Eye surgery
Eye surgery
The eyelid creases are a unique characteristic that differs among individuals. Double eyelids are characterized by an observable fold on the outside, whereas single eyelids or monolids lack such creases. The formation of double eyelids is determined by genetics, and those without them may opt for surgical procedures to create them for either cosmetic purposes or to resolve vision obstruction caused by the absence of eyelid creases.
The morphology of eyelids in Asian individuals is highly diverse, with varying arrangements of internal structures, presence of epicanthal folds, and organization of fat pads that all contribute to unique eye shapes. One prominent feature that differentiates Asian eyes is the presence or absence of a supratarsal crease, which has led to the increasing demand for double eyelid surgery. To better categorize Asian eyelids, they have been grouped into three primary categories, each containing two subcategories.
Subtype A - There is a single eyelid with no visible lid crease
Subtype B - There is a low eyelid crease, which is mostly hidden and is tapered toward the nose
Subtype A - Infold type: The supratarsal crease height is lower than the epicanthal fold
Subtype B - On fold type: The supratarsal crease height meets or is on the epicanthal fold
Subtype A - Outfold Type 1: The height of the eyelid crease is superior to the epicanthal fold
Subtype B - Outfold Type 2: There is a double eyelid crease, but no epicanthal fold is present
The morphology of eyelids among Asian individuals is highly diverse, with unique eye shapes resulting from the arrangement of internal eyelid structures, presence of epicanthal folds, and fat pad organization. The absence or presence of a supratarsal crease is a significant factor that has increased the popularity of the double eyelid procedure among Asians. Eyelid categorization among Asians is done based on three primary categories, with each category having two subcategories.
Genetic conditions, such as Down Syndrome, can cause people of any ethnicity to have more prominent epicanthal folds.
It is a common misconception that people of European descent typically have double eyelids while East Asians have monolids. This is an oversimplification as studies show that half of the Latino participants in one research had monolids or epicanthal folds. Heavy or "hooded" eyelids are also common among many people worldwide, regardless of their ethnicity.
A double eyelid is defined as an upper eyelid with a crease or fold, which is a dominant gene and is more likely to be expressed compared to the recessive monolid gene. In many Asian cultures, double eyelids are associated with attractiveness and beauty.
Individuals with a single eyelid often seek ways to create double eyelids. Fortunately, there are various treatment options available that can be customized to achieve desired goals. These options range from surgical to nonsurgical interventions.
The major reasons why people opt for double eyelids include;
Both incisional and non-incisional blepharoplasty require similar preparations in the operating room. The pre-operative preparation involves marking the eyelids in an upright position to visualize the final gravitational position. This is then evaluated in the supine position. The proposed supra-tarsal crease is drawn from the medial to lateral canthus at the patient's desired height, and symmetry is assessed in both positions before proceeding to sterile preparation.
A corneal shield and local anesthetic are applied to the upper eyelids, and the procedure can be performed with or without intravenous sedation. Suture material selection for the procedure is primarily based on the surgeon's preference, as few clinical or animal studies have been conducted to assess the efficacy of various suture types in facial surgeries.
Blepharoplasty is a type of eyelid surgery that plastic surgeons recommend to address various issues, including:
Asian blepharoplasty refers to plastic surgery aimed at creating double eyelids. This outpatient procedure involves forming a fold, or upper eyelid wrinkle, in patients who do not have one.
Epicanthoplasty is another procedure that may be combined with blepharoplasty. It involves removing excess skin at the inner corner of the eye, known as the epicanthal fold. This excess skin can hinder the natural formation of an outfold crease, which is why its removal may help in forming a natural crease without tension or scarring.
The first reported "double eyelid operation" was performed by Mikamo in 1896. Although this cosmetic procedure is commonly associated with an attempt to achieve a more "westernized" appearance, the first description of double eyelid blepharoplasty predates the western influence on Asian culture. Therefore, Mikamo's development of double eyelid surgery is believed to have been motivated by a desire to achieve a more aesthetic, round-eyed, and expressive appearance.
Double eyelid surgery can be performed for both cosmetic and functional reasons. On the cosmetic side, someone may opt for eyelid surgery because they prefer the appearance of double eyelids over monolids. Alternatively, they may choose the surgery because the natural loss of collagen and elastin in the skin with age has caused the eyelid skin to droop, obstructing vision. In such cases, eyelid surgery may be used to correct the drooping eyelid(s) and prevent vision problems.
It is important to note that double eyelid surgery is not suitable for everyone, and several factors need to be considered before deciding to undergo the procedure. These include:
It's important to keep in mind that an exaggerated height of the eyelid wrinkle added during surgery can appear unnatural. Therefore, discussing your eye form, facial structure, and surgical goals with your plastic surgeon beforehand is crucial.
Blepharoplasties are generally considered safe outpatient procedures because the majority of the physical side effects are transient. Consider the following disadvantages of this procedure:
Blepharoplasty is not reversible, and double eyelid surgery can be quite costly. If you decide to have your eyelids surgically altered for cosmetic reasons, you must be certain that this is what you truly want. It's important to wait until you are old enough to make your own decisions.
Although blepharoplasty can help with eyelid problems that cause vision issues, it's crucial to remember that both double and monolid eyelids are normal and healthy. If you want to undergo cosmetic surgery, consult with your doctor and possibly a trusted friend or mental health counselor to ensure that you are doing it for the right reasons.
Your plastic surgeon will help you determine the appropriate surgical procedure based on your goals, face shape, other medical conditions, and recovery time.
