Occidental, Shallow main crease (Size 5)
For Occidental eyelid profiles, if one eye has a shallow-folding higher-positioned crease compared to the other, then you can use Opti-fold to reinforce a lower naturally forming crease that is deeper folding.
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Introduction - Supratarsal crease (upper eyelid crease)
When uneven eyelids occur in people of East Asian ethnicity, the supratarsal crease (upper eyelid wrinkle) is either incomplete, weak or shallow, have multiple creases, or present on one eye but non-existent on the other.
It was concluded that wrinkle is a configurational change as a result of mechanical stresses acting on lax, excessive skin, without specific structural alteration at the histological level. An analogy may be drawn to a glove which has seen heavy duty over the years. Smooth when new, the fabric develops grooves at sites of long-sustained mechanical stress. There is no chemical or architectural alteration. The tissue or fabric simply acquires creases, purely a conformational change. (1)
The supratarsal crease is a skin tension line formed due to subdermal muscle contraction of the levator aponeurosis, which causes the upper eyelids to open. To treat uneven eyelids, the eyelid with the problem-supratarsal crease is modelled after the eyelid with the proper-supratarsal crease. That is to say, in the problem-eyelid, the location of the skin tension line that is chosen to be reinforced, is one that naturally matches the supratarsal crease in the normal-eyelid. One can experiment this by using a small pointed tool to ‘prop up’ the problem-eyelid’s upper eyelid skin and test if the crease momentarily formed is the most stable compared to other locations on the eyelid. This test method is also used by cosmetic eyelid surgeons when deciding where to perform surgery to get the most stable and natural-looking supratarsal crease.
Once the ideal supratarsal crease location is determined, the objective is to apply mechanical stress to that region to deform the skin with external compression and tension loads.
Wrinkles seem to occur when a tipping point is reached in the mechanical balance between skin layers. It has been suggested that epidermal and dermal stiffening occur at different rates and the layers successively buckle with compression. Repetitive damage ultimately results in permanent wrinkles. (2)
During growth, development or aging, different layers of biological structures usually have different expanding or shrinking rates, thus resulting in mismatch strains between the biological layers. The surface topographical patterns have long been believed to be results of mismatch-induced compressive strains in the skin layers which have higher growth rates or lower shrinkage rates than the underlying biological layers. Once the mismatch compressive strain rises to critical values, the initially flat surface of the film becomes unstable and bifurcate into different types of corrugated patterns. (3)
Resilience of created-supratarsal crease increases after each night of Opti-fold use
After the first week of tape use, subjects with uneven eyelids were able to sustain the supratarsal crease for around 1-3 hours, then 8-10 hours by the end of the third week. Subjects with single eyelids were able to get 5-30 minutes of crease-time after the first week of use, then 2-6 hours by the end of the third week. In 1-2 months of tape use, subjects’ crease-time were able to last all-day.
Increased water retention in the body compromises the created-supratarsal crease’s resilience
There was a negative correlation between the body’s degree of water retention and the resilience of the created-supratarsal crease. During incidences when the created-supratarsal crease had a shorter crease-time than the day before, it was noted that increased water retention lead to the swelling of the skin, which then made the depth of the crease shallow. Shallow creases meant they were weak and eventually the skin would not fold reliably. Common habits that created eyelid swelling were as follows:
Studying or watching TV for too long dried out the eyes if the rate of blinking was reduced.
Eating too much sodium or drinking too much alcohol increased water retention.
Insufficient rest meant less energy and the release of increased adrenaline to keep the subject alert. Adrenaline inhibites sodium loss, increasing water retention.
Excess sleep meant the subject has been lying down in the horizontal position for a prolonged period of time, making it easier for water to be retained in the facial tissues.
Doing physical exercise or strenuous physical activity to cause sweating.Sweat contain sodium. When it is wiped, it can soak into neighbouring areas, drying out the skin around the eye.
Crying. Tears contain sodium. When it is wiped, it can soak into the neighbouring area, drying out the skin around the eye.
Looking at a computer screen throughout the majority of the day at work. Having the visual gaze lower than eye-level meant the levator aponeurosis need not be activated to open the eyelids wide enough for the crease to be folded. During the early stages of crease formation, it was necessary for the crease to occasionally be folded the majority of the time in order for the skin to begin folding habitually on its own.
