Thank you for your question!
You submitted a question without any photos but you stated that you had Asian eyelid surgery
done about two weeks prior and you feel already that the crease is lower than you would like
and that you have minimal swelling and you want to know about the option of when is the
safe time to have revision and you want to know are there complications related to going
through the original incision.
Well, I can certainly assist you with this question in more broad terms.
I’m a board certified cosmetic surgeon and a fellowship trained oculoplastic and reconstructive
surgeon.
The oculofacial surgery background comes from first specializing in eye surgery before doing
very advanced training in cosmetic and reconstructive surgery of the eyelids through the American
Society of Ophthalmic Surgery.
So you can imagine that I do a lot of work with eyelids and I have been in practice for
over 20 years in Manhattan and Long Island and Asian eyelid surgery has been a focus
of my practice both in primary surgery and revision work.
So to understand this type of situation, I think it’s important first for you to reflect
back how you came to the conclusion of what type of surgery to have when you had your
consultation with your doctor.
To understand in broad strokes about how Asian eyelid surgery is divided, it’s divided
into incisional and non-incisional and then within those two types of surgery, we make
decisions about doing either a parallel crease or a nasally tapered crease and essentially,
with the occasional patient who may want an epicanthalplasty.
That being said, I’ll tell you how I approach this type of procedure in my practice.
It’s my philosophy and it has worked out well for me and for the people who come to
me that my goal is to create an eyelid crease as if nature has already created a crease
there.
It’s well understood that 50% of Asians have a crease and 50% don’t but even within
that population of having a crease, there is going to be a variety and variations based
on skin thickness, the genetics of characteristics passed through a family, the amount of fullness,
how deep-set the eyes are.
And what I usually conclude and I do a simple test using just a Q-tip or a special eyelid
crease device to just create the crease as if you already had it and it gives me an idea
of what kind of zone I’m able to work within.
I’ve learned overtime and I’ve seen from patients who have come through referral that
even though you may want to have a certain anatomy, a lot of times the body just doesn’t
allow that type of anatomy to be created.
And so when you write in your question that the crease is lower than you had wanted, understand
that there is still a relatively narrow zone in which an Asian eyelid crease is typically
placed.
Now, just for a sake of reference, the typical crease for an Asian eyelid is anywhere from
like 6-8 millimeters compared to a non-Asian eyelid which is closer to 10 millimeters and
that’s at the central height of the eyelid.
So if you think about it, if you feel like your crease is too low, how low can it really
be?
Is it more likely that you’re dealing with maybe some swelling above the crease that
may look like the crease is too low.
It also, from the procedure or at least the statement that you had an incision and you’re
concerned about getting another incision, it may be that what you’re dealing with
is more overlap of skin than you want and not so much the height of the crease.
As a general rule of thumb, the backbone of the eyelid called tarsus usually is consistent
with around the same height as the eyelid crease.
And so it’s likely that your surgeon placed the crease at that height but in determining
how much skin to remove, may have been more conservative to create a more natural appearance.
It’s very important to understand that as opposed to non-Asian surgery, you always have
to leave a certain amount of skin in order for the skin to fold over and look natural.
If you take a lot of skin over aggressively, then you don’t have any overlap and it doesn’t
look as natural.
So that being understood, yes you have time to see how things settle out.
Especially incisional eyelid surgery, you can have swelling that is above the crease
that can be causing some of that overlap to look more pronounced.
In general, I prefer to do revisions after there’s been adequate time for swelling
to resolve as well as for wound healing to a level where there’s some predictability
and we’re not dealing with potentially swollen tissue.
So generally, eyelid revision surgery should be done whether it’s Asian or non-Asian
as long as there’s no urgent issue, urgent issue meaning anything that comprises eye
functions or a problem in terms of abnormal scarring or something that’s more urgent,
as opposed to the cosmetic aspect.
You can do it as early as 3 months but it is usually more common to do it around 6 months.
A lot of my patients, before and after pictures are taken at 6 months because I know at that
point, even though wound healing can go on for years, with the exception of people who
may have a little swelling, I usually see the 6th month point as being closer to the
final place where it’s going to be settled.
Now it might be a straightforward thing in terms of the making another incision.
It might just require that you need a little bit more skin removed and then you’ll have
a better result.
There are also situations where I’ll actually do a non-incisional approach to create a more
defined crease and that can be sometimes be done at a higher point which means you may
have an option to do this procedure without opening incision again.
With all that being said, I think it’s very important that you speak to your doctor.
I’m sure that you have done your research and you were confident with the doctor you
chose and therefore I’m certain that the doctor who did this is familiar with this
concern about the height of the crease and will likely have the familiarity to have a
game plan for you in terms of potential revision but I’m also certain that the doctor will
give it appropriate time in order to do a revision if appropriate in a way that’s
predictable.
So I hope that was helpful, I wish you the best of luck and thank you for your question!