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.
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.
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.
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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
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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 & Reconstructive Surgery. 119(1):379-386, January 2007.