my double eyelid is sometimes a monolid what causes this a double eyelid or an
eyelid crease occurs in about 50% of people of Asian descent this is a
situation where a little fold occurred so you see more of the eyelid from the
eyelashes to the eyelid crease this is in contrast to a monolid where you don't
see a crease or a defined fault patients have come in with one double eyelid on
one eye and one monolid on the other eye or having an intermittent crease meaning
that sometimes they had a monolid and other times a double eyelid this
variability and eyelid crease stability is not unusual the explanation for this
Island behavior is found in the underlying Anatomy and other factors
I'll discuss how I approach this with patients who come in with concerns about
eyelid creases that come and go I'm Dr. Amiya Prasad 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 one of my areas of specialty is Asian eyelid surgery for both primary
and revisional surgery I have a lot of experience performing asian
non-incisional and incisional eyelid surgery as well as other procedures such
as ptosis surgery and epicanthoplasty what differentiates a double eyelid from
a monolid are the anatomic attachments between the levator muscle which is
responsible for lifting your eyelids and the connections to the eyelid skin the
levator muscle has fibers that attach to the skin when somebody has a defined
eyelid crease it means that these fibers have a strong attachment and if somebody
has a less defined eyelid crease often it is because they have multiple fine
attachments that a little weak or they don't have any
attachment at all and all they see is passive folding over of the skin which
results in a monolid sometimes people can wake up with puffiness or fluid
around their eyes and this can obscure these weak levator muscle connections to
the eyelid I've had patients report that when they're a little dehydrated their
crease gets deeper in other situations the sudden absence of an eyelid crease
could be associated with allergies sinuses excess salt intake essentially
anything that makes the eyes puffy and cause this crease to be less defined
this may be a cosmetic concern for many people because of the difference between
the two eyelids can make their features look asymmetric or even make one eye
look bigger than the other to address this concern of uneven eyelids due to a
weak levator muscle connection Asian double eyelid surgery can be done when
performing this procedure there are two techniques that can be employed the
incisional technique where incision is made on the eyelid to remove skin and
address fat that's preventing eyelid crease formation or the non-incisional
technique where small openings are made on the eyelid through which stitches are
passed in order to connect the skin and the muscle regardless of whichever type
of method is done the basic principle of this procedure is to achieve a double
eyelid fold by creating a strong connection between the skin and the
levator muscle in order to create a natural-looking double eyelid I take
into account factors such as age gender skin thickness skin quality skin
quantity fat volume how well you've healed from past procedures and your
bone and soft tissue anatomy around the eyes
based on this information I make recommendation for either the incisional
or the non-incisional method if there is extra skin and fat present in the upper
eyelid and incisional approach is performed after creating a design for
the skin to be removed the surgery is
performed and in addition to the skin that's being removed it's common to
remove a small volume of fat to help establish an unobstructed connection
between the levator muscle and the eyelid skin it's critical to avoid
removing too much skin or fat as it could lead to complications such as
hollowing or eyelid retraction if there is no excess skin or fat present which
is often the case in many younger patients I do the non-incisional method
in this approach I use a Q-tip or an instrument to create a crease which
looks natural and place marks where I need to pass the sutures the sutures are
passed through small openings to attach the upper eyelid skin to the underlying
levator muscle this will result in the eyelid skin folding in when the eyes are
open the approximate time for incisional upper eyelid surgery is about one hour
it's shorter for non-incisional surgery all procedures are done at our certified
operating facilities under local anesthesia with intravenous or IV
sedation our patients are comfortable and really appreciate avoiding going
under general anesthesia a week following asian eyelid surgery sutures
are removed for incisional surgery in both incisional and non-incisional asian
eyelid surgery the eyelid crease can look a little bit high in the first few
weeks to months due to swelling between the crease and the margin this swelling
continues to improve and it's usually not an issue as far as going back to
work or social activities practically speaking having a variable eyelid crease
is addressed by creating a connection between the levator muscle and the
eyelid skin if you're ready to consider asian eyelid surgery I recommend you
meet with the qualified experienced eyelid surgeons who have a lot of
experience with Asian eyelid surgery a proper examination will further reveal
any other issues that can potentially be of benefit
I can tell you from experience that Asian eyelid surgery patients have been
consistently satisfied with their outcomes as they feel confident about
revealing the true shape of their eyes while retaining a natural Asian
appearance I hope you found this information helpful thank you for your
question
you