Thank you
for
the question.
You are asking essentially about the healing process that occurs after Asian eyelid surgery
and you are focused on specific numbers in terms of level of the crease in millimeters
and as well as different points of time along the healing process and you want to know how
low does the crease fall as well as is it subtle or dramatic.
Well, I can certainly give you some guidance on this question with the absence of a photo.
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 focus and specialty of mine in my practice and this is a type
of question that we deal with every day when we do consultations for Asian eyelid surgery.
So to get some understanding and perspective, we have to basically understand a little bit
of the basic anatomy that is relevant to an eyelid crease.
First of all, in my practice and my style, if someone wants an eyelid crease my goal,
is try to create a crease in a way that looks as if nature created it.
It is well known that approximately 50% of Asians have a natural crease or double fold
and 50% do not and have something called a monolid.
Well, when I evaluate a patient, I usually place some type of instrument in a way to
cut and create a crease and see what would naturally occur if you were born with crease.
I feel that is the aesthetic that people come to me prefer and I feel it looks the most
natural.
So then we get into how we create that crease?
Well, there are two basic approaches to creating an eyelid crease and it depends on the presence
or absence of extra skin or extra fat.
So we make a decision between a non-incisional versus an incisional Asian eyelid surgery.
A non-incisional surgery means that I am placing small openings in the skin and what I am doing
is creating a connection between the skin and the muscle that lifts the eyelids called
the levator muscle.
If nature had created a crease, there would have been a natural connection there that
is responsible for creating that type of fold.
If someone needs skin removal, then we do an incisional Asian eyelid surgery or Asian
eyelid blepharoplasty.
Skin is removed and in some situations fat is removed.
Now there are hybrid versions of these procedures where there is a partial incision or in different
ways to try create a natural crease.
Now the healing processes whether it is non-incisional or incisional especially in the first few
weeks makes the eyelid crease look higher than it actually is and that is because there
is a certain amount of swelling that occurs between the eyelid crease and the margin or
the eyelashes and that makes the eyelid crease look like it is much higher than it is intended.
In general, I tell my patients that swelling is still going to be present even if you look
pretty good for several months and technically it can last up to a year.
Now for most people, six months is when the majority of swelling has resolved and you
can essentially feel that level of appearance is stable.
Now to address the question about a 7 millimeter versus a 6 millimeter versus an 8 millimeter,
the way I figure this out typically, if you want to make a natural crease, there is an
element or a part of the eyelid called the tarsus and that is usually the height of the
tarsus which is kind of the backbone of the eyelid is what usually determines where a
natural crease would have fallen.
Now the height of that crease is relevant but it’s only relevant up to the point where
the skin is anchored to allow for a certain amount folding over of the skin to create
a natural look.
When we do this type of surgery on a non-Asian patient, well it is very different story.
We are trying to often excise skin or remove skin more aggressively to create a larger
eyelid platform, basically, the place where you put eye shadow.
However when dealing with Asian eyelid surgery, it’s the amount of lid that shows that is
customized and so the anchor point is typically higher but, or should I say, at the height
of the tarsus but the amount of skin that is allowed to fold over is what we try to
aim for in terms of how much skin to remove if skin removal is intended or the amount
of skin that is folding over if it is a non-incisional.
Now there is always a natural equilibrium that occurs and technically that crease can
be somewhat mobile so that if you aim for let’s say a 7 millimeter crease as you questioned
and you actually measure it when you are done with the healing, on tension, the skin can
have a certain height and without tension the crease can have a different height.
In the end, I think it is not necessarily helpful for you to stay focus on the height
of the crease but rather on what is your ultimate desired result.
And so whether you want a particular elevated position of the crease to be exactly where
you place it, that is actually a more technical issue for the surgeon to try to ensure that
the final cosmetic outcome is desirable.
So I recommend you to meet with your doctors who have a lot of experience with Asian eyelid
surgery and discuss this question and concern.
A lot of times people get very focused on these numbers but the human body is much more
elastic and there is always a balance of factors that ultimately result in a good cosmetic
result.
So learn about your options and see what type of procedure will be best for you and review
some before and after pictures with your prospective surgeon and look at the different stages of
healing and I think you will get a much better sense than asking kind of in the theoretical.
So I hope that was helpful, I wish you the best of luck and thank you for your question!