Double eyelid surgery DST or incision surgery?
Low crease or medium crease?
I think I have different eye shapes on both of my eyes.
Whenever I smile, my left eye is noticeably smaller than the right, my eye bags will be
raised as well.
They aren't saggy though.
(Eye bags aren't my priority, double eyelids are).
My questions are: 1) should I go for DST or incision for double eyelids?
2) Low crease or medium crease for the ideal and most natural look that complements the
size of my eye?
(I smiled with my mouth wide open so that the eye bags are more noticeable.)
Thanks
Thank you for your question!
By the wording of your question, it’s clear that you’ve done a lot of research and with
the photos you submitted, with expression and smiling and mouth opening and etc. that
you have a general good understanding of how we make some of our decisions on what type
of surgery would be right for someone like yourself.
So you’re asking should you have a DST or incisional surgery, a low crease or medium
crease.
Well, with the photos you submitted, it’s difficult to give you an exact answer because
the one thing that we can’t is the one thing that we always do is a physical examination.
To give you just a background, I’m a board certified cosmetic surgeon and I’m a specialist
in oculofacial plastic and reconstructive surgery.
Asian eyelid surgery is something we do a lot in our practice and certainly, I’ve
been at this for over 20 years and I can give you my approach or evaluation so that you
would get an understanding of how I would, what recommendations I have for someone like
you.
So first, we decide incisional versus non-incisional.
Well to decide whether or not an incision is indicated, we look at two factors.
Is there excess skin, is there excess fat.
And whether there would be value in removal of extra skin in order to create an eyelid
platform that creates the double fold.
In your situation, although you mentioned DST which is one method of the non-incisional
technique, it is likely and probably safe for me, assuming that you are young and you
don’t appear to have that much extra skin, that you would probably have in our practice
a non-incisional surgery.
Non-incisional for clarification means making small entry points in the skin and creating
connections between the eyelid skin an and the levator muscle using sutures that are
tied effectively into small loops that connect the muscle with the skin.
DST basically does it in a way which is kind of a continuous threading of the suture all
the way across from one end to the other.
The other question you have is low versus medium crease.
Well, I think it’s important to understand that when you are doing a non-incisional procedure,
there’s a certain amount of relaxation that always happens whether there’s actually
incisional or non-incisional.
And that relaxation can have an effect on the height of the crease.
So I would say that the question is more about the way the crease naturally tapes in to the
epicanthal fold or whether or not you want to go parallel to the epicanthal fold.
Usually, what my approach is I recommend to patients that the goal from my perspective
is do the procedure as you are born with the crease.
And I would say that most of the time that means that the natural crease would be one
that naturally goes in to the epicanthal fold.
Now it can only go so high before it looks unnatural.
And so the difference between low and medium crease is a question of 1-2mm and that is
something that has to be determined by physical exam.
Generally, I tend to make the crease a little bit higher because I know there is a certain
amount of resolution of swelling and then the crease kind of sits in a way so that when
the eyes are open, you can see a decently defined crease.
Again, it has to do more with what you’re comfortable with and what is realistic in
terms of an option.
Again, the difference between low to medium can be very small.
And it doesn’t matter on how you label it as long as it looks good.
So this is where a physical examination and discussion and details about the height have
to be clarified before you do the procedure.
So I think at this point, you have more than enough research-based information.
Meet with some doctors, learn about the options, learn about the potential outcome would be
for you and would it be right for you, would you be comfortable with that.
This is still not an exact science and there is no one perfect solution for everybody.
Again, it’s all about getting the results that are close to what you imagine what those
results will be.
So I hope that was helpful, I wish you the best of luck and thank you for your question!