Asian Double Eyelid Surgery
By Ryan B. Tsujimura, M.D.
More than any other feature, Asians are identified by their eyes.
Among most ethnic groups in America, cosmetic eyelid surgery (technically known as blepharoplasty) is performed to reduce the signs of aging among people in their 40s, 50s and 60s.
But among many people of Asian ethnic groups, a very different type of blepharoplasty has become popular in the United States.
Double Eyelid Surgery
About half of all Asians have upper eyelids that appear to be taut and heavy from the eyebrow down to the eyelashes. That condition is simply known as a "single fold" eye. To create an eye that is more open and appears larger, many Asians request a cosmetic plastic surgery procedure known as "double eyelid surgery."
Even within Asian families, some will have single eyelids while others have eyelids with a crease above the eyelashes. Many patients requesting double eyelid surgery tell me they were often envious of their brothers and sisters with the double eyelid. For women, a double eyelid also means that makeup goes on easier and looks better. Others simply enjoy having a more open, slightly larger eye with eyelashes that are easier to see.
Many prospective patients say a single eyelid makes them look sleepy or tired and that it makes their eyes look too small. Most Asian patients don't want to change the natural almond shape of their eyes, but just have eyelids that are less heavy looking, with brighter eyes.
Asian Eyelid Surgery
Double eyelid surgery is extremely popular in most Asian nations and has been performed for many decades, long before the infiltration of Western media and before Hollywood movie stars became popular there. In fact, the first such double eyelid operation was reported in Japan in 1896.
Youth and Vigor
“About half of all Asians have upper eyelids that appear to be taut and heavy from the eyebrow down to the eyelashes. ”
The procedure is currently extremely popular among Asian movie stars because a larger, more open eye is a sign of youth and vigor among all nationalities. Consequently, many Asian patients requesting the procedure are in their teens, twenties, and thirties. Plastic surgeons have several methods available to create a double eyelid, with each offering its own advantages, depending on the patient's anatomy and wishes.
To perform the procedure, the surgeon removes some skin and fat from the upper eyelid along with a small amount of muscle tissue. The edges of the incision are then carefully sewn back together. Indeed, in some procedures, it is the sutures themselves that create the crease in the eyelid.
But the procedure does not stop with just the eyelid. Before the surgery starts, the surgeon must pay very close attention to a structure on the eye known as the epicanthal fold. That is a web of skin overlapping the corner of the eye where the eyelid meets the nose. Depending on how pronounced the epicanthal fold is, it may look like the edge of the upper eyelid meets the nose and then travels a little way down the side of the nose in a curving arc.
“Plastic surgeons have several methods available to create a double eyelid, with each offering its own advantages, depending on the patient's anatomy and wishes.”
Eyelid Surgery Scars
If the patient asks for it, the surgeon can soften the appearance of an especially prominent epicanthal fold. But the surgeon must be absolutely sure what the patient wants because if the epicanthal fold is softened too much, a rounder eye is created. And if too much tissue is taken from that fold, the scars can be difficult to hide. Most surgeons consider the procedure a challenge because the epicanthal folds lay over the tear drainage canals.
Double Eyelid Surgery
The surgeon must also take a careful look at older patients' eyebrows. If the eyebrows are heavy and sagging, creating a double eyelid will not help the eye to look more open. So, both a double eyelid surgery and an eyebrow lift must be performed in some cases.
“Post-surgical discomfort is very mild; many patients find that Tylenol is adequate, although they have recourse to stronger pain killers.”
Double eyelid surgery is usually performed under local anesthesia with I.V. sedation. The patient's eyelids are completely numb during surgery so that he or she senses only a little pulling and pressure. General anesthesia is not helpful because the surgeon must ask the patient some questions -- and receive clear answers -- during the procedure. A surgeon trained and experienced in the double eyelid operation usually needs about an hour to perform his work. Afterwards, the patient rests for about another hour in recovery.
Eyelid Surgery Recovery
Post-surgical discomfort is very mild; many patients find that Tylenol is adequate, although they have recourse to stronger pain killers. Sutures are removed on the fourth or fifth day; most bruising is gone after a week while vigorous exercise should be delayed for about ten days.