Asian Blepharoplasty (“Double Eyelid” Surgery)



Asian Blepharoplasty (“Double Eyelid” Surgery)


Clyde H. Ishii





DEFINITION



  • Asian blepharoplasty or “double eyelid” surgery is a procedure to create a supratarsal fold.


  • The fusion level of the orbital septum-levator aponeurosis and dermal insertions result in naturally occurring supratarsal folds.


  • The incision height, amount of remaining upper eyelid skin, height of fixation, and levator function affect pretarsal exposure or “show.”


  • The shape of the desired fold varies according to patient preference.


ANATOMY



  • Tissue connections between the levator aponeurosis and pretarsal skin result in the formation of the supratarsal fold1,2 (FIG 1).


  • Caucasians and Asians with naturally occurring supratarsal folds have a relatively higher fusion level of the orbital septum and levator aponeurosis.3 In contrast, these structures fuse at a lower level in Asians with low or absent folds4 (FIG 2).


PATIENT HISTORY AND PHYSICAL FINDINGS



  • Ethnic differences must be considered when performing Asian blepharoplasty. Asian blepharoplasty is not simply Caucasian blepharoplasty applied to Asians. Asians undergoing this procedure want to enhance their appearance while maintaining their ethnicity. Most Asians do not want to end up with deep-set eyelids and tall supratarsal folds as seen in Caucasians.


  • Physical examination:



    • The upper eyelid is examined for asymmetry, ptosis, abundance of skin/fat, and scarring or previous incision sites. The presence of brow ptosis should also be noted because this will affect the final appearance.


    • The chosen height of the supratarsal fold is key to the final result and must be discussed in detail with the patient. Patients are interested in the final amount of pretarsal exposure or “show.” Most Asians prefer to end up with a pretarsal exposure of 3 mm or slightly less. Older patients and males tend to prefer a smaller amount of pretarsal exposure. Pressing a lacrimal probe or bent paper clip against the eyelid may simulate the desired pretarsal exposure (FIG 3).


    • The shape of the desired fold is also very important and must be discussed with the patient.



      • Medially, the fold may taper toward the medial canthus resulting in an “inside” fold5 (FIG 4).


      • Folds that run outside the epicanthus (“outside” fold) will result in more of a Western appearance5 (FIG 4). Some Asians prefer such an “outside” fold because it gives the illusion of a narrower intercanthal distance.


      • Most Asians prefer that the central third of the fold runs parallel to the lid margin.






        FIG 1 • Dermal attachments from the levator aponeurosis result in the formation of the supratarsal fold.







        FIG 2 • Asians with short or absent folds have a lower fusion level of the orbital septum and levator aponeurosis.

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        Nov 12, 2019 | Posted by in Aesthetic plastic surgery | Comments Off on Asian Blepharoplasty (“Double Eyelid” Surgery)

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