Chemical Decompensation for Frontalis-Driven Multiple Eyelid Folds After Revision Double-Eyelid Surgery

Multiple eyelid folds after revision double-eyelid surgery are commonly attributed to structural factors. This single-patient report describes a possible contribution of acquired compensatory frontalis activation and a temporary intervention termed chemical decompensation.

AA 28-year-old woman with unilateral multiple eyelid folds after revision surgery underwent brow-eyelid continuum assessment. After manual confirmation of adequate independent levator function, unilateral low-dose onabotulinumtoxinA (5 U) was administered above the affected brow. Evaluation included paired photographs, perceived-improvement ratings from five evaluators, and eyelid-opening measurements. Follow-up ultrasonography was performed 116 days after injection.

At one week, paired photographic review showed reduced multiple folding, with a mean visual analog scale perceived-improvement score of 7.3 ± 0.67 and no observed functional compromise. Follow-up ultrasonography showed findings consistent with a local adhesion/fixation point. The improvement suggests that dynamic frontalis traction contributed to the visible deformity, but does not independently confirm adhesion or quantify the relative dynamic and structural contributions.

Chemical decompensation may provide temporary improvement during recovery while scar maturation and later reassessment proceed. The post-injection response offers supportive, case-specific information rather than a validated diagnostic test. This approach does not replace definitive revision when indicated. Prospective validation in larger cohorts is warranted.

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