Asian Double Eyelid
Asian eyelid surgery is a creation of a supra-tarsal fold, better known as double eyelid fold. Depending on the ethnic make-up, anywhere from 20 to 40 percent of Asians is born with natural eyelid folds. Usually those who are born with a distinct double eyelid fold have more aesthetically pleasing eyes since they don’t have the lids which are ruffled down and covering over their eyelashes and or puffy enough to give a wrong appearance of being sleepy, angry, or even mysterious looking. It is perfectly understandable then, to desire a double eyelid fold surgery to have an aesthetically more pleasing eyes resulting in more up-beat and brighter looking eyes. From a dynamic point of view, catching of the fold as one opens the eye during batting or blinking, is another aesthetically pleasing feature of having a double eyelid fold. Finally, having a well-delineated edge to place eye-shadow or eye-liner is also a cosmetically enhancing part of having a double eyelid fold.
The surgical technique unfortunately is not a situation of one technique fits all, and includes suture fixation techniques, partial incision techniques, and full incision techniques. Over the past three decades, so many variations of these surgical techniques have been reported, mainly because no one technique has been proven to be the best, definitive procedure for all the patients. The need for different techniques lies with the fact that there is so much variation from eye to eye in terms of how prominent or recessed the globe of the eye is, degree of skin thickness, muscle thickness, fatty deposits at different levels of the surgical planes, and variation in inherent muscle strength of the Levator muscle, to which the skin is surgically attached to create the fold. Finally because the eye is constantly blinking and swelling up and down throughout the day, the fixation at the time of surgery to create the fold may not always stay permanently.
Obviously the less invasive “suture fixation” techniques offer quicker recovery time. Unfortunately, due to shearing effect of the suture and the inherent bulk and heaviness of the underlying fat and muscle tissues, high percentage of the folds will disappear. Using the open approach, the surgeon has the ability to visualize and accurately remove the appropriate amount of fat and muscle, and skin if needed. In essence, Dr. Kang “sculptures” the eye to appear more naturally like those patients who were born with the double eyelid fold, allowing the double eyelid creation to be more reliable and exact. Very often the swelling is only slightly more than the suture fixation technique, and the incision site heals quickly. When performing the open technique, Dr. Kang believes that the surgeon must be “light-handed” and must never create an artificially “overdone” looking fold. Most of the time, the open technique provides a permanent result with imperceptible scar, which in time, should look almost as natural as perhaps another similar appearing Asian person born with the fold. You should definitely ask to see Dr. Kang’s Portfolio and see how well versed he is with this procedure.
There are two ancillary procedures unique to creation of double eyelid surgery. Most Asian patients have a degree of epicanthal fold which rounds out the “inner” aspect of the eye, sometimes limiting the degree of the double eyelid show. In patient with mild epicanthal fold, at the time of double eyelid surgery, the tissues in the inner part of the eyelid is sculptured to open up the epicanthal fold as naturally as possible, without any additional incision. In patients with severe eipcanthal fold, a formal Epicanthoplasty procedure can be performed, which advances the small flap of skin and opens up the inner part of the eyelid. However, no matter how successful the epicanthoplasty procedure is, the external scar can be visible to a discerning eye, and Dr. Kang always reserves this procedure for patients who carefully outweigh the benefit of more open inner eye versus permanently having a small visible scar in this area. Lateral canthoplasty is a procedure which attempts to widen the “outer” aspect of the eye, but by nature, “loosening” an anatomical structure rather than “tightening” can lead to a more variable result, which can create greater asymmetry between the two eyes and Dr. Kang feels that the procedure should be limited for patients with severe lateral slant of the eye.
In Asian patients over 40, with “existing” eyelid fold, only the excess skin is removed to rejuvenate the eye to allow better show of the existing fold. A “new “fold is only created if the patient never had a fold in the past, and every attempt is made to make it appear as naturally as possible. Extreme care is given not to give the eye a hollowed out appearance; in fact, for those starting to appear “hollowed out”, special surgical technique is use to bulk up the hollowness, so patients appear more youthful. Conversely, for older patients with “puffy” appearance of the upper eyelid area, very often it is partly due to early downward migration of their brow associated with relatively flat forehead, common in Asian patients. For these patients, brow lifting procedure is recommended using either surgical or non-surgical means to optimize the improvement of the double eyelid surgery. In male patients, once again, every attempt is made to make the double eyelid fold appear as natural as possible.