Thank you for your question.
You stated in
your question that you’re 40-years-old, Korean female and you submitted several photos.
The first photo was at rest, the second photo with your eyebrows raised and the third photo
is smiling or facial expression. And you’ve gone to a couple of doctors and you have this
desire to look, what you want is the appearance of photo number 2. One doctor recommended
eyelid surgery, the other doctor recommended brow lift so you want to know which one is
correct. And then you go on to ask about the under eye area as well. So I will certainly
give you my impression based on the photos you submitted in the question you’re asking.
And I’ll help you distinguish what you can expect with either of these procedures.
A little bit of background, 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. I specialize in Asian eyelid surgery amongst many other things that we
do in our practice and this type of question does come up a lot. And so, I will distinguish
for you how I would interpret the desire that you have to look like photo number 2.
What appears to be the situation when you show photo number 2 is that I think what you
like is the impression of the shape of the eyes when your eyebrows are raised. So if
you look at the first photo, the eyelid skin is hooded a little bit more and that shape
of that hood dominates the appearance of the eyes. When you raised your eyebrows, the shape
of the skin that’s overlapping is shifted upwards and the eye shape has a different
appearance.
That being said, I would ask the question first is do you want your eyebrows higher?
And that’s a very important question. From my perspective, your eyebrows are at a natural
position and where they should be. I would respectfully disagree with the colleague who
recommends the eyebrow lift because it is my feeling that eyebrow lifts are often done
too aggressively and it results in people who have normal eyebrows looking like they’re
perpetually surprised. Now that’s an aesthetic judgement and aesthetic style.
If your goal is to really have that shape, that shape is somewhat achievable with eyelid
surgery. Now that means that you and the prospective doctor have to really agree upon how much
skin you would want to leave behind in order to get that shape. What I routinely do when
I speak to patients about Asian eyelid surgery is I use a simple instrument like a Q Tip
and I’ll fold the skin inward to show what the shape would look like. It is not uncommon
for people to want to have a conservative result with just a little bit of eyelid showing.
A lot of people want a well-defined double eyelid. Other people want a more subtle eyelid.
I think that if that is the goal, then you could probably achieve that goal with eyelid
surgery. Now when it comes to Asian eyelid surgery, the decision point is often based
on the desired outcome and then the presence or absence of excess skin, excess fat.
Generally, with someone who has a fair amount of skin but who wants a conservative approach,
I’ve been able to do this procedure with what’s called a non-incisional Asian blepharoplasty.
What a non-incisional Asian blepharoplasty means is basically little openings are made
in the skin, skin is not removed and the skin is anchored to the muscle called the levator
muscle. That means then when the skin folds at a higher place, I would suspect in this
situation you’re in now, the skin doesn’t really fold but rolls passively and therefore,
the rolling of the skin goes on top of the eyelashes and dominates the shape of the eyes.
If that skin was fixated a little bit higher, it would probably reveal the shape of photo
number 2.
The other option is, if there was the presence of excess skin, it’s called an excisional
or an incisional type of blepharoplasty. That means that an incision is made and some skin
is removed. Typically, it’s very conservative. It’s no more than a few millimeters. And
last but not the least, if there is any fat which from my impression from the photos,
it doesn’t look like you have, then fat can be addressed at the same time.
Now as far as the lower eyelids are concerned, yes, when you look at photo number one, there
appears to be fat pockets that are pushing forward. So, in a situation like that, with
your type of skin type, I generally do what’s called a transconjunctival blepharoplasty.
What that means is I go from the inside of the eyelid to reduce the fat pockets that’s
causing puffiness.
Now to address to address skin quality, which is part of what you are dealing with when
you show photo number 3, your skin is folding and you have some lines. Well, there are a
couple of ways to address that. One is to address the activity of the muscle which causes
those lines, the orbicularis oculi muscle. That’s a muscle around the eyes that causes,
when contracted when you smile, causes these lines often referred to as crow’s feet lines.
We treat that with Botox™ and that relaxes those muscles. We improve skin quality with
a combination of platelet-rich plasma (PRP) which is derived from your own blood and used
to stimulate the collagen. And basically, the goal is to improve the backbone of the
skin, the dermis of the skin so that the skin doesn’t wrinkle as much. Understand that
you’ll always have some wrinkling when you smile. It’s very natural and appropriate
but to kind of prevent the lines from being too deep especially when you are at rest which
we refer to as static lines, a program of Botox™ and skin quality improvement is certainly
an option.
In addition, there are thermal energy based devices that help tighten the skin. And usually
for someone who has Asian skin, I go towards the radiofrequency treatments such as what
we have in our office called Pelleve to help tighten the skin but that is dependent again
on where in the hierarchy of importance these concerns fall.
So I think it’s important that you have this discussion with your doctor and look
at yourself with your eyebrows raised. If you focus not only on the shape of the eyes
but at the shape of the whole facial expression or the appearance of the facial expression,
I think you won’t want to have your eyebrows that high up. If you do, then you should certainly
move forward with the brow lift but I think you’ll probably be, most likely better off
with the upper eyelid surgery as well as possible lower eyelid surgery
So I hope that was helpful, I wish you the best of luck and thank you for your question.