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Topic 26 - 3
Asian Double Eyelid Surgery:
Not A Stock Operation
african eyelid surgery Variations

Note: A comprehensive discussion of double eyelid surgery can be found in the Asian Eyelid Surgery Resource section, over 100 pages devoted to plastic surgery for the Asian eye.

Men and women of Asian heritage seek aesthetic eyelid plastic surgery for the same basic reason as their Occidental counterparts, namely, to enhance the appearance of the existing eyelid so that it conforms to accepted standards of beauty and balance. In general, "bigger eyes" are perceived by almost all cultures -- Eastern and Western -- as contributing to a more youthful and "alert" facial appearance.

Double Eyelid
Crease Formation Surgery

In Western culture, an upper eyelid is generally considered attractive if it lacks excessive skin and fat, possesses a reasonably well-defined and high crease, and displays at least some platform of exposed skin between the crease and the eyelashes. Likewise, a well-contoured lower eyelid free of bulging fat projects an image of youth, energy, and rest.

Compared to the Occidental upper eyelid, the Asian eyelid crease tends to form closer to the eyelashes, is not as deep, and may be incomplete, irregular, or broken into multiple creases. In about half of Asian patients, there is little or even no crease at all. Sometimes, the creases on the two sides do not match.

The absence of a defined crease (sometimes called a "single lid") tends to make the opening between the eyelids appear narrower than it really is. A "double lid" (that is, a lid with a crease that divides the eyelid into two visual parts) makes the same size opening appear as if it were wider.

The Asian eyelid may also appear more puffy due to the extension of normal fat much closer to the lashes, and the soft tissue below the brow may be thicker.

A tiny crescent of skin (epicanthal fold) may exist between the eyelid angle and the nose, and the eyelid crease, if present, may appear to dive down and blend into it.

Because the eyelashes of a poorly-creased Asian lid are less supported and may point more downward, the opening between the upper and lower eyelids may appear as even more narrowed.

These fundamental differences between the Asian and Occidental eyelid are determined by the various ways in which the multiple distinct layers that make up an eyelid can attach to or interact with one another. To compound matters, there are also differences between Chinese, Japanese, and Korean eyelids, and so on (just as there are small differences between various Occidental lines of heritage).

By far, the primary concern in the majority of Asian patients seeking blepharoplasty is the final position and shape of the upper eyelid crease. Several options need to be considered:

Shape: While a typical Occidental crease tends to be highest in the middle position of the eyelid and taper lower at each end, such a "semilunar" shape appears unnatural on many Asian faces. More typically, an attractive Asian crease will either run parallel to the eyelid margin throughout its entire course or dip slightly downward as the nose is approached.

Height: While a typical Occidental female crease may sit 10 mm above the margin of the lid, Asian creases appear more "natural" at a lower height ranging from 2-6 mm.

Continuity: Discontinuous or incomplete creases may be enhanced without changing either the shape or height but by "completing" the crease so that it runs continuously. Multiple poorly-defined creases may be converted into one dominant crease.

Overall: Attempting to achieve too radical a transformation of the basic pre-existing anatomy is generally unwise and may result in eyelids that look unnatural or mismatched to the rest of the face.

To avoid an inappropriate or disappointing result, the steps of any eyelid operation may be adjusted to take into account the variations in anatomy as well as the particular desires of each individual patient.

While the primary points of concern in many Asian patients are emphasized above, Occidental patients may also have specific expectations about final lid shape and degree of correction that fail to be addressed if such expectations are not specifically discussed ahead of time.

Eyelid surgery -- Asian or Occidental -- is not a single stock operation.

Next: Laser Blepharoplasty

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