Asian Eyelid Surgery Resource
Cosmetic Blepharoplasty for the
Asian Eyelid
Caution: Actual Surgery Photos
= PREMIUM EDITION CONTENT available for preview
Following Multiple Previous Operations
(Surgery by Dr. Frank Meronk)
To bypass surgery photos, click 
(image cropped for privacy)
This patient had undergone previous incisional double eyelid surgery with an unsatisfactory result. Following attempted revision elsewhere, both lids were worse and she had no crease on either side. When first seen in our office, each upper eyelid demonstrated:• no crease with noticeable asymmetry
• multiple incomplete lines, folds, and scars over the full expanse of skin
• hollowed eyelids with the deepest depression extending up to and under the rim of bone
• ptosis (lid droopiness covering too much of the eyeball)
• lashes pointed downward into the field of vision
• inability to close fully when asleep
• slight skin shortageWithout adequate orbital fat extending forward from the socket, the lids cannot form a natural crease and will instead crumple into mulitple uneven folds. The depression resulting from volume loss can be distressing since "ages" the lids and face.
Ptosis is common in the setting of hollowness but may also indicate damage to the tendon (levator aponeurosis) that connects the lids's opening muscle to the eyelid edge.
In patients who have undergone multiple previous operations, the extent of scarring and damage to internal tissues is unknown until actual surgical exploration. Unfortunately, this general constellation of findings is not uncommon in patients seeking revision in our practice.
(To follow the description, open this pop-up window on pertinent anatomy.)
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| 1. Upon opening the lid along the site of the intended future crease, dissection and excision of scar tissue was accomplished until the levator muscle and aponeurosis were freed of adhesions. As seen in the photo to the right, the tendon had been disinserted from its normal attachment during previous operations and its edge had retracted upward (area colored in light green). |
2. (Same photo as on left) Normally, orbital fat from the socket extends forward and covers most of the levator aponeurosis (as drawn in light orange). In this case, a severe shortage of orbital fat was encountered (shown further in the photo directly below). Without adequate fat, the more exterior tissues of the lid can collapse onto the levator complex, prevent formation of a crease, tether movement of the lid when opening and closing, and bunch up into irregular external folds. |
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| 3. The free edge of the levator aponeurosis was freed from scar, advanced downward, and reattached to its normal anatomic position (ptosis repair). The blue arrows point to three sutures that have already been placed in this repair, while the green dots outline an area not yet repaired. |
4. Following completion of the ptosis repair, the highest part of the levator was retracted downward by forceps to expose the full magnitude of missing fat. The purple arrows point to the edge of bone covered only by a thin layer of brow fat. Deep inside the cratered area, only a few globules of normal orbital fat can be seen. |
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| 5. To address an orbital volume deficiency requires grafting of structurally-intact fat from another source (see orbital fat grafting). Care was taken to avoid injuring the eye muscles, nerves, blood vessels, and eye itself. |
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| 6. Remaining remnants of previously-damaged orbital septum were draped over the fat. The skin and closing muscle were draped over the septum. |
7. A new crease was constructed utilizing deep fixation between the skin edges and the previously disinserted but now reattached levator aponeurosis. Because the grafted fat now inflates the lid above this area of fixation and helps prevent reformation of previous scar as well as collape of overlying tissue, a defined crease will be able to form during healing. |
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9. The wound was closed in several layers. Notice full reinflation of the hollowed area shown in the "Before" photo at the top of this page. |
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Progress Before |
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Double Eyelid Surgery Options Surgical Options for Upper Eyelid Crease Formation Incisional Method | Suture Method Pros and Cons of Incisional Double Eyelid Surgery (Premium Edition only) Pros and Cons of the Suture Method (Premium Edition only) Patient Options Preoperative Preferences | Age Restrictions Best Height and Shape for the Asian Crease (Premium Edition only) |
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Double Eyelid Surgery Photos
Primary Surgery Photographed Step-by-Step Asian Double Eyelid Surgery | EpicanthoplastyVideos New Ideas Regarding Natural and Surgical Crease Formation (Premium Edition only) Video Morphs and Slideshows |
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Healing After Double Eyelid Surgery Experiencing Asian Eyelid Surgery | Care After Surgery Recovery | The Upper Eyelid Scar
Videos Healing After Double Eyelid Surgery (Premium Edition only) The First Eight Weeks After Surgery |
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Risks, Complications, Revision Risks | How Precise Are the Results Revision After Unsatisfactory Double Eyelid Surgery Consequences of Excessive Fat Removal Revisional Surgery Photographed Revision to Treat Multiple Folds Revision to Lower and Reshape the Crease Revision for Hollowness and Ptosis After Multiple Surgeries Healing After Double Asian Eyelid Revision Surgery Restoration of Deflated Eyelid Using Fat |
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Fat Loss and Multiple Folds in the Asian Upper Lid Basics Premature Hollowing in the Asian Upper Eyelid Surgical Fat Loss After Double Eyelid Surgery Treatment Options for Asian Upper Hollowness Hollowness in the Non-Asian Upper Eyelid Photos Before-and-After Photos of Asian Upper Fat Grafting Video Fat Preservation in Asian Double Eyelid Surgery (Premium Edition only) |
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Other Challenges in Asian Eyelid Surgery Drooping Upper Eyelid Ptosis Correction - Basics | Ptosis Correction - Advanced Lower Eyelid Fullness Asian Lower Blepharoplasty |
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Asian Plastic Surgery Information on all types of Asian cosmetic surgery |
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Premium Edition Upgrade The ultimate consumer eyelid surgery reference |
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Upper Blepharoplasty Cosmetic surgery for the upper eyelids |
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Lower Blepharoplasty Cosmetic surgery for the lower eyelids |
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Healing and Recovery Before and after upper and lower blepharoplasty |
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Blepharoplasty Photos Before-and-after patient photos |
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Insider's Guide to Blepharoplasty Advanced online book |
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Eyelid QuickNotes Compare and contrast procedure pros and cons |
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Blepharoplasty Introduction to cosmetic eye surgery with FAQs |
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Eyelid Surgery Videos View an analysis of actual patients and their results |
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Eyelid Owner's Manual Articles on eyelid care and maintenance |
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Operations Step-by-Step Cosmetic eyelid surgery shown start to finish |
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Atlas of Eyelid Anatomy Pictures and diagrams of lid and facial anatomy |
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Revision Blepharoplasty Unsatisfactory results after cosmetic eye surgery |
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Asian Eyelid Surgery On Asian blepharoplasty and double eyelid surgery |
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The Hollowed Eyelid Restoring fullness to hollowed & sunken eyes |
The Doctor | A True Eyelid Specialist | Contact
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