Asian double eyelid surgery.
What type of procedure should I get?
Can I get fillers for the hollowness at my eye socket?
I was born with double eyelids.
I am now 50 and my eyelid has drooped, making my double eyelid almost nonexistent.
In the second photo my eyes are semi-closed and you can see where the line is.
However with my eyes fully opened in the first photo, my double eyelid is not visible at
all.
What procedure(s) do I need to fix this?
In the photos you can also see the hollowness at my eye socket.
Could I get fillers there?
This is my first time asking for advice so I appreciate your time and help.
Thank you for your question!
You’re 50 years old and you articulated in your question that you’re born with double
eyelids but now your eyelids have drooped.
And you asked a series of questions regarding hollowness and filler and what would be a
strategy for you.
Well, reviewing those photos, I can certainly tell you one thing that appears to clear to
me about your eyelids.
And that is you appear to have something called ptosis.
Ptosis means drooping and we talk about eyelids that have drooped, we call that eyelid ptosis.
So, what is ptosis mean?
Well, typically when someone has a drooping eyelid as they get older, as long as there
are no other neurologic basis for the ptosis, it is typically called levator aponeurosis
ptosis or levator muscle attenuation, involutional ptosis.
They used to be called senile ptosis but terminology changed to involutional.
Basically, it means that the muscle that is responsible for lifting the eyelid becomes
thinner and eventually stretches and the eyelid level and height droops down.
So you could imagine if you have some traditional cosmetic surgery, whether it’s blepharoplasty
or any other surgery to enhance the appearance of the eyes, if the ptosis is not addressed
then there’s not much likely you will have a significant improvement because if the eyelids
are low, you’re still going to be looking like your tired.
So I would probably suggest doing the ptosis procedure first before you address the relative
hollowness of your upper eyelids.
So the ptosis surgery, I’ll let you know how we do that in our practice.
When we do ptosis surgery, we do this in our office, in our Joint Commission operating
facilities and we do the surgery with the patient under local anesthesia with LITE sedation
and ptosis is a relatively deceptively complex procedure.
It’s a muscle that’s very sensitive.
And so what we actually do is we let the patient open and close their eyes while they are lying
down and we would actually let them sit up.
Now the patient doesn’t feel any pain and is perfectly fine and comfortable but we are
actually able to adjust the height, shape and contour to try to make sure that you get
the correction and symmetry.
It’s something that we find that more than 95% of our patients get a really nice result.
Some people still need to come back for some type of revision whether the eyelid is too
high or too low.
So that’s something to learn if that’s the first time you’ve been told that you
have ptosis.
The other thing is as far as the hollowing is concerned, now this is very common.
When we think about Asian eyelid aging, you can have very full eyelids when you are young
and in a way, it’s almost comparable to the way there’s volume loss in the breast.
What happens in the breast is that you can get upper pole deflation.
You lose the fat and the volume at the upper pole of the breast and it diminishes.
Well, similar things happen in the upper eyelid.
It actually also happens in the mid face.
The little cheek areas and submalar space, the volume diminishes and the face gets flatter.
In the upper eyelids and a lot of Asian eyelid patients who had very full upper eyelids when
they were young, they become relatively hollowed.
So usually, my advice is not to be too aggressive about restoring volume in the upper eyelids.
This also applies to Caucasians or people who used to have full upper eyelids.
We said, they never had much of a lid and barely wear make-up and they’re fine, they
like that look.
But as they got older, they have extra skin and they try first to use fillers and try
get fat transfer and ends up having bagginess and excess and it doesn’t look very good.
It’s almost as if they have to embrace a new normal in order to move forward and try
to add some predictability.
In some patients, we have been very successful in using a hyaluronic acid filler to restore
some volume conservatively in the sub brow space to restore a nice natural appearance
that they’re satisfied with.
It’s not the same as what they had when they were younger but it looks more like them.
In other patients, we actually use fat but with fat, I always tell my patients that it’s
a graft and because anywhere from 30 to 70% of that fat can be absorbed, be prepared to
do a second procedure.
So in a situation like yours, I would probably address the ptosis first, allow everything
heal and see if you’re happy with just the ptosis correction.
Ptosis can have dramatic impact on the physical appearance of the eyes and you can really
look aesthetically better that the hollowing would not become so much important to you.
So in summary, consider the ptosis procedure as your first procedure, allow it to heal
and consider less invasive options such as hyaluronic acid filler and possibly fat transfer
or fat grafting to address the relatively hollowing.
So I hope that was helpful, I wish you the best of luck and thank you for your question!