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Asian Eyelid Surgery: My Thoughts

Khoo Boo-Chai of Singapore, a pioneer in this field since the 1960s, kindly furnished all the information in this chapter, which was abstracted by W.P.D. Chen and reviewed by Dr Boo-Chai for the second edition of this book. This was based on his 40 years of hands-on experience with aesthetic (cosmetic) surgery of the upper eyelid. Boo-Chai reported on his experience over five years with 625…

Advanced: Summary of Eyelid Crease Factors

This summarizing chapter covers the author's current concept of various anatomical factors that contribute to or adversely affect a crease formation. Familiar drawings will help illustrate the concepts and factors that have been discussed in the advanced chapters, and how these can be applied clinically. I am continually fascinated by the unpredictability of the eyelid crease; some of its factors can be represented by the expression…

Advanced: The Concept of Tarsal Tilt – Its Effects in Normal and Abnormal Clinical Conditions

This chapter deals with the author's original finding that the natural tilt of the eyelid's tarsal segment is at approximately 45° when the eyelids are open. The crease height is inaccurate when measured vertically and actually corresponds to the true anatomic crease height through a factor of √2 ÷1.0, assuming a 45° isosceles triangle, or is 1.41 X, with X being the frontally measured vertical extent.…

Advanced: Angle of Observation, Crease Height and its Effects on Clinical Outcome of Upper Blepharoplasty

This chapter deals with the author's concepts regarding the height and depth of an eyelid crease, which change in different view positions with respect to the patient's gaze, as well as the clinician's observing angle. An individual's upper eyelid crease height varies in its measurement and is influenced by various factors, including resting position, angle of observation and presence of associated ocular abnormality. Its effects should…

Revision Parameters

The Circle of Suboptimal Parameters, Etiology and Interrelatedness Of all the parameters that influence the outcome of surgery, perhaps the single most important factor will be the height of the crease, as drawn from the mid-ciliary margin. The crease should be designed based on the central height of the tarsal plate, and no higher. In Asians this is often between 6.5 and 7.5 mm. When designed in…

Optimal Closure and Management of Wound Healing

It is always desirable to be able to enter and exit the eyelid (through an existing crease) without leaving too much of a footprint. If one can strive to enter, perform the necessary task to the exact degree one had planned for, execute the plan without significant trauma, and exit without causing new impairment compared to before, leaving the area accessible for re-entry if indicated in…

Concept of Triangular, Trapezoidal and Rectangular Debulking – Application in Upper Blepharoplasty

This chapter deals with the technique used by the author to facilitate the likelihood of forming a crease in a single-lidded individual: by effective removal of redundant hindering tissues (proper orientation of the removal of different layers so as to allow natural closure), minimization of scar from tension, and thorough completion of each step with lessened postoperative swelling. The steps are applicable to any form of…

Asian Blepharoplasty III: Factors that Influence Outcome

Optimal Crease Design It is my experience that the nasally tapered crease is slightly easier to achieve surgically than the parallel crease. Most Asians who are not born with a crease have a medial canthal fold, to a varying degree. It is therefore not necessary in the design of a nasally tapered crease to excise the entire medial fold, but sufficient to reduce it and allow…

Asian Blepharoplasty II: The Second Vector

Continuing to describe the Asian blepharoplasty technique used by the author, this chapter looks at the handling of the middle layer structures of the eyelid once the preaponeurotic (middle) space has been reached. The chapter will take the procedure up to closure of the eyelid crease. Figure 9-1 shows the cleared preaponeurotic plane being readied for construction of the eyelid crease. Open full size image FIGURE…

Asian Blepharoplasty I: The First Vector

Japanese Kanji (Chinese-based characters) and Hiragana writing denoting ‘double-eyelid crease technique’. (Courtesy of, and in remembrance of, Kazuko Chin.) Open full size image It is my belief that a modified external incision technique allows maximum control and flexibility in order to achieve the goal of creating an optimal crease. This is based on setting a high benchmark of achieving an ideal crease height, with an appropriate…

Suture Ligation Methods

Open full size image This chapter provides an overview of buried suture ligation methods (also known inaccurately in Asian languages as ‘non-incisional’ or ‘no-cut’ methods). Historical perspective and variances in technique are covered. Evolution of Double-Eyelid Cosmetic Surgery in the Japanese Literature Publications in the early Japanese medical literature favored the suture ligation methods. The first description of the suture ligation method, by Mikamo, was published…