A few days after upper blepharoplasty, many people look in the mirror and think something has gone wrong. The crease looks too high. The fold is deeper than they expected, or there's far more eyelid showing than in the simulation. One side looks different from the other. The eyes feel heavy and harder to open.
Most of the time, this is what healing looks like — especially when the operation involved raising, creating, or reinforcing the crease rather than removing skin alone. This article explains why the crease looks the way it does early on, how it usually changes over the following weeks and months, and, just as importantly, which symptoms are not part of normal healing and deserve a prompt call.
If you're still deciding on surgery, my article on how the upper eyelid crease is planned covers the "before" side of this story. This one is about the "after."
Key takeaways
- An early crease that looks too high or too deep is common, particularly after crease work. Swelling, temporary strain on the eyelid-opening tissues, and brows lifting to help open the eyes all exaggerate it.
- Crease work adds roughly one to two weeks to the more noticeable phase of recovery compared with skin removal alone.
- The early exaggeration usually settles over three to six weeks. The crease and incision keep softening and maturing for many months; I consider the final result to be somewhere around six to eighteen months out.
- Asymmetry during healing is normal. One side almost always heals faster than the other.
- Some changes are not normal: worsening pain, vision changes, rapidly increasing swelling or bulging of the eye, or trouble closing the eyes. Those need a prompt call — and sudden vision loss is an emergency.
- Don't judge your final crease in the first few weeks.
Why the crease looks too high or too deep at first
When I raise, create, or reinforce a crease, I'm working with the deeper tissues that form the fold — not just the skin above it. That changes recovery in three ways that stack on top of each other.
Swelling. Crease work generates more swelling than skin removal alone, and swelling doesn't sit evenly. It tends to collect in the soft tissue above and below the new fold, which deepens the fold and makes the platform of skin below it look larger.
A new load on the eyelid-opening tissues. The muscle that opens the upper lid (the levator) works through a broad sheet called the levator aponeurosis. Creating or reinforcing a crease places a new load on that sheet and the tissue around it. Combined with ordinary post-operative swelling, this makes the eyelids feel heavier and harder to open in the first weeks. That's expected, and it isn't a sign that the muscle has been damaged.
Your brows try to help. When the eyelids feel heavy, the brain recruits the forehead muscle to raise the brows and pull the lids open. You won't notice you're doing it. But lifted brows pull the skin above the crease upward, which makes the crease look even higher and reveals even more eyelid. As the lids recover and open more easily, the brows relax.
Put those together and the early picture is an exaggerated version of the result: higher, deeper, with more pretarsal show (visible eyelid skin) than we planned. That's why I ask patients not to judge the crease in the first few weeks.
A realistic recovery timeline
Every person heals differently, and the type of surgery matters. These are the patterns I see, not guarantees.
The first few days. Swelling and bruising usually peak around day one or two and then slowly improve. The crease may look hard to read, or very high and deep. The eyes may feel heavy, tight, and a little dry.
The first one to two weeks. Bruising fades and stitches come out. With skin removal alone, many people are fairly comfortable being seen by this point. When the crease has been changed, expect the more noticeable phase to run about one to two weeks longer than that.
Three to six weeks. This is when the early exaggeration typically settles. As swelling goes down and opening the eyes gets easier, the brows stop working as hard, and the crease drops toward its intended position. Many people see the result "arrive" during this window.
Two months and beyond. The incision goes through a normal phase where it's pinker and slightly raised for the first couple of months before it softens and fades. The crease and the tissues around it keep maturing.
Six to eighteen months. I consider the final result to be somewhere in this range, depending on the person and the procedure. That doesn't mean you'll look unnatural for a year — most people look quite natural well before then. It means subtle refinement continues for a long time, and the crease you see at six weeks isn't necessarily the crease you'll have at a year.
"One side looks different from the other"
This is probably the most common worry I hear after eyelid surgery, and in the early weeks it's almost always swelling. One side nearly always heals faster than the other — that's completely normal, and it evens out. Swelling also changes through the day: it's often worse in the morning and after salty meals, and it can make one crease look higher on one day and lower on the next.
It also helps to remember that our two sides were never identical to begin with. The right and left sides of the face are sisters, not twins — the bones, muscles, and soft tissues differ slightly — so some difference between the two eyes is expected even after full healing. Surgery can improve asymmetry, often significantly, but it can't erase it.
The time to assess symmetry is after the swelling has settled, not during the first weeks.
What's happening with your eyebrows
Brows can change after upper eyelid surgery, and there are two different reasons — neither of which usually means something went wrong.
They may settle lower. If your eyelids were heavy before surgery, you were probably raising your brows all day to help see, without realizing it. Once the eyelids are lighter, that effort isn't needed, and the brows can settle to their true resting position. It can feel like the brows dropped, but they're often just where they would naturally sit.
