Asian Eyelid Surgery
About 50 percent of the Asian population lacks a natural fold just above the lashes in the upper eyelid. Depending on the aesthetics of your face, this single-fold structure can prevent you from having the bright, defined eyes you desire. Asian eyelid surgery is designed to address the unique needs of those with single folds to provide the facial appearance you want.
Asian Eyelid Surgery Techniques
Non-incisional Eyelid Surgery (DST – Double Sutures and Twisting)
This procedure relies on weaving a fine thread on the undersurface of the eyelid in order to have it crease at the desired location. Typically, the procedure works best on patients under age 25 who need no skin removed, have thin skin and little fat, and desire a crease on the smaller end of the spectrum. It also works best if both eyes are relatively symmetrical and have little ptosis (muscle weakness). While minor lid asymmetries and ptosis can be corrected, the results are less precise than an incision technique. It does not work well if you have had prior surgery, whether an incision surgery or multiple prior suture surgeries. The average longevity of this procedure is approximately seven years, in Dr. Lee’s experience. The advantages of this procedure are its short downtime, potential reversibility, and a very natural look.
Anchor Incisional Eyelid Surgery
This class of procedures gives the most flexibility to size, shape, and precision. It can correct varying degrees of asymmetry and muscle dysfunction (ptosis). The drawbacks are the slightly longer recovery period and the importance of finding an experienced surgeon, due to the long learning curve involved in getting a natural-looking result. Scarring is usually minor in non-smokers and patients who do not have healing issues. (Due to its thin nature, generally, the eyelid skin heals very well, even if other body parts scar easily.)
Frequently Asked Questions
What techniques are used in Asian eyelid surgery?
Asian eyelid surgery can be either incisional or non-incisional. Anchor blepharoplasty is an incisional method of creating a crease, giving the patient a double eyelid. To achieve this, the skin is cut, tissue is excised, and the skin is attached to a firm structure within the eyelid (tarsus, AKA tarsal plate). While many doctors simply attach the skin to the levator muscle, Dr. Lee prefers to additionally attach the skin to a deeper structure, the tarsal plate, along with the levator muscle. Whereas the levator muscle moves with the eyelid, the tarsal plate is static. Attaching the skin to both structures allows for greater precision when placing the crease and also reduces the possibility of fold failure. Medial epicanthoplasty, another incisional technique, is often used in conjunction to crease surgery to remove any excess inner fold skin (Mongolian fold) and allow the new eyelid crease to fold more smoothly.
The Double Suture and Twisting (DST) technique is a non-incisional method of creating a crease in the eyelid. Instead of being cut, the eyelid is simply stitched together. While the DST technique requires specific conditions in the patient to work to its full potential, it is an excellent technique for younger, qualified patients, as it is less invasive and involves less swelling and a shorter recovery than incisional techniques.
What are the limitations of DST suture-only surgery?
- 1. Small crease height. No skin is removed, so the crease will be smaller and more mobile than an incision technique. There is less control over the final size and shape.
- 2. Limited ptosis repair. If you have asymmetry of the eyes, and particularly if one eye is droopier than the other, there will be more limitation in how evenly the eyes can be matched up to each other. The resting tension of the eyelid-elevating muscle can be adjusted from the undersurface of the eyelid and incorporated into the DST procedure, but the correction is more difficult to control precisely, as can be done with an incision approach.
Can BOTOX® Cosmetic help with the excess forehead wrinkles and an angry look?
If the angry look is a by-product of having your upper visual field blocked, then you need to correct the eyelid surgically. BOTOX® Cosmetic will reduce the frown lines at the expense of dropping the brows and a return to a loss of your upper visual field.
My upper eye socket is hollow and my brows are very high. Why is this? Can I use fillers and BOTOX® Cosmetic for this?
Frequently, a retracted brow is caused by its attempt to help open a weak upper eyelid. This also creates an upper eyelid socket hollow. Correction requires adjusting the upper eyelid muscle tension and then repositioning the eye fat, which has been sucked up under the eye socket. BOTOX® Cosmetic will have the unwanted effect of drooping the eyelid; fillers will create a similar problem by making the upper eyelid heavier and burdening the already-weak eye muscle.
What types of eye anatomy are more difficult to operate on and at higher risk of a poor outcome?
Eyes that bulge forward are at risk for creasing at the wrong location. Similarly, patients with ptosis requiring correction at the time of crease surgery are also at risk for this. In these instances, there is not much clearance between the elevating muscle and the overlying skin. Therefore, the muscle can “catch” the upper lid skin as it is opening. For these reasons, very little fat should be removed for patients with at-risk anatomy. In some cases, fat grafting to the upper lid is necessary to create more distance between the skin and the moving muscle.
What is ptosis?
This is a droopy eyelid. The cause of this is related to either a weak eyelid muscle (which you are born with) or a detachment of the muscle from the tarsus (the cartilage skeleton of the lid margin), usually associated with aging. Ptosis, in Dr. Lee’s opinion, is more common in Asians, affecting as many as half the patients undergoing Asian eyelid surgery. Depending on the cause, the muscle needs to be reattached (if detached), or it needs to be strengthened/shortened so that the eyelid is in the proper position at rest.
