Q: How similar is eyelid anatomy in African and Caucasian patients?
A: As in Caucasians, there is a great deal of anatomic variation present within the diverse groups of people of African background. Broad generalizations are thus difficult. Eyes may be prominent or deep-set, skin may be thin or thick, and socket shape may vary from large but shallow to smaller but deep. Basically, however, eyelid anatomy is extremely similar in both African and Caucasian people with several minor but notable exceptions:
| On average, there seems to less fat present in the African orbit (the space surrounding the eye inside of its bony socket). While age-related fat bulging from the orbit into the eyelids thus presents less of a problem, the risk of hollowness from overly aggressive fat removal during both upper and lower blepharoplasty is increased.
Additionally, the bone of the upper cheek (maxilla) seems, on average, to be flatter in more than a few patients. While this lack of bony projection does not affect the eyelid directly, it allows the cheek to droop downward at an earlier age, a change that generates a depression just below the actual eyelid (variously known as the tear trough, orbital rim depression, or "dark circles") and may project a false impression of lower eyelid "fat bags" when little or no lower fat excess is truly present (as demonstrated in the photo at right and discussed below).
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Q: How similar is eyelid anatomy in African and Asian patients?
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A: While more than a few people of African descent believe their eyes look Asian, there is no real internal anatomic similarity.
Even in the African patient with a very low crease, internal crease connections are typically well-formed. This is in sharp contrast to the Asian patient in whom such connections may be weak or fully absent.
Asian eyelids tend to be much fuller than Caucasian and African lids due to more well-developed orbital, brow, and subcutaneous fat layers.
While an epicanthal fold (a crescent-shaped expansion of skin overlying the inner junction of the eyelids) is present on the vast majority of Asian faces, it is found rarely in the African.
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| Because the horizontal dimension of the eyelid opening is noticeably longer in a significant number of African people, the eye may appear more almond-shaped and sometimes slant slightly upwards. |
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Q: How does darker skin pigmentation affect surgery?
A: Deeper color introduces several surgical considerations:
Although tiny, the white scar from a well-healed skin incision may remain visible for a longer period than in people with lighter complexions.
Since the incision for upper blepharoplasty is hidden in the depths of the eyelid crease, scar color does not present much of an issue. On the lower eyelid, however, external skin incisions are more exposed, may remain noticeable for a period of at least several years, and are thus better minimized or avoided when feasible, as discussed below.
Additionally, non-blepharoplasty methods of wrinkle reduction (ablative laser resurfacing, chemical peels) are best avoided. Such methods may result in an irregular and noticeable loss of pigmentation in treated areas.
Q: How likely are keloids or more pronounced scarring?
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A: While keloids are well-known to occur at a higher incidence in patients of African descent, they are rare on the thin and tension-free skin of the eyelids.
Many patients are confused by the differences between a noticeable scar and a true keloid. A keloid is a thickened, raised, shiny area, while a widened flat line following an untreated or poorly sutured injury is simply a bad scar.
The term "hypertrophic scarring" is usually used to indicate a related but less significant disorder in which the healing process is overly aggressive for several months or more.
In patients who are known keloid-formers, specials gels and silicone strips can be applied to try to mitigate the process. That said, we have not seen a single eyelid keloid form after blepharoplasty in over twenty-five years.
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Q: How is upper eyelid surgery different in the African patient?
A: In general, there are no differences of significance. An overview of upper blepharoplasty surgical technique is presented here.
Q: How is lower eyelid surgery different in the African patient?
| A: When orbital fat is clearly excessive, it is best approached through a transconjunctival incision placed on the hidden inside surface of the lid. In addition to many significant advantages over older methods employing skin incisions, no external scar is created. |
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| When significant skin excess is present, ignoring its removal over concerns of excessive scarring risks compromising the final result. By using an advanced procedure known as "canthopexy" to tighten eyelid support, the amount of skin that needs to be removed is lessened, as is the length of the skin incision. The subject of canthopexy is discussed in detail on a video found here. |
Q: Is the healing process any longer or more difficult?
A: No. Recovery is similar to that after Caucasian blepharoplasty. More 
Q: Are results of African blepharoplasty similar to Caucasian lid surgery?
A: Yes. When properly planned for personal anatomical variation and properly executed, blepharoplasty in the patient of African descent yields results essentially identical to those after Caucasian surgery.
Q: What is Dr. Meronk's experience with African blepharoplasty?
A: A graduate of the The Johns Hopkins University School of Medicine, Dr. Meronk has been performing cosmetic eyelid surgery on African-American patients for over 25 years. He has operated on black movie and television celebrities, doctors, and people from all walks of life. More
