Thank you for your question.
You’ve submitted several photos and you stated that you are 12 days after Asian eyelid
surgery and you are concerned that the eyelid creases are too high.
And you also state that your mother who also had the same procedure done feels the same
way.
You state also that you wanted to see just 2 millimeters of eyelid to look natural and
so clearly, you are distressed and concerned.
Well, I can certainly give you some understanding of how a surgeon approaches Asian eyelid surgery.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I specialize in Asian eyelid surgery amongst several other areas and I’m certainly familiar
with this very important concern of looking natural.
So to begin with, I think it would be fair to assume that you did choose a doctor who
showed proficiency in performing Asian eyelid surgery and I would also expect that you had
a good thorough discussion about what the desired outcome would be.
Now that being said, I’ll explain to you my thought process when I meet with a patient
and almost always, the same concern is always expressed “I want to look natural”, great.
Then the question becomes what kind of desired outcome you want.
And then what I do is I use a simple instrument like a Q tip and I roll the skin and I show
the patient what I think they’re asking for and what I believe, also for me, aesthetically
looks natural.
Once we essentially have a shared understanding of what the desired outcome would be, we then
discuss what approach it is going to be.
Now when it comes to Asian eyelid surgery, whether you do one of 2 techniques and the
2 techniques that I am sure you are familiar with, one is called non-incisional and of
course the other is incisional.
Non-incisional means that little openings are made in the skin and stitches are placed
in a strategic way to engage the skin and attach it to a muscle called the levator muscle.
This is the muscle that lifts the eyelids and when it lifts, it folds the skin inward.
Incisional means that an incision is made and some skin is removed.
In addition, if there is extra fat then you address the fat in order to again engage the
skin with the muscle so it creates a crease.
Now that being said, I can tell you that most surgeons who do this who have experience will
basically have a shared idea of what the patient wants to have done and the fixation can be
relatively high in that it’s placed in the top of the backbone of the eyelid and it is
referred to as the tarsus and it can be slightly above that or just at the top part.
And when that fixation occurs, yes you can see just 2 millimeters of lid showing but
the skin has to be folded at a slightly higher place.
Now where it is folded is where the skin folds in but it doesn’t mean that’s how much
of the eyelid shows.
What it basically means is that it is where it is anchored to the skin.
Now how much skin overlaps, that’s the ultimate design so that when your swelling comes down,
the skin folds and overlaps.
That being said, it is extremely common for people to have significant swelling like yours
at this stage.
It is not unusual to have patients to be very conservative about the eyelid crease being
high and pre-operatively, I discuss this lot.
I always tell them it always looks very high in the beginning.
The swelling makes the eyelid crease looks high.
Now what I also do in my practice is I actually, after doing the drawing, we actually let the
patients review the process and understand and we’ll even take photos and show them
what my planned placement is, where will be this skin fixated so we are all in the same
page and we’ve communicated and we understand.
This way afterwards, there is a little swelling or a lot of swelling, we know what the final
outcome will most likely be.
So this question really is for you to bring to your doctor and your doctor is likely to
say, “Wait.” because right now, while your skin is swollen, no one can make a valid
prediction based on just the swelling and not knowing anything else about you prior
to surgery as well as the details and the actual surgery itself.
No one can ever tell you where that crease will finally settle and how much skin will
be overlapping but I think that you will be impressed at how that transformation can be
fairly significant in the course of a month to several months.
You can anticipate that you’ll have swelling not in the same level but swelling will be
present for months afterwards.
I always tell my patients that expect swelling until 4 to at least 6 months.
Technically, swelling can go on for over a year but socially speaking, a month later,
most people look pretty good and even a week after, people are able to go back to work.
And there are times especially with limited non-incisional procedures, patients look great
about a week.
So it is very individual and in your situation, most likely incisional procedure, you have
a fair amount of swelling and it is understandable why it so unsettling for you right now.
Contact your doctor and discuss this.
Make sure that you don’t feel like you don’t have any options but at least meet with your
doctor to discuss this and get a sense of what, where you are and really get an understanding
what your doctor’s design was and of course ultimately, you are going to wait to see what
happens.
So I hope that was helpful, I wish you the best of luck and thank you for your question.