What Are Triple Eyelids and How to Treat Them?

Look at the many faces around you, and you’re likely to see sets of eyes framed by one distinct fold across each eyelid.

For some people, that single fold turns into two, forming what is known as a triple eyelid. Keep reading to find out more about this condition and what can be done to help correct it.

What are triple eyelids?

The skin and muscle between the eyebrow and eyelid crease form the eyelid skin fold. Your skin and the muscle in your eye orbit that keeps the upper eyelid lifted called the levator aponeurosis attach together to form your eyelid crease.

A triple eyelid forms when the sole defining eyelid fold morphs into two or more folds. This can be disconcerting for some, especially if it occurs rather suddenly or conspicuously.

Why do people get triple eyelids?

Triple or multiple eyelid creases have various causes and are classified by clinical presentation.

Primary triple eyelid: Fat volume and skin elasticity

In most cases, the extra eyelid crease is caused by:

Loss of skin elasticity and weakened connections between the skin and levator muscle.
Soft tissue atrophy and lack or loss of fat volume (subcutaneous or deep fat) in the upper eyelid above a person’s natural eyelid crease.

These aren’t extra eyelid folds per se, but creased or depressed skin. Tissue atrophy and loss of skin elasticity contributes to:

Lack or loss of fat volume in the periorbital area
Hollowing or deepening of the upper eyelid sulcus
Asymmetry of the eyelid crease or the appearance of uneven eyelids

These, in turn, can predispose a person to multiple eyelid folds.

Secondary triple eyelid: Scar tissue adhesions

These creases may result from eyelid surgery known as blepharoplasty. Removing too much soft tissue in the upper eyelid flap can lead to adhesion or binding of scar tissue. This leads to an extra eyelid crease above the surgically created fold.

Tertiary triple eyelid: Scar tissue re-adhesions

These triple eyelid folds form after subsequent surgery to correct:

High eyelid folds
Eyelid retractions
Ectropion—a condition in which the eyelid turns outward and leaves the surface of the inner eyelid exposed and more vulnerable to irritation.

Additional eyelid creases form as the surgically deconstructed eyelid fold re-adheres.

What are common risk factors for developing triple eyelids?

These include:

Older age

As people age, their skin loses volume and elasticity. This can lead to ptosis or sagging of the skin around the eye, which changes the appearance of the eyelid fold.

Racial background

People of Asian descent are more likely to have folds that sit low on the upper eyelid, as well as greater fat volume toward the eyelid margin. This makes them more prone to triple eyelid creases as skin loses its volume and elasticity.

Skin shade and thickness

Individuals with a fair complexion and/or thinner skin tend to develop additional eyelid creases.

Body shape and size

Those who are thin and/or athletically shaped are at greater risk for developing triple or multiple eyelids.

Contact lens use

Long-term contact lens use weakens the muscles in this region.

Swelling

Certain health issues can cause swelling caused by fluid build-up in your tissues and cavities known as edema. Triple eyelid can manifest due to fluid retention.

Can you prevent triple eyelids?

Certain healthy lifestyle actions may help lower the risk for triple eyelids. These often involve activities that lessen inflammation, such as:

Staying well hydrated
Getting enough restful sleep on a routine basis
Quitting smoking
Limiting alcohol consumption, if any
Reducing salt intake
Caring for allergies, cold, flu, or other health issues that trigger inflammation

Protecting skin health by taking action to protect it can also help. Try to:

Limit sun exposure
Routinely apply topical SPF products
Wear wide-brimmed hats and sunglasses that block ultraviolet rays

When to seek medical care for triple eyelids

In most cases, this extra eye fold won’t go away on its own. It often requires medical or surgical intervention. Be sure to seek care from a fellowship-trained, board-certified oculofacial plastic surgeon for this condition.

Although the occurrence of a triple eyelid doesn’t usually warrant urgent or emergent medical care, it is vital to consult with your healthcare provider right away if you have:

Eye pain or discomfort
Blurry or distorted vision
Headache
Other unusual or persistent symptoms

If your symptoms are severe, be sure to get emergency medical care at your local hospital emergency department.

How are triple eyelids treated?

Various surgical and aesthetic procedures may help with triple eyelids. These include:

Blepharoplasty

Surgery is the treatment of choice for triple eyelids. Your plastic surgeon may perform blepharoplasty to remove excess skin and lift drooping skin.

And if blepharoplasty or another surgical eyelid procedure caused the excess eyelid crease, surgical release of the adhesion is vital.

Brow lift

Another surgical option is a brow lift. This procedure raises the soft tissue around the brow area, boosting a sagging brow and improving brow symmetry. A brow lift can be performed as a standalone procedure or with blepharoplasty.

Dermal fillers

Some doctors may also recommend a nonsurgical brow lift. This method of correcting the triple eyelid involves using injectable dermal fillers to lift, volumize, and smooth out the excess crease with natural hyaluronic acid fillers.

Lipofilling/fat transfer

Autologous fat transfer or lipofilling may also be used to lift the brow and provide volume to the eyelid. This method involves harvesting your fat cells through liposuction and then injecting and grafting them into your periorbital treatment area.

Lipofilling carries a minimal risk of an immunogenic reaction and may promote deposition of new collagen and boost blood flow to the treated area.

Radiofrequency

Radiofrequency treatments may also be used to enhance surgical interventions or as a separate, noninvasive means to tighten thin, drooping eyelid skin and saggy brows.

What can you take away

The cause of a triple eyelid can vary, and may have biological, physical, and genetic roots. It may also occur as a result of adhesions forming after eyelid surgery.

Certain lifestyle actions can help lessen the risk for triple eyelids whereas surgical measures tend to be the treatment of choice should they occur.

Less invasive techniques, such as nonsurgical brow lifts, lipofilling, and radiofrequency are also showing promise as eyelid and facial rejuvenation therapies.