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Triple eyelid occurs when the upper eyelid has two folds instead of one. It may be caused by extra skin, loss of fat due to aging, or weakness of the muscles in the eyelids. Credit Image: ozrimoz/Shutterstock

If you look at the many faces around you, 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’s known as a “triple eyelid.” Keep reading to find out more about this condition and what can be done to help correct it.

The skin and muscle between the eyebrow and eyelid crease form the eyelid skin fold. The eyelid crease is formed by attachments between the skin and the muscle in the eye orbit, which keeps the upper eyelid lifted.

A triple eyelid forms when the one main eyelid fold morphs into two or more folds. This can happen suddenly.

Triple or multiple eyelid creases have various causes and are classified by certain signs and symptoms.

Primary triple eyelid: Fat volume and skin elasticity

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

  • loss of skin elasticity and weakened connections between the skin and muscle beneath
  • soft tissue thinning and loss of fat under the skin in the upper eyelid, above your natural eyelid crease

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

  • loss of fat volume in the area around your eye socket
  • hollowing or deepening of the upper eyelid groove
  • asymmetry of the eyelid crease or the appearance of uneven eyelids

These can make it more likely for you to develop extra eyelid folds.

Secondary triple eyelid: Scar tissue adhesions

This type of extra eyelid crease may result from eyelid surgery known as blepharoplasty.

Removing too much soft tissue in the upper eyelid flap can cause the scar tissue to bind to surrounding tissue or thicken. This can lead to an extra eyelid crease above the surgically created fold.

Tertiary triple eyelid: Scar tissue re-adhesions

This type of triple eyelid fold forms after 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

Additional eyelid creases may form as the surgically corrected eyelid fold heals.

  • 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 tone and thickness. Individuals with a fair complexion and thinner skin may be more likely to develop additional eyelid creases.
  • Body shape and size. Those who are thin or athletically built 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 fluid to build up within body tissues and cavities. This swelling can cause triple eyelids to form.

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

  • staying well-hydrated
  • getting quality sleep on a routine basis
  • quitting smoking
  • limiting alcohol consumption
  • reducing salt intake
  • protecting skin from sun exposure
  • caring for allergies, cold, flu, or other health issues that trigger inflammation

In most cases, this extra eye fold won’t go away on its own. It often requires medical or surgical treatment. A fellowship-trained, board certified oculofacial plastic surgeon may be your best option to treat this condition.

There are several possible treatment options for triple eyelid. Here are the main ones.

Blepharoplasty

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

If a surgical eyelid procedure caused the excess eyelid crease, surgical release of the scar tissue is key.

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.

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

Lipofilling

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 the treatment area.

There are minimal risks of an immune reaction from lipofilling. However, this procedure may cause new collagen to form and may boost blood flow to the treated area.

Radiofrequency (RF) therapy

RF treatment uses high energy waves to heat the lower layers of your skin and cause collagen to form.

RF therapy may also be used to along with surgery or as a separate, noninvasive way to tighten thin, drooping eyelid skin and saggy brows.

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. Surgical measures are generally the treatment of choice if triple eyelids form.

Less invasive techniques, such as nonsurgical brow lifts, lipofilling, and RF therapy can also help reverse the condition.