The desire for a double eyelid fold or eyelid crease drives the overwhelming popularity
of Asian eyelid surgery.
Asian eyelid surgery does not describe only one type of surgery.
The term Asian eyelid surgery can include procedures for any one of the following:
A young person who lacks a fold and wants a double eyelid fold
A middle aged or older person with sagging skin and fat pockets
An individual with drooping eyelid caused by a weak muscle usually referred to as “ptosis”
Someone who has a fold of skin covering the inner corner of the eyes called the epicanthal
fold who wants the eyes to appear larger and show more of the inner corner of the eyes
In the next few minutes, I will discuss how I evaluate and plan with my patients the shape
in double eyelid surgery.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I have been performing non-incisional and incisional double eyelid surgery throughout
my career, as well as epicanthoplasty and eyelid ptosis surgery for patients of Asian
descent.
I am known for my natural looking aesthetic style with eyelid surgery, as well as my methods
to achieve shorter healing time with less post-op swelling.
People who come to see me for consultation are concerned about how their eyelids and
crease will look like after double eyelid surgery.
In particular, they express their interest in looking natural after surgery.
So,I show them how their body would naturally have had an eyelid crease.
I do this by using a Q-Tip or an instrument to lift the eyelid skin to create a fold to
revealing what the eyelid crease can look like after surgery.
The anatomy of the eyelid is important to understand.
The backbone of the eyelid is called the tarsus and this structure is used to determines where
the eyelid crease would naturally be and is important when surgery is performed.
In addition, the muscle which lifts the eyelid called the levator muscle is very important
in defining the eyelid crease.
When a natural crease is present, there are connections between the muscle and the skin.
In Asian double eyelid surgery, whether I use the non incisional or incisional method,
a connection is made with sutures to create a crease.
The simulated eyelid crease also helps me determine whether the crease would be naturally
tapered downward toward the inner corner eyelid fold or epicanthal fold resulting in a nasally
tapered crease.
If the eyelid skin at the crease runs parallel until the skin blends toward the nasal bridge,
this is called a parallel crease.
Some people come and see us with pictures of their favorite celebrities’ eyes, and
want that shape for their own eyes.
This provides an opportunity to help my patients understand the anatomical aspects that determine
eye and eyelid shape.
These include bone structure, the presence of fat, the amount of skin present, the soft
tissue, and the relative prominence of the eyes.
Of course, So it’s important recognize the limits the anatomy which if compromised can
impact the health of your eyes.
As with any eye cosmetic procedure, health and function of the eyes must never be compromised.
I do discuss how the procedure I perform can result in something comparable to the celebrity
but is unique to the patient.
There are two primary objectives of double eyelid surgery.
The first is to turn a single eyelid fold, also known as a monolid, to a double eyelid
fold, commonly referred to as double eyelid.
The second objective is to make the eyes look bigger and more open, which adds a look of
vibrancy and vitality to the whole face.
Having eyes that look bigger is not just a sign of beauty in Asian cultures, but among
all ethnicities and cultures.
When someone questions whether these procedures conflict with ethnic character, I respond
with an explanation where I explain that the procedure being performed makes the eyes look
bigger by revealing the true shape of the eyes.
Before the procedure, the fold effectively defines the shape of the eyes.
After the procedure, the eyes true shape is revealed which shows the beauty of Asian eyes.
After I show my patients where the eyelid crease would be naturally placed, measurements
are taken, and assessment of any extra fat or skin is done.
Measurements are important to determine where incisions are made and how extra skin can
be removed if necessary.
Excess fat above the eyelids is also assessed as the presence of fat can affect the formation
of the crease.
Generally speaking, little to no fat is removed.
For non incisional surgery, strategically placed marks are placed where small openings
will be made to engage the skin with the levator muscle.
During the actual surgery, patients are routinely give LITE IV or intravenous sedation followed
by some local anesthetic.
This approach allows for my patients to recover comfortably and walk out of our office without
difficulty.
I prefer this approach over putting patients under general anesthesia which often results
in more swelling, longer recovery and other issues such as postoperative nausea and vomiting.
In situations where there is no redundant (or extra) eyelid skin, and no excess fat
above the eyelids, which is common in younger patients, I usually choose to perform the
non-incisional method of double eyelid surgery.
This method involves making small openings in the eyelid skin to pass a suture through.
The sutures are placed to create a connection between the eyelid skin, and the muscle that
lifts the upper eyelid called the levator muscle, like word elevator without the letter
“e”.
The connecting points between the eyelid skin and the levator muscle causes the skin to
fold, and this fold is where the eyelid crease forms.
If there is extra fat above the eyelid preventing the crease from forming, and excess eyelid
skin that partially covers the eyes, then I would perform incisional double eyelid surgery.
Excess skin is precisely measured to the millimeter before a thin strip of skin is excised.
Through this approach, some fat is removed when needed.
Sutures are then placed to close the incision and to engage the eyelid skin to the levator
muscle to establish the eyelid crease.
Post-surgical swelling occurs in varying degrees after the procedure.
To manage swelling, patients are advised to use cold compresses for the first 2 days.
After 2 days, patients are encouraged to be more active to help the circulation clear
the swelling.
War compresses may also be used to increase circulation, and to allow fluid causing the
swelling to clear.
Sutures for incisional surgery are removed after a week.
The early recovery period after double eyelid surgery is a time for many patients to be
concerned since temporary swelling can make the eyelid creases appear too deep, and too
high.
It’s important not to panic about results during this time and to allow the healing
process to transpire.
Swelling resolves differently in patients, anywhere from several days, to a few months.
Total surgical healing can take up to year, but with advanced healing techniques, the
eyelids can be pretty close to the final results in just a few months, and even sooner in many
patients.
I follow my patients progress two weeks after surgery, then at one month, then at three
months.
When can you go back to work: Patients normally return to work in about a week after surgery,
but active healing and resolution of swelling still continue past the one week point.
When can you look good for an event: I’ve had patients look pretty close to their final
results in as little as 10 days, but healing that quickly is too difficult to predict.
While swelling may still be present, most of it should resolve in the first 1-2 months.
Generally, I expect appearance to by close to the final appearance around 6 months.
If a patient has a history of allergies, sinus problems, smoking or other circulation issues,
swelling can persist longer than is typical.
In the first 2 days after the surgery, cold compresses help decrease the initial swelling
after surgery.
After the first 2 days, the clearing of swelling depends on the amount of swelling and circulation.
I encourage my patients to be up and about walking, talking and smiling and if they’re
planning to be more sedentary, warm compresses can helpful.
Double eyelid surgery is a highly effective and successful procedure for Asians who are
interested in having an eyelid crease with brighter looking eyes.
It is important to understand that your individual anatomy determines how I design and create
a naturally appearing eyelid crease that suits your unique facial character.
Look for a cosmetic surgeon with extensive experience with Asian eyelid surgery, and
make sure you have a proper evaluation with an understanding of the anticipated outcome
for your eyes prior to any surgical procedure.
I hope you found this information helpful...thank you for your question