Thank you for your question.
You submitted two photos and you state in your question that you normally have a double
eyelid and suddenly you developed multiple creases in your upper eyelid.
And you’re concerned about whether or not the best solution will be a fat injection
or whether there’s excessive skin.
And also you mentioned that there are creases in the lower eyelid and you’re looking to
consult an oculoplastic surgeon.
Well, certainly I can share with you my approach to evaluating Asian eyelids.
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.
And Asian eyelid surgery in fact is a major focus in my practice both primary and revision
surgery and patients come to us from around the world for these procedures.
So it’s very important to have a basic overview of how I evaluate patients and determine what
is the most likely course of action that will be successful.
So to begin with, the first thing I try to figure out is there excess skin, is there
overlap or excess fat.
That differentiates or may help me determine the choice between incisional surgery which
means removal of some skin or non-incisional surgery which is the placement of stitches
to create a crease.
Both procedures, in principle, connect the skin to a muscle called the levator aponeurosis,
the levator palpebrae superioris muscle.
Now the ideology or the cause of your current situation of first previously having a double
eyelid and then having multiple creases can be a couple of things but more than likely,
it’s a weakening of the connection between the skin and the levator muscle that gave
you a defined crease.
It is generally my approach that when someone is younger and doesn’t have a lot of skin
and doesn’t look like they have the overlap of skin, I usually approach this by doing
a non-incisional Asian blepharoplasty.
This technique employs the placement of stitches that are permanent placed through several
little strategic entry points in the skin to engage the muscle and to basically create
a connection between the skin and the muscle so that when the eyelids are open, you see
a single crease.
Generally speaking, this procedure works out very well and is relatively minimally invasive.
Now as far as fat injections are concerned, I don’t think fat grafting in this area
has any benefit and I think that is something that wouldn’t even be a discussion.
As far as the creases in the under eye area, those lines appear to be very fine.
And I would probably suggest not doing anything about those lines because essentially, they’re
subtle and they’re just the natural result of facial expression.
So, as far as the upper eyelids are concerned, I think that you need a proper evaluation.
Certainly, I think you’re in the right vicinity when you think about an oculoplastic surgeon
but I would say further an oculoplastic surgeon with extensive experience with Asian eyelid
surgery.
Interestingly, as someone who has been practicing oculoplastic surgeon for over 20 years, I
can tell you that even within our specialty which is already super-specialized, there
are many of us who mostly do older patients or do reconstructive surgeries, hospital-based,
trauma.
The specialty itself is very broad even though it’s limited to a narrow specialty area.
So look for an oculoplastic surgeon who does a lot of Asian eyelid surgery so that you
can understand what their perspective is and I think that we’re dealing with a situation
that is relatively straightforward.
Of course, this is in the absence of a physical exam and it’s important to have clarity,
clarity about the outcome.
You may still have, even if it’s with incisional or non-incisional surgery, you may still have
a little bit of creasing of the eyelid but you should be able to achieve a defined upper
eyelid fold and that’s something that can be more easily predicted by physical examination.
So I hope that was helpful, I wish you the best of luck and thank you for your question.