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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .