Asian Eyelid FAQs – (Asian Eyelid Frequently Asked Questions).
- What does Asian eyelid enhancement or blepharoplasty mean?
Some Asians are born without a crease on the upper eyelid or a very rudimentary fold that is barely present. In these individuals, the eyes may look very narrow and tiny giving them a sleepy eye or overly ethnic appearance that may not be aesthetically pleasing. Asian blepharoplasty, also known more popularly as the “double eyelid” procedure, is a short operative technique to permanently create a crease or fold in the upper eyelid and thereby open up the narrow appearance of the Asian eyelid.
- Is this the same thing as “Westernization” of the eyelids?
Not really. Dr. Lam believes that the term “Westernization” applies to a type of procedure that was practiced more popularly in the 1980s in which an aggressive amount of fat was removed from the upper eyelid and the crease was made very high and artificial looking. This type of procedure that may be found more commonly in the older Asian generation is really not commonly practiced anymore. Dr. Lam does not perform this type of eyelid enhancement, as he believes that the results are very unnatural appearing. Interestingly, even when Dr. Lam operates on Caucasian or Occidentals, he believes that too many surgeons overcut skin and remove fat so that the appearance is unnatural and alters a person’s identity unfavorably.
- Does Asian eyelid enhancement represent a betrayal of one’s own culture and ethnicity?
This question is hard to answer. Everyone has a different opinion about whether a”double eyelid” procedure constitutes aesthetic enhancement or cultural effacement. If you look at the history of the Asian eyelid procedure, many of the early references to Asian eyelid crease formation were to procedures undertaken to emulate one’s own native peers, i.e., to look like the most beautiful Asians in a culture not Caucasians more broadly. Although aesthetic influences have greatly changed over a 1000 years, most Asians today seeking Asian eyelid enhancement are desirous of looking more like beautiful Asian pop stars and icons rather than resembling Caucasians. Clearly, the past 100 years and especially the past 10 years have shown a true cultural convergence and mixture of different races, as popularized in the mixed ethnic models that are ubiquitously on display today. Nevertheless, whether you decide to have Asian blepharoplasty should be derived from your own motivation not pressure from your peers, your family, or society.
- Is there an age that is too young to have Asian blepharoplasty?
Yes and no. Chronologic age is not so much a barrier for the procedure as maturity and motivation are. If Dr. Lam consults a mature, thoughtful, and self-motivated individual, he is more likely to undertake the procedure (with obvious parental consent in a minor) than if the parents appear to be the motivating force behind having the procedure done. For instance, Dr. Lam has performed Asian blepharoplasty for as young as a 12-year-old but rejected many individuals who are 18- or 19-year-old who do not seem to be choosing to have the procedure for the right, personal reasons.
- What technique does Dr. Lam use to create an Asian eyelid?
There are three main techniques for creation of an Asian upper eyelid crease. The suture, partial-incision, and full-incision methods. Dr. Lam does not use the suture or partial-incision techniques anymore for the simple reason that these types of procedures are more prone to fold loss over time. The full-incision method provides a permanent result in almost all cases. Also, no permanent sutures of any kind need to be kept in place at all. The full-incision method permits the greatest ability to modify the eyelid contour to the most desirable shape that you want.
- Can I help decide on the height of my crease or shape of my fold?
Yes, bringing in photos of models with eyelid shapes that you like can be informative in the discussion. Oftentimes, however, when a person looks at a model to see what kind of eyelid he or she likes, what the person may like is not the eyelid shape but the overall attractiveness of the face. Dr. Lam has photographs to show you how two models with exactly the same eyelid configuration may appeal to you very differently because of their other facial features. In most cases, Dr. Lam prefers a lower-eyelid crease with an inside fold that may or may not flare slightly. This shape is the most natural look but he can make some slight alterations to this design based on patient preference. However, Dr. Lam does not like to perform the older Westernization procedure (see previous question), as this kind of surgery is deforming and unnatural in appearance.
- Can Dr. Lam make two eyelid creases that are uneven to start with become even and symmetrical afterward?
If the brows are uneven, then the answer is no. If the asymmetry has arisen from prior surgery, then at times it is much harder to make the result afterward perfectly even and symmetrical. Most oftentimes, if one side has a partial or small crease and the other side has none at all, asymmetry in the size of the eye opening and crease height can be apparent. A standard “double-eyelid” procedure can sometimes improve the symmetry of one’s eyelids in this specific circumstance.
- Will I have any pain during the procedure?
Interestingly, there is really no discomfort at all with the procedure. Dr. Lam uses a method of intravenous sedation to alleviate all anxiety and discomfort. You are comfortably asleep for the first twenty minutes of the procedure. Only the final 5 minutes when Dr Lam requires you to cooperate with eyelid opening and closing will you be gently awakened. The type of anesthesia is known as conscious sedation and cannot be performed in a regular office. As Dr. Lam has a fully accredited, on-site surgery center, he is able to truly provide you with unsurpassed comfort and alleviate your anxiety during the procedure.
- What is the recovery time involved?
