar planes. Whether and when to intervene varies by individual anatomy, so persistent extra lines are best evaluated in a specialist consultation.
MediIndex articles are for general information only and are not medical advice, diagnosis, or advertising. Outcomes vary by individual — consult a board-certified specialist for personal decisions.