The Asian eyes are exotic, youthful looking and beautiful. Modern fashion photography often features the Asian eyes in many advertisements that want to create an image of beauty and youth.
As we age, the skin of our face ages and becomes lax often creating a hood which falls over the eye crease and creates a tired aged appearance. In addition normal fat pockets beneath the eyes bulge and push forward to create a puffy unhealthy look.
Traditionally, in America, plastic surgeons have done a procedure called the Double Eyelid blepharoplasty to remove excess skin and fat to make the eyes look younger. However, the procedure was often performed in the same way as the Caucasian Blepharoplasty which created a round eyed or exaggerated Western look which lost the beautiful ethnic look of the eye. In the past many doctors assumed that Eastern patients wanted to look Western with an open look that showed the double eyelid fold. This was a mistake in most instances.
Today, the approach to surgery and eyelid rejuvenation in Asian patients has changed dramatically, and proper modern Double Fold Blepharoplasty creates a discrete properly positioned double crease but also preserves the beautiful natural shape of the eye. This technique is a sophisticated one and requires the expertise and skill of an experienced plastic surgeon to create a natural refreshed look.
What Is Different About the Asian Eye?
The main difference from Occidental upper lid is the attachment of a small muscle called the Levator Palpebrae Superioris. This muscle lifts the lid upward to open the eye. In the Occidental this muscle is attached to the skin about 8 to 12 millimeters above the eyelashes so that when the muscle pulls on the skin to open the eye, a crease or line is created. This line is called the Supratarsal (above the tarsus or lower edge of the lid) Fold. This crease is visible about 10 millimeters above the eyelashes when the eye is open in most women, and is called the double eyelid fold or double eyelid crease.
In the non double lid this muscle attaches very weakly or not at all to the skin but does attach to the tarsus which allows the eye to be pulled up and opened. Because the muscle is not attached to the skin when the muscle pulls up, the Supratarsal Crease does not appear. In many people a small crease is present, but it is very low, only 3-5 millimeters from the lashes. Thus the Supratarsal Fold or double crease is low, about 3-5 millimeters above the lashes or not present at all if there is no muscle attachment to the skin.
The fat distribution is also different in that the fat is present across the entire upper lid and not limited to two deep pockets as it is in the Occidental. This makes the eye look fuller.
What is the Double Eyelid Blepharoplasty Technique?
The blepharoplasty operation starts with an incision placed in the skin along the exact position of the desired post operative Supra tarsal Crease or upper lid crease. In Occidentals this line is placed from 10-12 millimeters above the eyelashes. This results in a normal visible fold 10-12 millimeters above the eyelashes when the eye is open. Loose skin is removed. Also any protruding or bulging fat that is causing eye bags or puffy eyes is also removed during the Caucasian or Occidental blepharoplasty.
In the Asian blepharoplasty this incision is placed lower on the lid usually about 3 millimeters above the eyelashes-this creates a more natural look to the crease after surgery. The incision is made much shorter than in the Occidental to avoid scarring the fold near the nose.
In addition, the Levator Palpebrae Superioris muscle is attached to the tarsus and skin to create the normal attachment which is missing. This assures that the normal crease will appear after surgery. This is a very important and technically refined component of the blepharoplasty.
A deep suture is also placed beneath the skin to pull the upper skin down so that a small amount of skin falls down to hide the incision. In Occidentals this area is left open so the crease shows. The ideal non Caucasian eye has a small amount of skin over the deep crease to hide the depths of the crease. It is also very important to be conservative with fat removal. If the same amount of fat is removed as is done in Caucasian blepharoplasty, the eye will look unnaturally hollow.
Finally, the hood of the skin near the nose, the Epicanthal Fold is normal.. It should not be violated and a short incision should be used that avoids this area. This will help hide the incision and leave the natural shape of the eyelid.
What Are the Essential Elements For A proper Double Eyelid Fold Blepharoplasty?
The main important elements of the Double Crease Blepharoplasty which must be done are:
o Proper location of incision 3-5 millimeters above the eyelashes
o Insertion of the muscle to create the Supratarsal Crease
o Minimal fat removal
o Do not violate the Epicanthal Fold near the nose
o Create a very small amount of skin over the incision hiding the depths of the Supratarsal Crease.
Where Do I Find An Experienced Double Eyelid Blepharoplasty Surgeon?
You will have to do your homework to find an experienced board certified plastic surgeon who is experienced at the Double Eyelid Blepharoplasty. Consult board certified plastic surgeons and ask specifically if they have experience with this technique. Search the internet, as most surgeons who do this procedure will express their interest in their internet writing.
Ask friends who have had this procedure if they are happy with their results and if they are happy with the doctor who performed the surgery.
Ask the doctor how he/she plans to do the procedure and be certain he includes a discussion of the essential elements discussed above.
Bring a photograph of a model in a magazine who has the shape and look of the eyelid you desire and ask the doctor if he/she can achieve the look you want.
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