Asian Upper Blepharoplasty

(Double Eyelid Surgery)

Primary goal: Creation of an eyelid crease

Secondary goals: Removal of skin and fat

Special anatomy: One major anatomical difference between Asian and Occidental eyelids is that the orbital septum (the layer that holds back the fat) extends further down towards the eyelid edge. This lower insertion allows orbital fat to travel further into the lid, thus interfering with fibrous extensions from the levator (opening) muscle that pull in a "crease" when the eye is opened.

Anesthesia: Sedation should be kept light so that the surgeon can check the developing crease by asking the patient to open the eyes.

Operation: The preferred approach requires a full skin incision. Skin, muscle, and/or fat are removed in a manner very different from conventional 'Occidental' upper eyelid blepharoplasty. "Deep fixation" closure is utilized.

Variations: Less invasive techniques have been described that involve no skin incision but rely on differnt schemes of weaving and twisting suture through the eyelid. Such sutures create internal inflammation during healing, which "welds" in a crease.

Advantages: Surgery done through a skin incision creates a very long-lasting crease. Although suturing techniques are still practiced widely in the Orient, the crease is less customized in shape and height and often disappears in just a few years.

Limitations: A proper goal of Asian eyelid surgery should be to enhance the Asian crease in a manner that is consistent with the rest of the facial appearance. Attempting to "Westernize" the lids is not wise.

Care and recovery: Asian eyelid skin may be more "reactive" than Occidental skin and thus may stay swollen for a longer time after surgery.

Risks and complications: Too high or too arched a crease may look unnatural.