Blepharoplasty Eyelid Plastic Surgery in
Patients of African Descent

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Cosmetic eyelid plastic surgery on the patient of African descent is, essentially, a neglected topic in the medical literature. The following comments are based more upon Dr. Meronk's personal observations and experience with patients seeking blepharoplasty than published studies on the general population.

The term "African" is preferable to "African-American" since the discussion here relates to people of a particular continental ancestry (central and southern Africa) rather than their location of current residence. The term "black" is preferred to "people of color" since the second term includes those of Hispanic and Asian lineage. Likewise, "ethnic" (often used in rhinoplasty) is too non-specific. "Caucasian" is used to reference a diverse grouping of people from throughout Europe, some parts of northern and western Asia, and certain regions of northern Africa.

African Blepharoplasty

• How similar is eyelid anatomy in African and Caucasian patients?

• How similar is eyelid anatomy in African and Asian patients?

• How does darker skin pigmentation affect surgery?

• How likely are keloids or more pronounced scarring?

• How is upper eyelid surgery different in the African patient?

• How is lower eyelid surgery different in the African patient?

• Is the healing process any longer or more difficult?

• Are results of African blepharoplasty similar to Caucasian surgery?

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).

Q: How similar is eyelid anatomy in African and Asian patients?

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.

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.

Q: How does darker skin pigmentation affect surgery?
A: Deeper color introduces several surgical considerations...

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