Asian Eyelid Surgery Resource

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"The key steps in complex Asian revision surgery are
adding to and adjusting the orbital fat. Unfortunately, only a
handful of doctors know anything more about managing fat
than how to take it out."

Three years after double eyelid surgery performed elsewhere.

Three months after orbital pearl fat grafting and internal fat repositioning.

Although Asian cosmetic eye surgery, or double eyelid surgery, is the most common cosmetic operation performed worldwide, the incidence of aesthetic and functional complications is surprisingly high. Not counting insufficient patient education leading to unrealistic expectations, the most frequent reasons for dissatisfaction in an approximate order of frequency are

Less severe problems:
	• more than mild asymmetry of the creases • overly low creases • incomplete or shortened creases • loss of creases over time, especially after suture methods • overly noticeable scarring
More severe problems:
	• overly high, deep, or arched creases • formation of highly irregular or multiple creases • ptosis (inability to lift the eyelid fully) • upper eyelid hollowness • skin shortage or internal tissue damage preventing adequate lid closure

Double eyelid surgery is sometimes described as "simple" and yet in the hands of the occasional eyelid surgeon who may lack a thorough understanding of Asian eyelid anatomy and the experience to properly plan and meticulously execute the most appropriate procedure, the rate of aesthetically disappointing asymmetry is reported to vary between 13 and 35 percent.

The most common causes of problems following double eyelid surgery include:

• insufficient preoperative evaluation
• poor choice of surgical procedure
• unpredictable tissue healing
• poor execution of the surgical procedure, including:

- incorrect placement of skin incisions
- incorrect amount of skin removal
- excessive fat resection
- failure to treat the orbicularis muscle and orbital septum optimally

I don't think I could ever express my gratitude to you for drastically altering my life in such a positive way. I never dared to think it was remotely possible to have the result I have now, as it has exceeded all my expectations. Most of all, thank you, Dr. Meronk, for being a consummate professional, a compassionate doctor, and a brilliant surgeon. I will never forget what you've done for me. Won Kyong Kim New York, New York Six months ago I was frustrated by having no options, not to mention that I was confused and scared by the different analyses I received from many doctors. I had to literally travel half way across the world to do the surgery with you which my family thought was absurd, but in the end it was worth it. I could not be more pleased. Robert W. Jakarta, Indonesia (each following complex revision after unsatisfactory double eyelid surgery performed elsewhere)

The subject of revisional Asian eyelid surgery is technical and demands a professional understanding of operative technique and eyelid anatomy. While a full description of surgical options is thus beyond the scope of this discussion, an overview of advanced techniques can be gleaned from the case studies of actual patients shown below.

Each revisional surgery must be custom-tailored to the problem at hand. Although a variety of procedures have been described for treating the less severe group of problems noted above, most previously published approaches provide suboptimal results in more advanced cases due in large measure to shortcomings in reestablishing more normal orbital and periorbital fat relationships (video).

The key requirement in complex Asian revision surgery is augmenting or relocating the upper orbital fat. Unfortunately, only a handful of doctors know anything more about managing fat than how to take it out.

Because double eyelid surgery is performed commonly, many patients seem surprised that correction of surgical flaws is so difficult. However, once tissue has been removed, damaged, or scarred, efforts to restore an eyelid are challenging and not always successful. For this reason, undergoing more surgery simply to refine an acceptable result into "perfect" is not recommended.

Caution: Actual surgery photos

Eyelid crease revision 1 Crease undefined and multiplied

Eyelid crease revision 2 Crease high and hollowed

Eyelid crease revision 3 Creases irregular from lid hollowing

Double eyelid surgery revision 4 Ptosis, hollowness, no crease after two operations

Unless the eyelids have been severely compromised, revisional surgery will generally yield improved function and a more aesthetically-pleasing shape to the lid and crease. Perfection or near-perfection, on the other hand, are never realistic goals in secondary surgery. The limitation is usually not with the surgeon but rather the damaged tissues and their reduced and unpredictable capacity for healing. Patients who cannot understand or accept this reality will always be disappointed.

Since revisional double eyelid surgery requires one year or more to reach a final result, over-analyzing progress during the early months will only lead to unnecessary worry and frustration. In complex cases, more than one operation may be required.

Healing after double eyelid revision surgery Scarring, multiple creases, hollowness after surgery

Some conditions (especially those that persist after multiple previous operations) may prove highly resistant to even the most advanced revisional techniques.

Costs for revision of unsatisfactory results following Asian double eyelid surgery (incisional or suture technique) generally range from between $ 4,500 to $ 9,800 depending upon the nature and magnitude of the problem. Unusually complex problems or treatment after previous failed revision surgery performed elsewhere may cost more. If more than one surgery is required, each is considered a new operation and is billed separately.