Double eyelid surgery is one of the most common plastic surgery procedures for Asians. Asian and western eyelids have different anatomy, and thus traditional upper eyelid surgery techniques do not apply. Asian eyelids often do not have the usual attachments between the upper eyelid muscle and the skin that western eyelids contain. This results in an absence of an upper eyelid crease. Some Asian eyelids do, indeed, contain creases, which are frequently located lower (closer to the eyelash line). Asian eyelids also often appear “puffier” or fuller than western eyelids due to an increased fat layer under the skin and from orbital fat protrusion.
The goal of the surgery is to create a pleasing upper eyelid fold that does not rob the patient of his/her ethnicity. In the past, surgeons have had a tendency to “overly Westernize” eyelids by placing folds too high. This concept of “westernization” of Asian eyelids has now undergone a welcome paradigm shift. The current emphasis is to accentuate and enhance a typically Asian eyelid – not to completely alter it. We also focus on patients’ particular desires to help tailor the surgical outcome. Some want defined, higher creases, while others simply want minimal refinements without noticeably changing the eyelid’s characteristics. Other important considerations are the contouring of the eyelid by removal of excess skin or fat, preservation or elimination of the inner eyelid fold, differences between male and female aesthetics, and ethnic eyelid variations between Koreans, Japanese, Chinese, etc.
How to Treat
Double eyelids can be created through 2 primary methods: either a suture or an incisional technique. Suture techniques involve the placement of 2 to 4 sutures at key points in the upper eyelid to contour the eyelid fold. Incisional techniques involve surgically removing a small portion of eyelid skin, fat, and/or muscle prior to placing key sutures to create a new fold. Younger patients with good eyelid symmetry and minimal fullness are good candidates for the suture technique. Older patients, or those with excess eyelid skin, fat, or muscle, or those with asymmetric eyelids are better candidates for the incisional techniques. There are obvious advantages and disadvantages to each. Suture techniques are simple to perform with less post-operative swelling, but do not allow for the ability to remove excess skin or fat. Also, some surgeons find that suture techniques have a higher incidence of relapse – or loss of the fold due to breaking sutures. Incisional techniques allow for precise contouring of the upper eyelid fold and for removal of any excess skin or fat. Recovery is a bit longer due to increased swelling and healing incisions.
Either technique is usually performed under local anesthesia (injection) with light sedation. This allows the patient to open and close his/her eyes at the surgeon’s direction to optimally contour the creases.
Recovery can be quite variable depending on patient individual healing characteristics and on the particular technique performed. In general, Asians have very thick, sebaceous skin that is prone to swelling and bruising. This usually lasts for several weeks, but in some patients can last up to 2 months. Healing is often more protracted than with our Caucasian counterparts. Scars will usually heal very well, but any incision that is performed on the body generally takes up to 9-12 months to completely heal (soften and fade).