Asian Blepharoplasty / Double Eyelid Surgery
Beverly Hills Facial Plastic Surgery Center
Kimberly J. Lee, M.D., Female Facial Plastic Surgery Specialist
Serving Beverly Hills, Los Angeles, San Francisco Bay Area and Worldwide
ASIAN EYELID SURGERY
Asian blepharoplasty is a common and popular procedure to create a double eyelid or eyelid crease. Although the presence of a double eyelid crease can naturally occur in Asians population (double eyelid), those who have a single eyelid will often seek “double eyelid” formation. There has been a shift away from Westernization of upper eyelid surgery. Traditionally, surgery has consisted of aggressive removal of skin, muscle, and fat, which often led to a volume loss in the upper lid with a deep sulcus and higher crease. The modern approach is aimed at restoring a more youthful and healthier appearing upper-eyelid region, by performing conservative excision of skin, formal crease formation when necessary, coupled with some level of volume augmentation of the lateral eyebrow and infrabrow region. This approach is aimed at creating a less deflated and “fuller” eyelid, which will more accurately approximate the youthful Asian appearance. To perform successful surgery, a strong understanding of the aging process affecting the upper-eyelid region in the Asian patient, management and treatment of different anatomic types of the supratarsal crease, surgical technique and complementary treatments to restore the youthful structure of this area are critical.
ANATOMIC CONSIDERATIONS OF ASIAN UPPER EYELID SURGERY
There are features that differentiate Asian and Caucasian eyes that need to be understood by the surgeon in performing Asian blepharoplasty. Approximately half of Asians do not have an upper eyelid crease while the remaining have some form of crease. Asians with a double eyelid crease have an appearance of a larger eye. This feature is desirable aesthetically as it confers a more feminine appearance, and because it makes application of eye cosmetics easier and more noticeable. The fundamental difference between Asian and Caucasian eyelid appearance pertains to the anatomy with the location of orbital septum insertion on to the levator aponeurosis lower in Asian eyes. This allows the fat pad in the upper eyelid to descend, giving a fuller eyelid appearance. You will see patients with a puffy eyelid without a crease.
DOUBLE EYELID CREATION
The primary goal is to create a naturally appearing, supratarsal crease. The desire to have a “double eyelid” is largely cultural, as this feature is considered attractive. To successfully perform surgery requires a comprehensive understanding of the natural eyelid crease shape as well as mastery of the surgical techniques required to fashion it.
During the era of Westernization upper blepharoplasty, the focus was on creating a high supratarsal crease found in Caucasian eyes. It was the evolution of results of this era that led to the current philosophy of Asian blepharoplasty that preserves ethnic characteristics. The current techniques can be broadly categorized into suture based, full-incision, and partial incision techniques.
The full-incision technique is favored because of its 1) relative permanent results compared with other methods, including DST and partial incision methods, 2) independence from buried sutures to maintain the crease formation, 3) wide exposure to facilitate identification of structures, and 4) ability to manage dermatochalasis in the aging eyelid. The major disadvantage of the full-incision method is the 1-2 week recovery period and persistent swelling, which can persist for months if not a full year. Scarring has proven to be insignificant if the tissues near the epicanthus is avoided. The suture ligation method for Asian blepharoplasty is relatively non-invasive, with limited postoperative swelling and reversibility of the procedure by removing the sutures. However, if the desired upper eyelid crease has been achieved, it may vanish with time requiring revision blepharoplasty. The disappearance of upper eyelid crease has been found to be higher in those with thicker skin of excess subcutaneous fat. The suture ligation method is relatively non-invasion; however, asymmetry, cyst formation, and eyelid crease attenuation requiring full revision is noted. The partial incision method often requires multiple stab incision through the skin or multiple needle passes through the skin to achieve the exposure and suture anchoring required to create an upper eyelid crease.
STRATEGIES FOR THE AGING ASIAN EYELID
ASIANS WITH A NATURAL CREASE
Dr. Lee devotes her meticulous aesthetic skills to perform surgery. Sometimes, patients may have a crease on one side or even a faint crease present. Dr. Lee believes it is essential to maintain an eyelid crease position that is natural and will discuss with you during your consultation how to best achieve symmetric eyelid creases that will achieve a natural appearing result that fits your face.
ASIANS WITHOUT A CREASE
Asians desiring a creation of a double eyelid crease often also desire a more open eye appearance. Many surgeons simply decide on an arbitrary height at which to remove skin without reference to thinking about the crease, but not Dr. Lee. She will discuss with you during the consultation an appropriate height for the eyelid crease that will achieve a natural appearing result that fits your face.
REVISION EYELID SURGERY
Unfortunately, many Asians seeking revision Asian blepharoplasty who have undergone double eyelid procedures, their creases were surgically created during a time in which Westernization blepharoplasty procedures were performed, e.g., aggressive fat and skin removal and a very high crease formation. These patients offer a difficult situation to address. Removing additional skin or elevating their brows can make their crease appear even more unnatural and should be avoided. If you are seeking a revision Asian blepharoplasty, you should choose a facial plastic surgery specialist like Dr. Lee so that your next surgery will be your last surgery to address these issues.
Contact Dr Kimberly Lee today to schedule your Asian Eyelid Surgery in Los Angeles – Beverly Hills consultation at 310-882-5656.