Performing eyelid exercises assists the created-supratarsal crease in folding
Three eyelid exercises were found to have provided effective supplementary mechanical stimulation to the skin in helping the created-supratarsal crease fold while the skin was most swollen in the morning, or when the subjects were tired in the afternoon or evening. The exercises were as follows:
Tracing the crease-line.This exercise involved using a pointed tool and gently but firmly use frictional force to trace over the entire length of the crease starting from the medial canthus towards the lateral canthus.This focused-rubbing of the skin created a weakened zone for folding. Skin will buckle along weak areas or faults in the superficial skin layers. (2)
Holding the crease-line.This exercise involved flexing the eyelids so that the crease can form and then using the fingers to compress the crease as to mimic the function of the n-Tape.It was noted for some subjects that when their supratarsal crease was weak in the afternoon or evening – due to them being tired or sleepy and the skin became swollen – manually compressing the crease for 5 minutes allowed the crease to be resilient for an additional 30 minutes.
Flexing the eyelids. This exercise involved wearing only the f-Tape and flexing the eyelid muscles until a stretching sensation was felt. The exercise was most effective in the morning after subjects removed the n-Tape, but kept the f-Tape on as they did their morning routine.
Caucasian subjects’ supratarsal crease is more susceptible to influence
Caucasian subjects reported of faster changes to their asymmetric supratarsal crease. On their first day of Opti-fold use, the effects were more responsive compared to East Asian subjects. Their relevant differences in ocular anatomy of having less subcutaneous fat present, meant their lid epidermis received a higher degree of mechanical stimulation compared to East Asian subjects. For East Asian subjects, since they had more subcutaneous fat in the ocular region, the mechanical loads were distributed onto the skin and underlying fat, reducing the concentration of stimulation meant for just the skin. In a study of sleep wrinkles, Goesel Anson described how compression, shear, and stress forces acted on the face in lateral or prone sleep positions. She observed that “the greatest impact of the forces [was] expected to be in the areas where skin [was] most tethered to underlying attachments, where retaining ligaments of the face [anchored] skin to underlying bone.” (2)
Efficient biomechanical folding of uneven eyelid skin leads to the perception of being more alert
Uneven eyelid subjects noted that without looking at a mirror, they knew if their created-supratarsal crease was stable or not, because it felt different; it took less physical effort to open that eyelid. Through proprioception, subjects could sense their eyelids were less ‘heavy’, which then translated to the feeling of being less tired and more alert.
Configurational changes in the upper eyelid skin, from a significant degree of supratarsal crease asymmetry to symmetry, increases subjects’ self-esteem
When increased degree of symmetry in the subjects’ eyelids are achieved by the simple exertion of external non-invasive mechanical stresses to the dominant eyelid skin tension line that corresponds with the activation of the levator aponeurosis, perceived self-conceptualization aligns more with the ideal self-conceptualization. That is, when the discrepancy between the two body of conceptualizations is reduced, it bolsters the subjects’ feelings of worthiness and sense of belonging. It helps them understand they are completely normal as their eyelid abnormality was just a configurational issue of the skin, rather than a more serious concern of having bad genes or poor health overall.
East Asian supratarsal creases forms more readily when uneven eyelids develop naturally
East Asian subjects that developed uneven eyelids from endogenous causes generally occurred during the age of puberty (10 to 14). The subjects had single eyelids and then suddenly overnight, one eye would develop the supratarsal crease – making the eyelids appear asymmetric overall. In these cases, using Opti-fold to reconfigure the remaining single eyelid skin to form a supratarsal crease, was very effective. Immediate resilient results were possible.
The site of temporary wrinkles, from repetitive folding, predicts the site of permanent wrinkles
East Asian subjects with uneven eyelids due to multiple or incomplete creases, or a supratarsal crease on one eyelid but non-existent on the other, achieved a temporary supratarsal crease that lasted all-day within their first month of Opti-fold use. These temporary creases became permanent in 10 months.
Susceptibility to wrinkling [was] dependent on genetics, age, hormonal status, and environmental exposure. (2)
1. Kligman AM, Lavker RM, Zheng P. The Anatomy and Pathogenesis of Wrinkles. British Journal of Dermatology. 1985 Jul; 113(1):37-42.
2. Anson G, Kane MA, Lambros V. Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep. Aesthetic Surgery Journal, Volume 36, Issue 8, 1 September 2016, Pages 931–940.