| Other names: Asian blepharoplasty
Primary goal: Formation of an upper eyelid crease
Secondary goals: Removal of skin and fat
Special anatomy: The pertinent anatomical difference between Asian and Occidental eyelids is that the orbital septum (the layer that holds back the fat) extends lower down towards the eyelid margin before attaching. The allows the eyelid fat to extend further down into the lid, thus interfering with some fibers from the levator (opening) muscle and tendon that might otherwise extend to the "back" of the eyelid skin (and pull in a "crease" when the eye opened).
Anesthesia: Ideally, sedation should be kept light so that the surgeon can check the position of the new crease during surgery by asking the patient to open the eyes.
Operative technique: The preferred approach requires a skin incision. Skin, muscle, and fat removal are undertaken in a manner similar (although not identical) to non-Asian upper eyelid blepharoplasty. The incision is placed much lower and amount of tissue removed is more conservative. A "deep fixation" closure is utilized.
Variations: Less invasive techniques have been described that involve no skin incision (non-incisional) and rely instead on varying schemes for placing sutures through the full-thickness eyelid. The sutures create internal eyelid "inflammation" during healing, which "spot welds" a crease into place.
Advantages: Surgery done through a skin incision creates a long-lasting, if not permanent, crease. While simple suturing techniques are still practiced widely, the crease disappears with time.
Limitations: The goal of Asian double eyelid surgery should be to enhance the appearance of the Asian lid in a manner that is still consistent with the rest of the facial appearance and with the patient's heritage. Attempting to "Westernize" the lids is ill-advised; special consideration at the time of consultation should be directed to determining proper crease height and contour.
Care and recovery: As a rule, Asian eyelid skin is more "reactive" than Occidental skin and may stay swollen for a longer time interval (4 months). The crease position and shape will vary as healing progresses and not reach its final configuration for one year or more. Scars may stay red and thickened for a longer time.
Risks and complications: In addition to the general risks of blepharoplasty discussed elsewhere, a number of additional items should be mentioned. Too high or too arched a crease may look unnatural on an Asian face. Since many Asian patients are concerned about the crease and seek surgery for this very reason, unsatisfactory final height and shape can be disappointing. Furthermore, attempts to eliminate the inner epicanthal fold may create excessive scarring. Unless the folds are objectionable, such surgery should be undertaken cautiously.
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