Asian Eyelid Surgery

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Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.


November 28 2007

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Your eyes are one of the first facial features anyone notices about you. They are said to be the windows of the soul. The eyes of Asians and Asian-Americans are a special feature of their faces: almond shaped with a small fold at the inner corners. They are part of your Asian heritage.

Many Asian-Americans are taking advantage of the rise in popularity of cosmetic surgery. Many of them are seeking eyelid surgery. But even though many Asian-Americans like you are choosing to have cosmetic eyelid surgery (called Asian blepharoplasty or Asian eyelid lift), it does not mean they want to turn their back on their Asian heritage.

You want eyelids that have a more prominent crease or eyes that have a more open appearance, but you want to look natural. You want to look like you, but better.

The Anatomy of Asian Eyelids
Many people seek Asian eyelid surgery to create a crease in their upper eyelid, something that is absent in many—but not all—people of Asian descent. This crease is also called the pretarsal crease. Asian eyelid surgery (Asian blepharoplasty) can create a pretarsal crease where one does not exist. The surgery was performed in Japan as early as the late 1800s.

About half of people of Asian descent have what is known as a single eyelid, which looks as if it does not have a crease when the eye is open. An eyelid that has a crease when open is called a double eyelid. Some people who are not of Asian descent have a single eyelid. Some Asian eyes have a crease that appears to be incomplete, in that it does not go all the way across the lid. The lack of an upper crease can make the eyes look narrower (although the opening between the lids may not actually be smaller) and less alert.

A more open-looking eye is a quality that is prized in many cultures, including many Asian cultures. Cosmetic surgery to change a feature on an ethnic face has often been frowned on as a denial of ethnicity. However, a good cosmetic surgeon understands how to improve a person's look without changing the ethnic nature of his or her face. An Asian face should not look westernized after an Asian blepharoplasty; it should still be Asian.

It is important to understand the anatomy of the upper eyelid. An eyelid is not just a flap of skin. Single eyelids have a crease due to a slight difference in their anatomy. A tendon in the eyelid called the levator aponeurosis attaches the levator muscles (which raise the upper eyelids) to the tarsus, the very thin layer of cartilage that gives the eyelid a bit of stiffness. In a double eyelid, such as that seen in most non-Asian eyes, the levator aponeurosis attaches at a higher point on the lid than it does on a single eyelid. This lower attachment pulls the lid up in a way that allows subcutaneous fat, sub-brow fat, skin, and the orbicularis oculis muscle (which closes the lids) to slip down and fold over the lid, hiding the crease, often completely. The crease rests right on the eyelashes.

In addition, many Asian eyes may have a bit more fat just under the skin (subcutaneous fat) and a pocket of fat under the brow. This fat combines with the lower tendon attachment to create the single eyelid. Although it would seem easy to help create a crease by removing some of this fat, doing so can cause the eye to look too hollow, especially in later years when the face naturally loses some fat around the eyes.

Most people of Asian heritage also have a small fold in the inner corner of their eyelid, called the medial epicanthal fold. This fold is also often seen in babies of all ethnicities, but usually disappears by early childhood. Although it is a stereotype and slur to consider Asian eyes to be "slanty," they are actually no more likely to slant than non-Asian eyes. The presence of a medial epicanthal gives the inner corners of the eyes a slight downwards appearance.

The medial epicanthal fold can be removed surgically, but this kind of surgery can leave a prominent scar. It is usually reserved for very deep folds that can make the eyes look cross-eyed or too far apart.

How Asian Eyelid Surgery Is Performed
There are several surgical techniques used to create a double eyelid for an Asian person without one. These techniques fall into basically two different types, the open method (which uses a larger incision) or the suture method.

In the open method, some skin of the upper lid may be removed and some of the structures of the upper lid may be shortened or rearranged. The levator aponeurosis may be detached from the tarsus and either shortened or reattached higher, or both. One variation of the open technique is the Flowers' anchor blepharoplasty.

In the suture method, the surgeon may make a few short incisions in the upper lid and place sutures along where the crease is being created. The sutures are buried within the skin. One suture technique is the Double Suture and Twisting (DST) method.

Asian eyelid surgery carries the same risks and benefits as other types of blepharoplasty. The recovery is also the same. You can find more information at blepharoplasty.

Swelling may distort the lid for some time and make the crease look wrong or out of place. You will not be able to see the final results of your surgery for some time. Although the bulk of healing takes place within 6 to 8 weeks for most people, healing will continue for many months after surgery, and the final results may not be completely visible until then.