Monday, June 27, 2011

Asian Eyelid Surgery Houston

Asian Eyelid Surgery ~ Houston
Asian eye lid surgery (blepharoplasty) has become an increasingly popular cosmetic surgery all over the world. A common erroneous belief is that the goal of this type of procedure is to achieve  a  "westernized" appearance, which is rarely the case. Instead, the goal is most commonly a natural and younger appearance.
There are of course, exceptions to this as is shown in the linked report by CNN  below.
Often patients will seek this surgery because they feel that a heavy upper lid will limit their expressive ability and thus limit their ability to interact socially. This concept is often misconstrued by American, European and non-Asian individuals as a desire to appear more Caucasian.

Video Courtesy of CNN

A deep understanding of the delicate regional anatomy is essential to performing any eyelid surgery. The nuances of the Asian blepharoplasty (Lid surgery) escape many surgeons.

Basic Asian eyelid anatomy


What are some of the characteristics of an Asian eyelid when compared to an occidental eye?

  • The presence in varying degrees of an epicanthal fold. When prominent epicanthal folds are present medially (on the nasal side) they can give the undesirable illusion of esotropia (cross-eyed).
  • An eyelid crease which is lower set and often not visible. When present, it differs from the non-Asian population in that is parallel to the lid margin and narrows as it reaches the nasal edge of the lid
  • The angle of the brow tends to be higher medially (Close to the nose) in Asian eyelids
  • Shallow orbits (eye bones)
  • Minimally or non Cantilevered supraorbital ridges

The so called "double lid surgery" is the commonly requested surgery make the eyelid crease a more noticeable trait.  This procedure has been analyzed over the years and modified many times over the years.

Fast facts about the double eyelid procedure

  • The prominence of the epicanthal fold is decreased by doing local flaps
  • A lid fold is created by applying parallel sutures that create a new crease which is parallel to the edge of the eye lid
  • In expert hands the procedure takes around an hour
  • There is a "non-incisional" method for Durable Suture Technique (DST). Long term follow up results on this  technique are not yet available.

Potential complications:
One major single surgeon study quoting over 6000 patients in 18 years showed the following complications

During the perioperative period, the patient may have eyelid swelling which may take weeks to months to return to a normal volume. This must be discussed in advance with the patient.

                                                           Courtesy of

Principles of the Asian "double lid surgery
"This varies greatly between individuals since the presence of an epicanthal fold or how noticeable the eyelid crease is or isn't to begin with differs from person to person. However the principle can be reduced to addressing two key issues:
  • A decrease in the prominence of the epicanthal fold
  • Creation of a more noticeable eyelid crease

In the right hands, this procedure yields fast and satisfying results to the patient. However it must be kept in mind that the immediate appearence postoperatively does not reflect the final outcome, which is true of so many other procedures in cosmetic plastic surgery.
Other issues should be recognized, acknowledged and addressed prior to undergoing a blepharoplasty. Amongst these are the presence of asymmetry, eyelid ptosis(droopy eyelid), disfunction or dehiscence of the levator muscle of the eyelid causing droopiness for reasons other than mere excess tissue.

Rafael Magana M.D.
Guest Blogger, New York Plastic Surgeon

1.Aesthetic Plastic Surgery;By Sherrell J Aston, Douglas S Steinbrech and Jennifer Walden  Chapter 33
2.Asian Blepharoplasty: An 18-Year Experience in 6215 Patients; Arthi Kruavit;Aesthetic Surgery Journal 2009 29: 272  DOI: 10.1016/j.asj.2009.04.004
3.Anatomic Microstructure of the Upper Eyelid in the Oriental Double Eyelid,Jian Cheng, M.D., and Feng- Zhi Xu, M.D. Plastic & Reconstructive Surgery. 107(7):1665-1668, June 2001.
4.A New Crease Fixation Technique for Double Eyelidplasty Using Mini-Flaps Derived from Pretarsal Levator Tissues ;Choi, Yeop; Eo, SuRak;Plastic & Reconstructive Surgery. 126(3):1048-1057, September 2010. doi: 10.1097/PRS.0b013e3181e3b72a
5.The Concept of a Glide Zone as It Relates to Upper Lid Crease, Lid Fold, and Application in Upper Blepharoplasty Chen, William Pai-Dei Plastic & R
econstructive Surgery. 119(1):379-386, January 2007.
doi: 10.1097/01.prs.0000244908.04694.32

Saturday, June 11, 2011

Smile Train China & Operation Smile Vietnam

The global incidence of cleft lip and/or cleft palate is approximately 1 in 750 child births.  Because surgery to repair a cleft lip/palate is routinely performed in the United States as early as 3 months of age and since the incidence is less as compared to Asian countries, we don't think about the condition as much as in other countries.  In countries like Egypt, people with cleft lips/palates are looked upon as "cursed" and shunned upon by Egyptian society.  

In Third World countries, surgical correction of cleft lips/palates are unaffordable, especially the indigent population.  Majority of children born with cleft lip/palate in developing countries are too poor that they can barely buy food to eat, and thus can never afford surgery that they so desperately need.  As these children grow, "they quickly learn that life with a cleft can be a long and painful struggle, often hidden away by their family out of shame and ignorance."  In some countries they are not allowed to attend school or hold a job.  Most of these children with cleft lip/palate will never be able to speak or eat properly.  Cleft lip and/or cleft palate surgery "provide new smiles, hope & a new beginning to children who otherwise would lead lives of isolation and shame."  Let's help support the non-profit organizations Smile Train and Operation Smile to give these children a second chance at life.

Emmanuel De La Cruz MD, PLLC


Houston Plastic Surgeon

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