• Other names: Double eyelid operation
• Primary goal: Creation of an upper eyelid crease
• Secondary goals: Removal of excess skin and fat as with conventional surgery
• Special anatomy: The pertinent anatomical difference between Asian and Occidental eyelids is that the orbital septum (the layer that holds back the fat) extends lower down towards the eyelid margin before attaching. The allows the eyelid fat to extend further down into the lid, thus interfering with some fibers from the levator (opening) muscle and tendon that might otherwise extend to the "back" of the eyelid skin (and pull in a "crease" when the eye opened). Diagram
• Anesthesia: Ideally, sedation should be kept light so that the surgeon can check the position of the new crease during surgery by asking the patient to open the eyes.
• Operative technique: The preferred approach requires a skin incision. Skin, muscle, and fat removal are undertaken in a manner similar (although not identical) to conventional upper eyelid blepharoplasty. The incision is placed much lower and amount of tissue removed is more conservative. A "deep fixation" closure is utilized. Details
• Variations: Less invasive techniques have been described that involve no skin incision but instead rely on varying schemes of placing sutures through the full-thickness eyelid. The sutures create internal eyelid "inflammation" during healing, which "spot welds" a crease into place.
• Advantages: Surgery done through a skin incision creates a long-lasting, if not permanent, crease. Although simple suturing techniques are still practiced widely, the crease tends to disappear with time.
• Limitations: The proper goal of Asian blepharoplasty should be to enhance the appearance of the Asian eyelid and crease in a manner that is still consistent with the rest of the facial appearance and with the patient's heritage. Attempting to "Westernize" the lids is ill-advised; special consideration at the time of consultation should be directed to determining proper crease height and contour.
• Care and recovery: As in Section Four. As a rule, Asian eyelid skin is more "reactive" than Occidental skin and may stay swollen for a longer time interval (4 months). The crease position and shape will vary as healing progresses and not reach its final configuration for six months or more. Scars may stay red and thickened for a longer time.
• Risks and complications: In addition to the risks discussed in Chapter 28, a number of additional points need to be emphasized. Too high or too arched a crease may look unnatural on an Asian face. Since reversal can be difficult, careful avoidance of this surgical result is crucial. Since many Asian patients are most concerned about crease position to start and undergo blepharoplasty specifically for this reason, unsatisfactory final placement is thus very disappointing. Attempts to eliminate the inner epicanthal fold by skin removal or by creating complex skin flaps may be complicated by excessive scarring in highly visible skin; however, removal of underlying thickened orbicularis muscle through the original blepharoplasty incision (a "no scar epicanthoplasty") may help to soften its appearance. Details
• Comments: Because of variations in Asian and Occidental eyelid anatomy and the operations involved, blepharoplasty performed by a relatively inexperienced eyelid surgeon may increase the risk of an unsatisfactory aesthetic result. Following the advice in Section One regarding selection of a surgeon seems especially important.
• Photos
