Best double eyelid procedure?
I'm 15, and I'm flying out to Korea this summer break for about a month to get my double eyelid
surgery.
I've read online about different procedures such as full incision and partial incision.
After using double eyelid glue and tape, my eyelid skin started sagging a little.
And now, on one eye, there’s a crease forming, but that’s not the line I want my double
eyelid.
So as for me, what procedure is recommended?
I want a permanent result.
And is it okay that I'm doing it in summer?
Thank you for your question!
You’re 15-years-old and you have been doing a lot of research about how to get an eyelid
crease.
And you’re asking a very good questions about the different types of procedures and
you also described how you have been using eyelid tape to try to create a crease but
you described some issues with sagging and the eyelid skin not responding the way you
like.
So tell help you understand what’s the best procedure as you’ve asked, I’ll explain
to you how I do my consultations in my practice.
I’m a cosmetic oculofacial plastic surgeon working in Manhattan and Long Island for over
20 years in practice and I have a particular area of specialty in Asian eyelid surgery
and I do all the different methods and techniques and I customize these to the individual.
So what’s important to understand is there’s no one best method but there is usually a
better method that’s right for your individual situation.
So I’ll share with you the approach that I have when I meet a patient in consultation
who expresses an interest in having an eyelid crease.
To understand the anatomy as well as the genetics, we have to look at some of the details of
eyelid structure.
It’s well understood that 50% of patients with Asian origin have an eyelid crease while
50% do not and there are people have a partial crease and maybe multiple creases and they
want to have one defined crease.
So there’s a wide variety within the 50% who have and 50% who don’t have the crease.
But when we look at the anatomy of Asian eyelid, it has to do with a muscle called the levator
muscle.
The levator muscle is like the world elevator.
It’s the muscle that lifts the eyelid.
And what comes off the levator muscle are these fibers that go in to the skin.
And when they go in to the skin, they pull the skin in and they create a crease.
So every Asian eyelid surgical procedure whether it’s incisional, non-incisional, partial
incisional has to do with creating that connection.
So how do I make a decision on whether or not to do an incisional technique versus a
non-incisional.
Well the first question I ask to myself when I’m doing my physical exam is, is there
fat that’s getting in the way of the eyelid crease, is there extra skin that is obstructing
or overlapping and preventing a crease from forming.
Those are two very important questions.
And then less frequently present but still an important question is there ptosis, is
there drooping of the eyelid and drooping of the eyelid is also related to the muscle,
the levator muscle and we need to recognize that before doing the eyelid surgery.
Now, with those variables understood, for someone who is young, who doesn’t have fat,
who does not have extra skin, my preferred technique is a non-incisional procedure.
Now the term non-incisional procedure isn’t quite accurate because by design, we are making
little openings in to the eyelid skin.
And what we’re doing is along the natural crease, the crease that we want to create,
we make strategically placed openings and through those openings, we pass a suture.
And those sutures are essentially creating that connection between the eyelid skin and
the underlying levator muscle.
Once those creases are formed using these sutures and it can vary.
There are techniques where you can do single suture.
There are techniques where you do several sutures.
Again, it’s about customization and looking at the behavior of the eyelid even as you
are doing the procedure.
A lot of times, I actually ask my patients to open their eyes during the procedure.
They are never in pain, they don’t feel anything but it sometimes helps to position
and the movement of the eyelid as I’m doing this.
For younger person again with no extra fat, no extra skin, then a non-incisional approach
is preferred.
Now you asked about longevity and when you’re starting at the age of 15, you have many decades
ahead of you.
You have to understand that as you get older, things do change.
Now you’re not going to change well in your 30s, 40s and beyond, but it is one of the
concerns about the non-incisional approach is how well those adhesions form or those
connections form and will they last a long time.
And there is some variability.
In my experience, our patients look good and hold up for many years and that connection
seem to work very well but again, you have to think about different skin types in terms
of thickness as well as lifestyle, eye rubbing, allergies and other factors that contribute
to whether or not the crease holds.
But I think there isn’t any clear indication to make an incision if we can avoid it and
most likely, in your situation I would probably go with the non-incisional approach.
So your options is, your young and you have to go with your parents, your mother or whoever
your guardian is to meet with doctors, get an understanding of what’s involved and
what the procedure is like and whether you’re comfortable with what they’re comfortable
doing this at relatively young age.
There are have been many patients who come to me with their parents who wanted to have
this done in a relatively young age like yourself so that as they got a little bit older, it
was always as if they’ve always had the crease.
It’s just seems a particular value that is important to some people who have come
with their families for this procedure.
So once again, to summarize, in your situation, with no extra skin which is determined in
physical exam and the absence of fat which appears to be the case from just the photos
you submitted, a non-incisional approach would be most likely that I would do in my practice.
So I hope that was helpful, I wish you the best of luck and thank you for your question!