Asian Blepharoplasty

Synopsis

Upper eyelid blepharoplasty in Asians often refers to double-eyelid plasty and epicanthoplasty because about half of Asians lack an upper eyelid crease, so-called single eyelids. Many procedures for double-eyelid plasty have been reported since the suture technique was described by Mikamo in 1896. Although the surgical principles are similar to those for occidental eyelids, the surgical design and operative technique are different because there are distinct anatomic differences in Asian eyelids.

The Aesthetic Problem

Asian upper eyelids are anatomically different from that of white upper eyelids. Single eyelids are one of the most characteristic features of Asians. There are many causes, such as lower fusion point of the septum and levator, lack of levator aponeurosis penetration into the pretarsal orbicularis oculi muscle, and lower penetration of preaponeurotic fat into the pretarsal area ( Fig. 7.1 ).

Epicanthus is another feature of the Asian eye. The epicanthus covers the lacrimal lake and width of the interepicanthal distance. Patients who have surgery for epicanthic folds and desire concurrent double-eyelid surgery often develop aesthetically unpleasant results.

Indications and Counseling

The indications for the upper eyelid blepharoplasty are as follows:

• 1.

  Type of crease—lacking, low-set, incomplete, asymmetric, multiple creases

• 2.

  Epicanthal fold

• 3.

  Entropion

• 4.

  Puffy eyelid without exophthalmos

• 5.

  Blepharoptosis

Creating a lid crease is not the most challenging operation of Asian blepharoplasty. Creating a symmetric and natural crease is more important but difficult to achieve. In the East Asian individual, the natural crease typically parallels the lid margin in the outer two-thirds of the eyelid, closing toward the eyelid margin as it proceeds nasally. On the other hand, there are some variations in the medial area. Medially, the crease ends above the epicanthus, fuses with the epicanthus, or dives beneath epicanthus.

The surgeon should evaluate the presence of blepharoptosis, morphology of the upper eyelid crease, and eyebrow position, then simulate the upper eyelid crease by pressing a bougie onto the lid skin. Simulating several heights of the crease can help both the surgeon and patient realize the ideal position of the crease. The surgeon should ask about the patient's desire for the medial area. When the patient chooses the parallel type, medial epicanthoplasty should be taken into consideration.

Some patients choose a semilunar crease. A semilunar crease in an Asian face is quite unnatural, so the surgeon should not agree with making a semilunar crease.