Double eyelid surgery - infold vs outfold. What is the difference?


Patient with a natural outfold
Patient with a natural outfold

When you are considering double eyelid surgery, one question that you will need to consider is how you would like the start of the fold to be placed on the inner corner of the eyelid. The terms most frequently used are an 'infold' vs an 'outfold'. But what exactly do these terms mean and what would be best suited to your eyes?

 

There are a few factors which should be considered in choosing fold placement. 

 

1. Is there a pre-existing fold and what is the current shape of the inner corner area?

 

2. What is the desired post operative fold height?

 

3. Is the eye profile 'enothalmic' or 'exopthalmic'.

 

The first of these questions can be a significant determing factor on what you may perceive as 'natural'. Patient's with a pre-exiting infold, where the corner of the eye has a fold line that arises from it, is usually seen as a natural result. Those who have a pre-existing outfold may prefer their shape also. Maintaining a current inner corner shape is simple and often provides the most natural results.

 

Patient with infold creation and medium fold height creation resulting in a natural appearing double eyelid surgery crease
Patient with infold creation and medium fold height creation resulting in a natural appearing double eyelid surgery crease

Where it becomes more complex is in the situation where a change in fold shape is desired. Depending on the amount of skin excess, an outfold can be brought down into an infold shape. The alternative is also possible, however often results in an unnatural appearance and a 'drawn on' double eyelid crease shape.

 

 

 

Patient with high folds placement and outfold double eyelid surgery crease. These results can look natural and distinct in those with a sunken or enotphalmic eye position
Patient with high folds placement and outfold double eyelid surgery crease. These results can look natural and distinct in those with a sunken or enotphalmic eye position

The desired fold height is also a factor that needs consideration. Infolds work well with a lower fold height. Outfolds can work well with a high double fold height in the right patient. Outfolds do not typically suit a lower crease height while an infold can cater to a higher height and is therefore the most versatile placement option.

 

Enopthalmic eyes in those of East-Asian descent is not common. The typical East-Asian (Korean, Japanese, Chinese, Vietnamese, Taiwanese etc.) have a flatter facial profile than a Caucasian face. Eyes are more 'exopthalmic' or outwardly placed, while noses are smaller and cheek bones wider and higher. High folds with outfolds are a typical fold seen in a Caucasian or Middle eastern eyelid. These eyes are deeply sunken compared to the overal facial profile and when double eyelid surgery was initially invented decades ago, the first operations were designed to mimic this Western appearance. Unfortunately, the results were never natural and resulted in highly positions folds that looked drawn on and often gave a sleepy or aged appearance that was only coverable with heavy makeup use. 

 

Modern double eyelid surgery techniques strive for a natural appearance and have shown that unless the eye is enopthalmic or sunken in, an infold with lower fold height is usually best.

 

 

Fold placement is one of the factors that will be discussed with you during your initial consultation with Dr. Ahn regarding double eyelid surgery in Sydney. Please contact us if you are interested in discussing your options.