Many Asians seek eyelid plastic surgery to create “double lids”. 50% of Asians have a double lid, while 50% are born with a “single lid”.
The Asian eye differs from the Occidental (Caucasian or White) eyelid by some basic anatomic differences. The traditional teaching is that one of the muscles the lifts the eyelid, the levator neurosis, attaches lower or does not attach at all in the Asian eyelid versus the Caucasian eyelid. However, recent anatomic studies have disputed this.
Additional differences include the location of eyelid fat (preaponeurotic fat), presence of an epicanthal fold, and lash posit on.
Two types of procedures are available to rejuvenate Asian eyelids: partial incision and incison surgery. The partial incision surgery is used more commonly in Asia, can be performed quickly, is potentially reversible. The downside is that it can lead to suture breakage and the permanence of this procedure is questioned.
The incision eyelid surgery is considered permanent. It is typically necessary in patients with promienet aponeurotic fat. A small amount of fat and muscle is removed to allow for better adhesion of the skin to the pretarsal tissues. A series of sutures are placed through the levator to encourage this creation.
Eyelids can be designed in several ways. Some patients seek a low crease, medium crease or a high crease. This varies by surgeon and patient preference. The shape of the eye can vary from round to oval. In addition, the eyelid crease can be soft or hard depending on patient preference.
The epicanthal fold can be difficult to manage. It is along a highly visible portion of the face. Patients seeking surgery here should be cautioned about prolonged healing and visibility of scars.
Overall, the vast majority of patients seeking Asian blepharoplasty are satisfied. Patient dissatisfaction is typically from presence of scars and eyelid asymmetries. Most eyelid scars heal well, however patients seeking epicanthoplasty will have increased risk of scarring. This is a difficult area to correct secondarily. Eyelid asymmetries can be from a result of preexisting eyelid asymmetries being accentuated or creation of an asymmetry.
Analyze your eyes:
- Look at shape, amount of preaponeurotic fat, thick or thin skin, type of epicanthal fold
Design your eyelid:
- Amount of lid to show
- Epicanthal fold management- treat it separately
- Hard versus soft crease-pronouncing crease
- Round versus oval eyes
- Removal of fat
- Minimal incision type
- Full thickness incision type
Pros and Cons to Both:
- Potentially reversible minimal incision
- Chance of lid
- Minimal swelling
- Scarring about same not an issue
- Much quicker with minimal incision type
- Maintain identity, apply eyeliner
How does an Asian eyelid differ from a Caucasian’s?
The orbital septum fuses with the levator aponeurosis further inferiorly in Asians than in Caucasians.
The orbital septum, which lies just deep to the orbicularis oculi muscle, forms the anterior border of the orbit and confines the orbital fat. It is a fibrous sheath that is formed at the orbital rims as the arcus marginalis, and it is an extension of the orbital periosteum. In Caucasian upper lids, the septum fuses with the levator aponeurosis approximately 3 mm above the superior tarsal border. In Asian upper lids, the septum fuses with the levator aponeurosis further inferiorly, below the superior tarsal border; this allows orbital fat to lie anterior to the tarsal plate, thereby preventing the attachment of the levator to the skin and preventing the formation of an upper eyelid crease.