The recovery time for healing of the Asian eyelid is a bit longer with the full-incision method. For all of the benefits enumerated above for the full-incision method, Dr. Lam believes that it is worth an extra week or two of increased swelling in the upper eyelid crease. In general, the first week after Asian blepharoplasty, the result looks very unnatural. There is no discomfort and usually very little bruising but the degree of swelling makes the eyelids appear abnormal. Dr. Lam removes the sutures on the 7th day following the procedure. During the second week that follows Asian blepharoplasty, the crease already appears much more normal but is still slightly swollen. There are a few important and helpful considerations that can aid to shorten the perceived recovery time following the “double eyelid” procedure. First, mascara can be worn above the crease to make it harder to see the swelling. This should only be done after the sutures have been removed on the 7th day following surgery. Eyeglasses that partially obscure the upper-eyelid crease are also recommended. In general, it is advisable not to wear contact lenses the week following the procedure to limit manipulation of the upper-eyelid incision and also to help cover the visible swelling. Most people take 1 to 2 weeks off from work to limit other people’s ability to discern that you had a procedure done. For students, the summer and winter breaks are the ideal times to have the procedure performed. Although it can take a full year for all of the minor swelling to subside, Dr. Lam will show you a series of photos during the consultation to walk you through week by week and month by month the healing period and to alleviate your concern about the recovery time. For people that have more Caucasian friends, the recovery can actually be even somewhat faster if the person is young since many Caucasians are simply unfamiliar with this procedure and do not suspect you had anything done especially if you are a younger person.
- Does Mederma (onion extract), Strivectin, or Vitamin E oil work to help improve the appearance of my incision?
Dr. Lam does not believe that any of these remedies work to help a scar mature well. In fact, rigorous scientific studies that have involved blinded, prospective, randomized, split scar analysis (in other words, good and controlled scientific research) have indicated that these treatments provide no improvement at all in an incision or scar. In fact, Vitamin E oil has been shown actually to worsen wound healing in some cases. In the past, Dr. Lam used Vitamin E oil to help with wound healing. However, with recent evidence to the contrary, he no longer believes that any of these topical ointments do any good to help with scar healing.
- I would like to change the shape of my epicanthus (epicanthoplasty). How does Dr. Lam perform epicanthoplasty.
Epicanthoplasty entails reshaping the inner part of the eyelid by advancing the skin and shortening a structure known as the medial canthal tendon. The objective in epicanthoplasty is to reconfigure the shape of the inner eyelid so that the appearance is less ethnic. By redirecting the epicanthus inward, a little pink mucosal area known as the lacrimal lake becomes exposed, which is thought to be more appealing.Dr. Lam has developed a special type of epicanthoplasty that eliminates an external skin incision and does not join with the principal incision of the upper eyelid during double-eyelid creation. The reasons that this tiny incision method is so effective are threefold. First, without an external incision, scarring is virtually eliminated. Second, by not connecting the incision with the main incision, webbing of the fold is also almost unheard of. Finally, by making a separate, limited internal incision, the procedure can be undertaken completely separately (i.e., on a different date and time) from a double-eyelid procedure.
- I have heard about a procedure known as lateral canthoplasty. Does Dr. Lam perform this procedure?
Lateral canthoplasty is a procedure in which the outer part of the eye (the opposite side from the epicanthus) is opened up by 1 to 2 mm to create a wider eye appearance. However, Dr. Lam believes that this procedure is somewhat overrated. Although technically the easiest and simplest procedure to perform, Dr. Lam usually only uses this technique to correct scarring or to reconstruct the shape of the outer canthus due to previous surgery, micropigmentation, or accident. Nevertheless, if you understand the limitations of this procedure, Dr. Lam can help open up the outer part of the eyelid very easily for you. It is usually advisable to combine this limited procedure with epicanthoplasty and/or “double-eyelid” creation for optimal aesthetic gain.
- I am an older Asian individual and want to rejuvenate my eyelids and I have no crease. What can Dr. Lam do for me?
This is perhaps one of the least understood topics in facial rejuvenation. It is oftentimes a mistake to simply remove skin from the upper eyelid in someone that has no crease to begin with for several reasons. First, the patient who was born with a narrow eye opening will perceive very little benefit after just skin removal. Second, a visible line can appear where the incision was made, which is unacceptable. If fat is removed along with skin in order to open the eye without creating a crease, a crease may be inadvertently created. Accordingly, in patients without a discernible crease or a very rudimentary one, Dr. Lam offers two strategies for eyelid rejuvenation. First, traditional Asian blepharoplasty can be performed in which a crease is created and excessive skin is also removed. Second, fat grafting alone to recontour the eyelids into a more youthful look may be preferred. At times, he combines both procedures for optimal effect.
- I am an older Asian individual and want to rejuvenate my eyelids and I already have a natural crease. What can Dr. Lam do for me?
Just removing skin and/or doing a browlift in this kind of Asian patient may actually create an artificial “Westernized” appearance. Dr. Lam will decide whether fat grafting with or without skin removal is the best method for you depending on your anatomy and your current crease height. Dr. Lam is very sensitive to how the crease height for an Asian is integral to preserve identity, ethnicity, and even more importantly a natural look.
- I am an older Asian individual and want to rejuvenate my eyelids and I already had a prior surgical crease created. What can Dr. Lam do for me?
Although a person who has had an upper-eyelid crease made in the past may seem identical to someone who was born with one, this is sometimes not the case. If the person had the crease created many years ago, an older style “Westernization” procedure may have been undertaken with excessive removal of skin and fat. Accordingly, just removing skin or lifting the brow may result in unmasking a bad procedure from many years ago. Instead, conservative to no skin removal with or without fat grafting may be a better alternative to maintain crease height without exposing a bad prior result. The subtleties in your situation must be conveyed to you after a careful consultation and physical examination by Dr. Lam.
If you have additional Asian eyelid surgery questions not answered on this Asian eyelid FAQ page please ask Dr. Lam in the Asian Plastic Surgery Forum.