Exact surgical technique will vary surgeon to surgeon depending upon his or her training, experience, and preferences. Likewise, variations in preexisting patient eyelid-facial anatomy will require a customized approach in each individual.
While Dr. Meronk has developed his own personal algorithm for achieving different lid heights and shapes based upon a number of variables considered both preoperatively and intraoperatively, what follows below is a simplified overview of general principles.
• Incisional Technique
Because Asian skin is said to be "more reactive," incisions are best make with a scalpel instead of the laser to minimize scarring.
The skin is incised with a scalpel at a height dictated by measurements of certain existing anatomical landmarks. The incision may be tapered into the epicanthal fold towards the nose (if desired) and/or flared slightly upwards at its outer end (if desired).
Most typically, a small strip of skin above this initial incision is excised using scissors. The amount of skin removed varies depending upon the proposed height of the new crease as well as preexisting anatomical conditions. In some cases, no skin is removed.
The incision is carried deeper into the eyelid through the orbicularis muscle and orbital septum until the orbital fat is exposed.
Small strips of orbicularis muscle and orbital septum are excised. The amount and location of orbital fat removed has a significant influence on the height, shape, and depth of the new crease. In most cases, no fat is removed.
The levator aponeurosis (tendon) is identified just beneath the fat. In contrast to an older form of incisional double eyelid surgery known as "anchor blepharoplasty," the levator aponeurosis is not aggressively exposed or detached from its connection to the tarsal plate, a step that is, in our opinion, unnecessary to formation of a natural-appearing crease and invites a higher incidence of serious complications such as ptosis, lid retraction, or peaking of the eyelid margin.