The outer brow may look more hooded by contrast. After surgery, the central eyelid is crisper and more tucked in. If the outer brow sits low, its hooding can look more obvious next to the improved eyelid — even though the brow itself hasn't moved.
During the first weeks there's a third, temporary effect: the brows working harder than usual to help open swollen, heavy eyelids. That one fades as the eyelids recover.
For many people none of this is a concern. If outer hooding still bothers you once you've fully healed, a brow lift is the operation that addresses brow position. Removing more eyelid skin generally isn't the answer to a brow problem.
What you can do to help
Your surgeon's written instructions always come first — they're tailored to the operation you had. In general, the things that help most in the first week are:
- Cold compresses early, then warm. Something clean and cold for 5–10 minutes at a time in the first few days, then switching to warm compresses, which usually help more with bruising.
- Keep your head elevated, including while you sleep.
- Don't rub or pull on your eyelids. Dab and pat only.
- Use your ointments and lubricating drops as directed. The eyes often feel dry or gritty early on.
- Ease back into activity. Avoid heavy lifting and strenuous exercise until your surgeon clears you.
- Go easy on salt and alcohol in the first week; both increase swelling.
Later on, a silicone scar gel can help the incision soften, if your surgeon recommends it.
When a change is not normal
"Harder to open" and "looks too high early on" describe normal healing. These do not, and they warrant a prompt call to your surgeon:
- Pain that is severe, worsening, or not controlled by your medication
- Any change or decrease in vision
- Swelling that increases rapidly, especially with the eye bulging forward or feeling very tight
- Inability to close your eyes enough to protect them, or eye pain with marked redness
- Fever, spreading redness, or discharge from the incisions
Sudden loss of vision, especially with pain and rapidly increasing swelling, is an emergency. Call your surgeon immediately, and if you can't reach them, go to the nearest emergency room.
When you call, a photo taken in bright light with the flash on, with your eyes open and your whole face in frame, helps your surgeon a great deal.
When should you worry about the final crease?
Not in the first few weeks. Most of what looks wrong early on is the swelling, strain, and brow compensation described above, and it changes considerably as those settle.
If the crease still looks too high, too low, or noticeably different between the two sides once the early phase has passed, the right next step is a calm conversation with your surgeon. It's also worth knowing that the visible fold doesn't always sit exactly where the incision was placed; the eyelid has its own folding mechanics, and the fold can settle slightly differently from the anatomical crease.
If a revision is ever considered, it's generally best done after the tissues have matured, which takes months. And it helps to know that lowering a crease is much harder and less predictable than raising one.
If you had surgery elsewhere
Some people reading this had their surgery with another surgeon and are looking for reassurance or a second opinion. Your own surgeon knows exactly what was done and is the right first call, especially in the early weeks.
If you'd like another opinion after you've healed, I'm glad to evaluate your eyelids. I approach those visits with respect for you and for your surgeon — there's no way to know from the outside exactly why a result looks the way it does, so the focus is on what can realistically be done now and what to expect.
Frequently asked questions
Why does my eyelid crease look so high after blepharoplasty? Early on, swelling, temporary strain on the eyelid-opening tissues, and your brows lifting to help open your eyes all make the crease look higher and deeper than it will be. It usually settles over three to six weeks.
How long until my eyelid crease looks normal? The early exaggeration typically settles over three to six weeks, and about one to two weeks longer when the crease was raised or reinforced. The crease keeps refining for months; I consider the final result to be around six to eighteen months out.
Is it normal for one eye to look different after eyelid surgery? Yes, in the early weeks. One side almost always heals faster, and swelling shifts day to day. Assess symmetry once the swelling has settled.
Why are my eyes hard to open after upper blepharoplasty? Swelling, plus a new load on the tissues that open the eyelid when the crease has been changed. It's expected and improves as healing progresses. Any vision change or severe pain is different and needs a prompt call.
Did my eyebrows drop after eyelid surgery? Often they've settled to their natural resting position because you no longer need to raise them to see, or the outer brow looks lower by contrast with a crisper eyelid. Neither usually means something went wrong.
When can a crease be revised? Generally only after the tissues have matured, which takes months. Lowering a crease is much harder than raising one.
Eric S. Ahn, MD is a board-certified ophthalmologist and fellowship-trained oculofacial plastic, cosmetic, and reconstructive surgeon in Torrance, California. He specializes in eyelid surgery, ptosis repair, Asian eyelid surgery, and facial rejuvenation. To schedule a consultation, call the office at (310) 791-2233.
This article is for educational purposes and does not replace an individualized medical evaluation or your own surgeon's post-operative instructions. All surgical procedures carry risks, and results vary with individual anatomy and healing.