When the eyes are opened, the upper eyelid rises, causing the skin to wrinkle. The position and appearance of this fold plays a vital role in the expression and aesthetics of the eyes.
Loosening of the skin is the first cause of change with age, as the skin stretches, causing the crease to sag and eventually touch the eyelashes, giving a tired expression and a heavy look.

However, this is not the only factor: the volume of fat in the eyelid also plays a role. As we age, this volume tends to diminish, hollowing the eyelid and causing the crease to rise. This makes make-up easier to apply, but ages the eyes.

The height of the eyelid in relation to the iris is also important. If the free edge descends with age, due to relaxation of the muscle that raises the eyelid, this narrows the palpebral slit, raises the crease and ultimately gives a flat appearance to the free edge and a completely lifeless gaze.

The fold also depends on a connection that exists in the normal state between the eyelid skin and the levator muscle, whose role is to raise the free eyelid margin. This connection is always present in Europeans, but at a variable height. The lower the connection, the lower the crease, and vice versa.
So, at most, in the absence of a connection, as in the case of some Asians, the crease is not visible, but is in contact with the eyelashes from birth.

Finally, there is a relationship between the fold and the position of the eyebrow. The lower the eyebrow, the greater the amount of skin and the lower the fold. The eyebrow itself is in a variable position, often lower in men or when the bony arch is low in relation to the eye. In these cases, even when young, the crease is often not visible and the skin covers the eyelashes.

To be successful, a blepharoplasty must recreate a harmonious crease at the right height, generally 3-4 mm above the lashes. The position of the fold when young, around the age of 30, should be taken as a starting point. To achieve this, we need to intervene on these different parameters, and in a specific way for each individual according to his or her anatomy.

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