LAM FACIAL PLASTICS

Dear Dr. Lam,

I am wondering if you could enlighten me on dynamic versus static creases in the creation of double eyelids? I had mine done a year ago with a concurrent ptosis repair. It resulted in more ptosis and too high folds. I have consulted a few surgeons who suggested I fix the ptosis and lower the crease. One surgeon said he could that but the crease will be static, as in he would fix the skin to the tarsus plate. Other surgeons (from Korea) said they could fix the ptosis and lower the crease, making the crease a dynamic crease (fixation to the underlying muscle rather than the tarsus plate). Some even promise me the sky, saying they can lower the crease to as low as I want it to be but I rather be realistic about this.

However, my question is, do you know if the results from a static crease is going to be highly unnatural? Will it create very deep folds and more adhesion that will not subside with time? And what do you think of surgeons who want to fix my ptosis and give me a dynamic crease at the same time?

Also, a couple of surgeons said that my ptosis is not real ptosis but caused by persistent oedema due to the too high folds which resulted in very bad adhesion. They said that removing the adhesion and lowering the fold will fix my "ptosis" and there is no need to manipulate any muscles. And then there were other surgeons who said that I should just fix my ptosis and leave the creases alone as they will come down in time.

My plan now is to fix the ptosis and revise the double eyelids later as I want the best healing and best results and I don't want to cause too much trauma at once to my eyelids. But I am very tempted by the surgeons (some of them very prominent) who said they could fix the ptosis and give me a dynamic lower crease at the same time.

I know this is a long post but what are your thoughts?

Thank you,
Tammy

thanks for the question. to be honest, i only perform what you term dynamic folds because i place the adhesion to the muscle. i honestly do not see a visual difference between the two. i perform a levator adhesion because i get a more durable fixation than when placing to the tarsus. i wish i could guide you regarding this but i simply do not do "static" type of double eyelids. it is funny because i do not even see a real difference between so-called dynamic and static creases. i do not believe my creases placed into the levator are truly moving dynamically. just my thoughts.
best,
sml

Dr. Lam,
Why do you say a levator adhesion is a "more durable fixation than when placing to the tarsus"? If you do not perform static creases, how do you know this as true? Is there some proven research on this? Also, do you really think there is no visible difference in the 2 methods? I have heard or may be a misconception that static creases appear deeper.

Thank you in advance for answering these questions.

you're right. i should say more durable in my hands. when i have tried to grab the tarsus in the past, i do not get a good bite of material and the levator i can grab an almost full thickness because it is a soft muscle. i don't know about the depth thing. i do not think there is any proven reseach on any of this since surgeons practice what they practice.
sml