Thank you for the question.
You submitted a question without submitting any photos but you are asking about a situation
which I think I can assist you with.
You describe in your question that you’re Asian and you have typically double eyelids
but there are times when you wake up a little bit more swollen and you end up having monolids
and it can last up to 2 weeks and you are looking for an understanding as to why this
happens.
Well, I can certainly give you some understanding of this based on my experience.
I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and
reconstructive surgeon.
One of my areas of specialty is Asian eyelid surgery both primary and revisional surgery
and I’ve been practicing in Manhattan and Long Island for over 20 years and I have done
a lot of different variations to help our patients achieve their desired look.
So I can say that you have a situation which is not that unusual and it comes down to basically
understanding some anatomy.
First of all, in terms of definition, a double eyelid or an Asian crease is basically something
that occurs in general around 50% of people of Asian descent.
And what that means is kind of a little bit of a fold where you see a little bit more
of the eyelid, from the eyelashes or the margin to the crease.
And then the opposite of that, the monolid, where you don’t see that crease and you
just see the top of the eyelid platform in a way where you don’t see a defined fold.
So what differentiates one from the other are attachments and these attachments are
anatomical attachments between a muscle called the levator muscle.
The word levator is like the elevator.
It’s the muscle that lifts your eyelids and this muscle has fibers that come over
it that attaches to the skin.
When somebody has a strong crease, it means they have a strong attachment.
And if somebody has some variability, well very often it is because they have multiple
fine attachments that are a little bit weak or they don’t have a strong or any attachment
at all but the crease they do see is actually just passive folding of the skin.
When I perform Asian eyelid surgery, there are basically 2 techniques: one is called
incisional surgery where an incision is made to remove skin and to address fat or non-incisional
surgery where little openings are made and the skin and the muscle are attached using
stitches.
In the end, either procedure is intended to engage the skin with the levator muscle to
create a more consistent, permanent connection.
So I think it will be reasonable to believe that in your situation, with puffiness or
waking up with some fluid, you can be may be straining some of those connections and
those connections are not strong enough to bounce back and create this consistent crease.
And I’ve had patients report that when they are a little more dehydrated, their crease
gets deeper which makes sense.
And in other situations, it could be just from allergies or sinuses or salt intake that
can make the eyes puffy and cause that crease to be less obvious.
Again, understanding the principles of Asian eyelid surgery should give you an idea on
why you have some variability.
Basically, it has to do with the anatomy of the muscle attaching to the skin.
If you have a stronger attachment, then even with swelling, the crease will still eventually
be a little bit stronger and you won’t be having this absence of crease for 2 weeks.
I think that something to explore is why you have swelling when you wake up and that’s
a little bit more unusual than it’s typical and why you don’t have that consistency.
If you are willing to have this constant double fold, then you may want to consider Asian
eyelid surgery.
We have patients who actually, before they had this procedure, that we put a little strip
of tape that are specially designed to create a crease just to see how they like that crease
and how it looks and then we work on deciding whether to make a nasally tapered fold and
a parallel crease something like that but it might be worth considering trying that
just to see how things work.
You may want to discuss this option of maybe doing something more permanent so that you
will have a more consistent look by meeting with qualified, cosmetic surgeons who do a
lot of eyelid surgery.
So again in summary, the fluid may be causing stretching or just a natural volume occupation
of this area so that the double fold doesn’t form or you just may have a situation where
this may be an opportunity to look into an Asian eyelid procedure if this is a desired
look that you want to be more consistent with.
So I hope that was helpful, I wish you the best of luck and thank you for your question!