ASIAN BLEPHAROPLASTY (Double Eyelid Surgery)

1. What makes the Asian eyelid so special? 

All eyelids are composed of skin, muscle, connective tissue, and fat. In the Asian eyelid, the fat pads tend to occupy a lower position than in its Occidental counterpart, often rendering a fuller appearance to the eyelid contour. In many cases, the lower fat pads may either prevent the connective tissues from forming a crease, or allow for a very low crease. Whereas the Occidental eyelid crease is typically located 7-10 millimeters from the eyelashes, the average Asian eyelid crease is shaped slightly differently and located 3-6 millimeters from the eyelashes. These differences, while they may appear inappreciable, are of upmost importance when considering surgery. For this reason, Asian blepharoplasty deserves a special consideration and requires that the surgeon have a comprehensive understanding of the Asian eyelid anatomy, the natural shape of the eyelid crease, and how the eyelid ages. 

 

​

2. What is a double eyelid and why have an eyelid crease? 

Approximately half of all individuals of Asian ancestry have no distinct upper eyelid crease. When an eyelid crease is absent, the upper eyelid is referred to as a “monolid” or a single eyelid, which is a normal variation of Asian eyelid anatomy.  When an eyelid crease is present and distinct, it effectively divides the eyelid into two parts, hence the “double” eyelid.  It has become desirable to have an upper eyelid crease among many Asians as it causes the eye to appear more open, more accented, and more attractive. Double eyelid surgery is currently one of the most popular cosmetic surgical procedure among Asians. Those seeking double eyelid surgery generally desire to maintain the beauty of their Asian features without appearing “westernized.” Additionally, having a double eyelid can ease the application of eye make-up.

 

​

3. What are the different types of eyelid creases?

The ideal Asian upper eyelid crease is typically lower than that of the Occidental eyelid, tapers as it approaches the inner corner of the eyes, and runs parallel to the eyelash line.  However, there are variations to the eyelid crease patterns among Asians. 

​​

• Tapered crease: The eyelid crease tapers and becomes more narrow toward the inner corner of the eye. 

• Parallel crease: The eyelid crease does not narrow at the inner corner of the eye. 

• Crease with lateral flare: The eyelid crease contours away from the eyelash line and widens toward the outer corner of the eye. As such, the outer part of the eyelid platform is wider than the central part.

• Partial crease: A crease is present; however, it is not well defined or it may not extend entirely across the eyelid. As the eyelid ages, the partial crease may become more distinct as the skin above it becomes looser. 

• Multiple creases: The eyelid may have multiple creases. Double eyelid surgery can be performed to merge the creases to form a single eyelid crease. 

 

The type of eyelid crease you choose to have ultimately depends on what you find most attractive. It also depends on whether you wish to simply accentuate the crease you already have or to make your eyelid creases more symmetric. 

 

​

4. What procedures are available for crease formation? 

Due to the popular demand of having a double eyelid among Asians, several products, such as specially designed tape or glue, have been commercially available.  However, these methods are temporary and can often be visible to others.  

 

 The suture method of eyelid crease formation is a minimally-invasive technique using stitches that can be done with very small incisions. The recovery is shorter, but the results are relatively short-lasting. 

 

 The incision method of Asian blepharoplasty involves the surgical removal of a thin strip of skin at the level of the desired crease, sculpting the low-lying fat pads if necessary, and fixating the newly-contoured eyelid crease with stitches. Despite the slightly longer recovery for this method, Dr. Abboud prefers it over the suture method as it allows him more control over contouring the eyelid and because the results are typically longer-lasting and often permanent. 

 

​

5. Who should perform my double eyelid surgery and does the surgeon need to be Asian?

Asian blepharoplasty is a delicate procedure that involves the precise contouring of the upper eyelid by conservatively removing skin (and possibly fat) and creating an eyelid crease when necessary. While your surgeon does not need to be Asian for your surgery to be a success, it is vital that they have the requisite training and a mastery of the surgical techniques required to fashion a double eyelid crease. They should additionally have a comprehensive understanding of the anatomy of the Asian eyelid and of the natural Asian eyelid crease shape. Equally important is that you seek a surgeon you can trust with your cosmetic needs and with whom you have the highest level of comfort.