Thank you for your question.
You submitted a question with two photos and you’re looking for an alternative to eyelid
surgery.
And you state in your question that you’re 29-years-old and that you have essentially
an asymmetry where one eyelid crease is more well defined than the other.
You refer to the one side as a monolid, just a difference between the two eyes.
And you are concerned that if you have surgery now that you would potentially make it difficult
for a surgeon in the future, let’s say 30 years from now, if you were to have the surgery
again.
Well I can certainly share with you my perspective on this type of situation which I deal with
a lot in my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Asian eyelid surgery is a significant part of my practice.
In fact, patients come to me from around the world for both primary or first time having
surgery as well as for revision surgery for undesirable outcomes.
So, when I look at your photos, one thing that you didn’t clarify in your question
but I think it’s fair for me to assume is that in the second photo where you appear
to have more symmetry that you used some kind of a tape to create that lid appearance and
this is a very popular strategy that a lot of people of Asian background have used to
try to create a double fold.
Well certainly, that helps you understand and differentiate the type of procedures that
can be useful and also, ultimately meet this concern about doing something minimally invasive.
So let’s understand something.
First of all, eyelid surgery or Asian eyelid surgery is typically divided into two types:
incisional versus non-incisional.
And although there’s certainly a lot of debate about what is the best way to approach
or create a double fold, in my mind, the incisional approach has a specific indication.
Now what do I mean?
When we do the non-incisional or the incisional approach, we’re create the connection between
the skin and the muscle that lifts the eyelid called levator muscle.
The way I make this distinction, the questions I have are: is there too much skin?
Is there excess fat?
And those are the two main questions and of course, is there drooping of the eyelid or
ptosis?
But basically, if there isn’t any of those conditions, then I would suggest you consider
this procedure called a non-incisional Asian eyelid surgery.
So what does that mean?
Basically in the non-incisional procedure, you are technically making openings which
are technically incisions but they are little points along the projected crease or the intended
crease that allow access for the placement of stitches and these stitches connect the
skin to the levator muscle.
Now when it comes to the level of invasiveness, this is as minimally as you can get because
there is no removal of skin.
There’s generally no removal of fat and you’re essentially placing stitches that
can create the same type of crease or comparable crease as you have with the eyelid tape.
So as far as the concern about future operation, you have to understand that you deal with
an issue or at least in my philosophy, you deal with the issue and it bothers you.
And although you feel like you’re young at 29, certainly you’re not too young to
have this type of procedure.
As far as the concern about a future doctor doing another procedure, well I think that
either operation whether it’s an incisional or non-incisional, a future doctor is going
to do what needs to be done based on your anatomy at the time.
And to help you understand that, you think about 30 years from now, there are going to
be changes related to facial aging.
There’s going to be changes in bone structure, bone mass, volume in terms of the skin, soft
tissue and fat around the eyes.
So although, yes, it is technically somewhat of a challenge, different from a primary surgery,
generally speaking, you treat the anatomy for what it is at the time.
And so, I don’t think you necessarily have to be overly concerned about what the future
surgeon needs but really, if this is something that is bothering you now, I think the option
of doing a non-incisional procedure pretty much meets the criteria.
Essentially, underlying anatomy is not really significantly altered by a non-incisional
procedure.
Sometimes I refer to it like quilting.
We’re placing a stitch in a way that connects the skin but really, there’s nothing else
that’s changed.
And so, I think that that’s something worth considering as you further investigate your
options.
So I hope that was helpful, I wish you the best of luck and thank you for your question.