What’s the big deal about double eyelids?
The “Asian eyelid” (or “single eyelid”) refers to the characteristic absence of the upper eyelid crease in people of East Asian descent. This crease is known as the supratarsal or double eyelid fold, and is almost universally present in Caucasian eyelids.
Asian double eyelid surgery is one of the most popular cosmetic operations performed throughout Asia. It aims to:
- Create a stable, natural double eyelid fold, making the eyes appear bigger and brighter.
- Remove redundant skin and eliminate smaller, unstable folds in the eyelid skin.
- Conservatively remove of some of the fat behind the eyelid, resulting in the eyes look less puffy.
Eastern Plastic Surgery’s Mr Frank Lin has answered some common double eyelid surgery questions below.
How does the surgeon create a double eyelid fold?
Anatomically, the absence of the double eyelid fold is due to a lack of connecting fibres that extend from the deeper muscle layer of the upper eyelid (called the levator aponeurosis) to the upper lid skin.
Creating this connection is the basis of all methods of Asian eyelid surgery. Different methods include an open incision technique, buried suture technique and other variations in between such as the 3 point and 5 point techniques. While the principle is the same, there are significant differences in how the double eyelid fold is achieved.
What is the difference between these surgery methods?
Closed (or partially closed) methods such as the 3 or 5-point techniques will often blindly stitch skin onto the underlying eyelid structures. While this does create a fold, it relies on a single layer of sutures and so can be unstable and give the unnatural appearance of a hard, fixed eyelid fold.
Mr Lin prefers an open technique which creates a “dynamic” double eyelid fold. This requires at least two layers of sutures, creating a separate “glide” plane between the strong fixating sutures below and fine skin sutures above. This allows the new double eyelid fold to glide subtly as the eye looks up and down – perfectly mimicking the natural eyelid movements of someone born with a double eyelid fold.
What will my new eyelid fold look like?
It is important during the consultation to have an in-depth discussion about the height, length and shape of your desired double eyelid fold. From Mr Lin’s point of view, it is also important to ensure these desired goals result in a double eyelid fold that not only looks natural but also complements your overall facial harmony.
One of the most important discussions relates to the shape of the fold, which may be either parallel or tapered to the eyelid margin. While this is largely a matter of patient preference, there are limitations that may be associated with your individual characteristic (such as whether an epicanthal fold is present).
Mr Lin will provide both a careful analysis and realistic recommendation based on your individual characteristics and preferences. You will also be shown a large number of case photos to demonstrate what can be achieved and establish what is most suitable for you.
Which technique would I be most suitable for?
While Mr Lin’s open double layer technique is suitable for patients of all ages, a careful assessment will be made for each patient during their initial and subsequent consultations to formulate an individual surgical plan.
The closed suture or 3 point techniques are suitable for a very small group of younger patients who have less skin redundancy. A careful assessment is required to ensure that the patient is fully aware of the limitations of this technique.
What is an epicanthoplasty?
The majority of East Asian patients have a fold of skin at the inner corner of the eye called an epicanthal (“Mongolian”) fold. The severity of this fold differs significantly between individuals. In some patients, the severity of the fold can limit the ability to create the desired shape or height of a double eyelid fold. In these cases, an epicanthoplasty may be the solution.
Whether to proceed with epicanthoplasty at the time of surgery or a later date is an individual choice and can be associated with some limitations, especially with respect to the length of the scar. Once again, this requires a careful analysis at the time of the consultation.
In Part 2 of this series Mr Lin will outline the practical issues of double eyelid surgery, including preparation, recovery and scar management.