Asian Eyelid Surgery ~ Houston

Asian Eyelid Surgery:  Westernization of the Asian Eyelid?

Beauty has been shaped to a Eurocentric point of view when it comes to the Asian eyelid.  To create that Asian eyelid crease, tape or glue has been used by many Asian women who desire that upper eyelid crease.  There is indeed an obvious influence of the Western culture over several Asian countries, and the overtones of cultural rejection still exist when it comes to discussing Asian blepharoplasty.  But do these women really desire to have a more Occidental look?  In fact, in Asian women who were born without a crease who later desired to have double eyelid surgery, very few sought to look Western.  Interestingly, the double eyelid surgery was first described in the Japanese medical literature in the 1800s long before the Westernization of Japan.  

Asian with an Upper Eyelid Crease (Courtesy of makeupbeauti.blogspot.com)

Fast Facts about The Creaseless Eyelid

• Approximately half of the Asian population of Chinese descent possess an upper eyelid crease.  
• Approximately 1/3 of Asians of Korean descent possess an upper eyelid crease.
• 10% of Asians from the Far East or South East Asia show a natural eyelid crease on one of their eyelids, and the other eyelid creaseless.
• Some native North & South American lineage possess traits designated to be "Asian." These native Americans may have the heavier "creaseless" upper Asian eyelid and an inner epicanthal fold (a skin fold of the upper eyelid  overlapping the corner of the eye near the nose.) 

The Beautiful Eyelid 

Although the standards of physical beauty may be variable across cultures, the qualities of what constitutes beautiful, especially the upper eyelid, transcends racial boundaries.  Large eyes, a well-defined nose and a smaller chin are standards of beauty in women of various cultures.  An upper eyelid is  considered attractive when it lacks excessive skin and fat.  The presence of an upper eyelid crease is also considered beautiful since it creates the illusion of making the eye appear bigger, which is a universal sign of youth.    This upper eyelid crease also serves as a platform of exposed skin for a more effective application of makeup.

The Epicanthal Fold

The epicanthal fold is the skin fold of the upper eyelid that overlaps the nasal corner of the eye.  In the Asian population, it is present in approximately 40 to 90%, depending on the region in Asia or the study one would read.  There have been numerous procedures developed and described in the medical literature to eliminate the epicanthal fold.  However, most procedures are flawed by creating an unsightly scar in the area of the eye near the nose.  

The Goals of the Double Lid Surgery for the Plastic Surgeon

• To maintain the natural beauty of the opening of the eye (palpebral fissure).  Being overly aggressive with making the Asian eye appear Western would be a mistake since the new crease that will be created will appear unnatural and look "surgical."
• To improve the beauty of the eyes by giving an illusion of a larger, more open eye.

Fast facts about the double eyelid procedure (Excerpt taken from Dr. Magana's article)

• 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:
Before one undergoes any procedure, one should be informed about its potential complications.  It is not uncommon that one would have some asymmetry of the upper lid crease (1-2mm difference) that is created after an Asian double lid surgery.  Scarring may occur as well as disappearance of the upper lid fold.  Moreover, blindness after an eyelid surgery is a very rare complication (1 in 30,000 patients).  Severe pain and a pressure sensation on the eye are common symptoms for an impending visual loss after a blepharoplasty procedure, and one should be aware of these symptoms so that immediate evaluation and treatment can be performed by your plastic surgeon. 

                                                          

Emmanuel De La Cruz M.D., PLLC

Houston Plastic Surgeon

Recommended reading:

What Makes a Face Beautiful?

References:

Kruavit, Arthi.  Asian Blepharoplasty: An 18 Year Experience in 6215 Patients.  Aesthetic Surgery Journal.  2009; 29; 272
Mejia, Ergo and Foad Nahai. Visual Loss After Blepharoplasty: Incidence, Management, and Preventive Measures.  Aesthetic Surgery Journal.  January 2011;31(1): 21-29  
Meronk, Frank. Double eyelid surgery for the Asian eye.

Park, Jung. Modified Z-epicanthoplasty in the Asian Patient.  Archives of Facial Plastic Surgery. 2000; 2 (1):43-47.