JENNIFER KIMBERLEY
Eyelid surgery has the tongue-twisting name of blepharoplasty. It’s a different surgery when performed on Asian eyes than it is when performed on Occidental eyes. Typically, Asians requesting eyelid surgery are in their teens or twenties, compared to Occidentals requesting it, who are usually in their forties or older.
That’s because on Occidentals, blepharoplasty is most often done to repair the stretching and drooping of age, whereas on Asians it’s done to make the eyes appear wider. Some doctors therefore consider “blepharoplasty” to be two different surgeries, and give it another name when it’s done for Asians: double eyelid surgery.
If you’re interested in blepharoplasty, contact an experienced plastic or cosmetic surgeon.
Anatomy of the Eye
The anatomy of the human eye is hard to describe without using a lot of specialized words that have to be explained. So for this article we’ll keep it simple and just say that the eyelid area consists of the eyebrow, the upper and lower lids, and the epicanthal fold, which is a piece of tissue draped over the inner part of the eye. In most Asians it’s quite obvious and in most Occidentals it’s almost invisible.
To summarize, the relevant physical differences between Asian eyes and Occidental eyes.
In Asian eyes:
- There’s typically less of a crease on the upper eyelid and sometimes none at all
- The epicanthal fold is larger
- There’s a thicker eyebrow fat pad that extends further down into the eyelid
- There’s a thicker layer of subcutaneous (below the skin) fat that gives a more padded look to the eyelid
- Eyelashes more often grow downwards, causing the open eye to appear more narrow
Eyelid surgeries
The earliest description of eyelid surgery ever published was in Japan in the late 1800s. And the most commonly requested cosmetic surgery today for Asians, both in Asia and in the U.S., is double eyelid surgery, which means creating a crease in both top eyelids so that the eyes will appear wider.
Asians request this surgery not to look more Occidental, but for other reasons, such as to look more emotionally expressive, to have more area for applying make-up, to look younger (from removal of fat padding), or to have eyes that look bigger and therefore more attentive and alert. And cosmetic eye surgeons mostly agree that all of us, regardless of race or culture, consider large eyes to look more youthful. After all, babies are born with big eyes, even baby animals, and we constantly see photographs featuring their adorable, fresh look.
Double eyelid surgery
Double eyelid surgery is usually done in a clinic or doctor’s office and takes about two hours including preparation and post-op recovery. Only local anesthesia is used and perhaps some sedation.
The incision is made about 7 mm above the upper eyelashes, across the lid, and then very small stitches are placed connecting the skin with the levator muscle. This is the muscle that opens the eye (cf elevator, levitate). In some patients, fat is removed also and perhaps some muscle tissue.
Discomfort lasts only a few hours afterwards. Swelling may persist for several weeks but bruising will be gone in one week. Sutures are removed after 4 or 5 days, or dissolving stitches may be used.
The new crease will settle into its final position after 6 or 8 weeks. But since usually a very small amount of swelling will remain for several months, the final new look won’t be established for about six months. There’ll be a scar visible at first, perhaps red and prominent, but as the six months progress, it will recede into the new crease and be barely visible. As tissues settle into their new positions, the eyelashes turn upwards instead of being pushed down as before.
Eyebrow lifts
Some patients who request double eyelid surgery are found, when the eyebrow is manually lifted, to already have a crease or partial crease at the top of the upper lid. In these patients, the eyebrows may be sagging, or they may be just naturally positioned low, and when they’re raised, the eyes appear larger. So double eyelid surgery isn’t necessary, just an eyebrow lift.
There are two ways of doing an eyebrow lift.
- An incision is made inside the hairline around the top of the forehead and some muscle tissue is removed. This releases the attached tissue, thus smoothing forehead wrinkles. The skin is pulled upwards gently, bringing the eyebrows up with it, excess skin is removed, and the remainder is redraped over the forehead and stitched. This method takes between 1 and 2 hours and is done with local anesthetic and sedation, or sometimes with general anesthetic.
- The second method is called an Endoscopic Browlift and is used on young patients who have no sagging or stretched skin needing to be removed. It uses a very small fiberoptic lens, inside an endoscope (hollow tube), and inserted through a small incision under the hairline. The lens has a camera attached to it, which in turn is connected to a television.
Another incision, or perhaps two, allows the cosmetic surgeon to insert tiny instruments, such as a scalpel for cutting tissue, and a retractor for pinning tissue back out of the way. As the cosmetic surgeon works, he can see his movements on the television screen. Frown wrinkles can be removed and the uplifted eyebrows make the eyelid crease visible, making the eyes look larger.
With this method, incisions are smaller, there’s less bleeding, numbness or scarring, and recovery time is shorter
Eyebrow lifts can be done in conjunction with eyelid surgery. When assessing the outcome, it should be remembered that eyelid surgery is really two surgeries, left and right. Each eye may respond differently, both in the short term with swelling and bruising, and in the long term, in the rate of healing and final appearance.