Will I end up sleeping with my eyes open?
This is not likely to happen unless you have ptosis requiring significant shortening of your eyelid muscle. In many such cases of ptosis repair, the eyes will be able to close over time.
What techniques are used in Asian eyelid surgery?
What techniques are used in Asian eyelid surgery?
Asian eyelid surgery can be either incisional or non-incisional. Anchor blepharoplasty is an incisional method of creating a crease, giving the patient a double eyelid. To achieve this, the skin is cut, tissue is excised, and the skin is attached to a firm structure within the eyelid (tarsus, AKA tarsal plate). While many doctors simply attach the skin to the levator muscle, Dr. Lee prefers to additionally attach the skin to a deeper structure, the tarsal plate, along with the levator muscle. Whereas the levator muscle moves with the eyelid, the tarsal plate is static. Attaching the skin to both structures allows for greater precision when placing the crease and also reduces the possibility of fold failure. Medial epicanthoplasty, another incisional technique, is often used in conjunction to crease surgery to remove any excess inner fold skin (Mongolian fold) and allow the new eyelid crease to fold more smoothly.
The Double Suture and Twisting (DST) technique is a non-incisional method of creating a crease in the eyelid. Instead of being cut, the eyelid is simply stitched together. While the DST technique requires specific conditions in the patient to work to its full potential, it is an excellent technique for younger, qualified patients, as it is less invasive and involves less swelling and a shorter recovery than incisional techniques.
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What are the limitations of DST suture-only surgery?
What are the limitations of DST suture-only surgery?
- 1. Small crease height. No skin is removed, so the crease will be smaller and more mobile than an incision technique. There is less control over the final size and shape.
- 2. Limited ptosis repair. If you have asymmetry of the eyes, and particularly if one eye is droopier than the other, there will be more limitation in how evenly the eyes can be matched up to each other. The resting tension of the eyelid-elevating muscle can be adjusted from the undersurface of the eyelid and incorporated into the DST procedure, but the correction is more difficult to control precisely, as can be done with an incision approach.
Close
Can BOTOX® Cosmetic help with the excess forehead wrinkles and an angry look?
Can BOTOX® Cosmetic help with the excess forehead wrinkles and an angry look?
If the angry look is a by-product of having your upper visual field blocked, then you need to correct the eyelid surgically. BOTOX® Cosmetic will reduce the frown lines at the expense of dropping the brows and a return to a loss of your upper visual field.
Close
My upper eye socket is hollow and my brows are very high. Why is this? Can I use fillers and BOTOX® Cosmetic for this?
My upper eye socket is hollow and my brows are very high. Why is this? Can I use fillers and BOTOX® Cosmetic for this?
Frequently, a retracted brow is caused by its attempt to help open a weak upper eyelid. This also creates an upper eyelid socket hollow. Correction requires adjusting the upper eyelid muscle tension and then repositioning the eye fat, which has been sucked up under the eye socket. BOTOX® Cosmetic will have the unwanted effect of drooping the eyelid; fillers will create a similar problem by making the upper eyelid heavier and burdening the already-weak eye muscle.
Close
What types of eye anatomy are more difficult to operate on and at higher risk of a poor outcome?
What types of eye anatomy are more difficult to operate on and at higher risk of a poor outcome?
Eyes that bulge forward are at risk for creasing at the wrong location. Similarly, patients with ptosis requiring correction at the time of crease surgery are also at risk for this. In these instances, there is not much clearance between the elevating muscle and the overlying skin. Therefore, the muscle can “catch” the upper lid skin as it is opening. For these reasons, very little fat should be removed for patients with at-risk anatomy. In some cases, fat grafting to the upper lid is necessary to create more distance between the skin and the moving muscle.
Close
What is ptosis?
What is ptosis?
This is a droopy eyelid. The cause of this is related to either a weak eyelid muscle (which you are born with) or a detachment of the muscle from the tarsus (the cartilage skeleton of the lid margin), usually associated with aging. Ptosis, in Dr. Lee’s opinion, is more common in Asians, affecting as many as half the patients undergoing Asian eyelid surgery. Depending on the cause, the muscle needs to be reattached (if detached), or it needs to be strengthened/shortened so that the eyelid is in the proper position at rest.
Close
Will I end up sleeping with my eyes open?
Will I end up sleeping with my eyes open?
This is not likely to happen unless you have ptosis requiring significant shortening of your eyelid muscle. In many such cases of ptosis repair, the eyes will be able to close over time.
Close
Before & After Photos
Patient Testimonials
I wanted to take this time to express my deepest gratitude to your for the epicanthoplasty you did for my eyes. It takes such tremendous precision, skill and experience to do what you did and I am truly pleased with the results. Not only are you one of the world’s finest surgeons, you are also compassionate. I admire your keen eye and mastery as a surgeon…