Asian double eyelids can be achieved through a variety of procedures, including:
This involves making an incision in the upper eyelid and removing tissue. This approach is nearly painless and allows for a more personalized outcome, as well as the removal of wrinkles on the eyes.
The skin of the upper eyelids is the thinnest in the body, so any scars resulting from the surgery are barely noticeable and only visible when the eyes are completely closed. Plastic surgeons who perform this procedure may use small sutures that dissolve in about six or seven days and do not require removal.
In this technique, the plastic surgeon creates small holes and uses three buried sutures to create an eyelid crease. This approach is suitable for people who want a quick recovery without any scars. However, the double eyelids may fade over time, and the lids may return to their natural state.
This involves placing six sutures through the lid and stabilizing them using beads to prevent them from cutting through the skin. After the double eyelid scar forms, the sutures are removed a few days later.
This is the least invasive option, but it does result in a lot of inflammation, which is necessary to form the double eyelid scar. Although this procedure does not require any cutting or incision, it takes the longest to recover due to postoperative swelling.
Recovery time after eyelid surgery can vary from person to person depending on the approach used. Incisional blepharoplasty may leave a scar, but patients who undergo non-incisional blepharoplasty may experience more persistent swelling and irritation after the procedure.
The recovery time for double eyelid surgery largely depends on the type of surgery performed. With incisional procedures, sutures are inserted and may need to be removed after a few days. Initial recovery generally takes around two weeks, while complete recovery can take several months.
For partial incision and non-incisional procedures, patients can expect to recover after surgery in about two weeks. However, individual recovery times may vary, and it's important to follow your surgeon's post-operative instructions carefully to ensure a smooth and successful recovery.
After your eyelid surgery, your plastic surgeon will provide you with detailed aftercare instructions. These instructions will include ways to manage pain and discomfort, as well as tips to ensure proper healing.
Asymmetric and excessively high folds are among the most common complications of double eyelid surgery. Asymmetrical eyelid height or shape can occur in up to 35% of cases and may result from differences in preoperative marking, unequal tension during supratarsal fixation, or uneven amounts of fat excision.
Excessively high folds occur in approximately 7% of patients and can be caused by adhesions between the orbicularis and skin above the surgical fixation level or excessive removal of preaponeurotic fat pads. Ideal eyelid crease position should be around 6 to 8mm above the lid margin. It is essential to consult with a plastic surgeon to determine the best surgical approach and minimize the risk of complications.
Blepharoptosis is a potential complication of Asian blepharoplasty, caused by inadvertent injury to the levator palpebrae superioris muscle and its aponeurosis. This can result in drooping eyelids following surgery. Separation of the levator from the tarsal plate or excessive fixation of the aponeurosis to the muscle can lead to scarring and impaired function of the levator, contributing to blepharoptosis.
Hemorrhaging is a potential hazard associated with any surgery, which can vary from long-lasting ecchymosis to large hematoma. The incidence of bleeding in blepharoplasty is similar to that in all ethnic groups.
In some cases, patients may experience a recurrence of skin laxity and a loss of the double eyelid crease over time. This is a rare complication and occurs in less than 3% of cases. It is more common when using absorbable sutures or the suture ligation technique because the anchoring suture weakens, and there is a failure of adhesion between the levator and muscle or dermis. This can be prevented by debulking orbital fat or using suturing techniques to strengthen the levator-dermal junction and the tarso-dermal junction during crease formation.
Everted or upturned eyelashes are a common problem among people with an epicanthal fold, which is more common in Asians and can lead to trichiasis. The creation of a double eyelid can help with cilia eversion, but it's important to follow proper preoperative planning and postoperative care to prevent the upper lid eyelashes from inverting and exposing the palpebral conjunctiva.
Dry eye symptoms may be aggravated or caused by the creation of a double eyelid, as discussed in the preoperative evaluation section. In individuals without an eyelid crease, ptosis can be protective against the onset of dry eye. Therefore, it is essential to evaluate patients for the development of these complications during the preoperative period.
Ectropion is a potential complication of Asian blepharoplasty that can occur when there is damage to the facial nerve branches during surgery. It can result in impaired orbicularis oculi muscle function and a change in the position of the lower eyelid margin. Excessive tension on the eyelid levator can also cause ectropion, which may happen when the inferior skin flap or incision of the levator is misplaced. It's essential to be aware of these risks before deciding to undergo Asian blepharoplasty.
For those who are not willing to undergo surgery to achieve double eyelids, there are temporary options available. They include;
Eyelid tape
Eyelid glue
Complications may arise during the recovery period of your blepharoplasty, as with any other surgical procedure. It's essential to monitor your health and notify your doctor if you experience any concerns.
Your doctor may prescribe pain medication after the procedure. If you are still experiencing pain even after taking the medication, contact your doctor immediately. While a little dryness in the eyes is normal, excessive dryness should be reported to your doctor.
It's essential to watch out for any potential complications during your recovery from eyelid surgery. Seek medical attention right away if you experience any of the following:
Additionally, if you notice any signs of infection such as swelling, warmth, redness on your eyelid or the area surrounding it, red streaks leading from the incision, pus draining from the incision, or fever, seek immediate medical care.
Double eyelids are a characteristic determined by genetics, with single eyelids being a common recessive feature. However, in many Asian societies, double eyelids are highly sought after, leading to the prevalence of double eyelid surgery, including in Korea.
While this surgical procedure is mainly for aesthetic purposes, it may result in complications such as uneven eyelids or vision loss. It is crucial to conduct thorough research on the different techniques available and consult with a qualified plastic surgeon to determine if double eyelid surgery is the right choice for you.
Natural results of surgery
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