One of the most confusing things that I have encountered is how to manage the aging Asian eyelid.  The reason for this is twofold.  First, if an Asian is born without an upper-eyelid crease where do you make the incision so that you don’t have a visible scar?  Second, when you remove skin from the upper eyelid of an Asian, you raise the position of the crease, which may look okay in a non-Asian (I would disagree) but it can look absolutely fake in an Asian because Asians typically are not born with high eyelid creases.

I have divided the management into three clinical scenarios:  Asians who are born with a natural crease, Asians who are born without a crease (or a very partial crease), and Asians who have had a surgically created crease made for them in the past. In the first clinical scenario, Asians who are born with a crease may be viewed just like a white person, i.e., one could simply remove skin.  And that is true.  However, the problem is, as mentioned, when skin is removed, the eyelid crease can ascend to the point that it looks unnatural.  In my opinion if I just put fat into the eyelid and brow in an Asian, I am able to make that individual appear much more youthful but at the same time maintain his or her eyelid crease height at a normal or natural position.  In an Asian that has a very low hanging skin that folds over the eyelash margin, I will remove skin from that person but almost always in conjunction with adding fat to the upper eyelid at the same time to maintain the crease position so that it does not artificially go too high.

In an Asian born without an eyelid crease, the biggest mistake is to try to remove skin, for two reasons.  First, since there is no natural position where the skin creases over, there is no place to make the cut.  When you arbitrarily define a line for incision, you can see the scar and if you try to take fat out, you can create a partial crease adhesion so that the person develops a partial crease.  That is a bad thing because it can change the person’s appearance and at the same time still the individual does not have a definable crease.  If you try to make the incision very long along the eyelash margin, the problem is unpredictable scarring, as the incision should never be placed there in the first place.  Interestingly, because one has a narrower eyelid opening that one has when one does not have a crease even removing skin from the upper eyelid does not help to make the eyelid position really look more open, which disappoints patients.  There are two ways then to manage this situation of an Asian without a crease.  First, one can make a crease, which can truly make the eyelid appear more youthful.  The problem with this approach is that it does change the way an eyelid appears from when that person was youthful (if that is ok with the patient).  Furthermore, there can be a long recovery period when creating an upper-eyelid crease, and the patient must know that.  The second way to rejuvenate an Asian eyelid without a crease is simply to add fat or fillers, which can plump up the eyelid to make it more youthful in appearance without any incisions.

The final scenario is an Asian who had a crease made in the past.  If the crease were made only a few years ago, then typically the creases made during the period from the 2000s forward were quite natural.  In the 1980s however the creases made were quite artificial in nature since a lot of skin and fat were removed and the creases were made artificially too high.  Interestingly, over time many of these eyelids start to descend and the crease can actually look low again.  The problem of removing eyelid skin at this point is that one can then unmask the previously bad result and at times even make the result look more unnatural in appearance.  The reason for this is that in fact when one is removing the upper-eyelid skin one is actually just removing brow skin, which is thicker and unnatural.  If the surgeon has a question as to whether it was an old-style Asian blepharoplasty or a new one, all one need to do is to lift up the eyelid skin to evaluate the height of the crease to determine if it was made unnaturally in the past or not.  This algorithm will hopefully help Asian patients seeking eyelid rejuvenation and also help surgeons seeking to help Asian patients with eyelid rejuvenation.

 

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum.

Why Asian Eyelids Can be More Easily Made Symmetrical

Symmetry is perhaps the hardest thing for me to fix.  I can improve one’s asymmetry but I can’t fix it.  In fact, in all my consent forms I state “the two sides of the body are not the same and can never be made the same,” a point that I typically try to underscore to every prospective patient who is considering a procedure no matter how big or small.  Curiously, when it comes to Asian eyelid surgery, i.e., creating a crease in the upper eyelid, in most cases I can actually make the eyelids more symmetric even if one was born with a slight or gross asymmetry.  The reason for this is that the asymmetry results from a partial crease on one side and an absent crease on the other side that when I create symmetric creases surgically the asymmetry disappears. Let me explain it another way.  When one has a partial crease on one side and a non-existent crease on the other side, the side that has the partial crease typically has an eyelid opening that is wider or bigger than the side with a non-existent crease.  The reason for this is that the side without a crease has more fat that slides downward since the levator muscle does not insert into the skin crease causing the eyelid opening to be smaller on that side.  The side with a partial crease has less fat that slides down over the eyelid and therefore that side the eye opening is bigger.  When the surgery is performed and there is a much more durable and defined crease, then both eyelids open even more and look less “sleepy eyed” but typically also in a symmetric fashion.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a Asian eyelid consultation please call (972) 312-8188. To Learn more about Dr Lams’ Asian blepharoplasty surgery or to ask Dr Lam a question please visit his Asian plastic surgery forum.

Does Asian Eyelid Surgery Represent a Loss of Ethnic Identity

Asian eyelid surgery or Asian blepharoplasty is perhaps one of the most controversial procedures that I perform because it has deep social and cultural connotations that are tied to it.  The biggest question is whether creating an upper eyelid fold constitutes making Asians look White?  The answer is not so simple, but I will try to explore my philosophy herein.

First, the procedure itself involves creating a crease in the upper eyelid to make the eyelid appear rounder and more open.  It is a surgical procedure that can be undertaken in myriad ways depending on surgeon preference.  Having performed all different types of techniques, I have found that the full-incision method provides the most predictable and durable outcomes for this procedure.  For women who want to put make up along their upper eyelid, creating a crease truly makes this task easier and doable.  For those who just want their eyelids to look less sleepy or ethnic in appearance, this procedure also works.  For those with limited vision from the hooding of the upper eyelid skin and fat descending downwards, this procedure can also be of benefit.

In order to seek the answer for whether this procedure constitutes a betrayal of one’s ethnicity, we can start with how this procedure developed.  It started back in the late nineteenth century when Mikamo, a Japanese surgeon, created the first double eyelid in individuals who lost their fold due to illness or infection.  He was able to restore the double eyelid through a suture-based method.  Interestingly, this was a time that was steeped in Westernization of Japan, known as the Meiji Period, that must have influenced the aesthetic values in the Far East for beauty at that time.  The procedure was developed further in Hawaii during the mid-part of the twentieth century and the language with which it was written was colored by ideas of Westernization.  In fact, the term “Westernization” was popular for most of the twentieth century until the last two decades in which “Asian blepharoplasty” or more colloquially “Asian double eyelid surgery” has been favored.

Looking at the procedural style that dominated the scene until the late 1980s, there was excessive removal of fat and very high eyelid creases made that were an attempt to “westernize” the eye.  Unfortunately, the individuals who received this type of surgery did not look White or even Asian but rather distorted, unnatural, and scarred.  A lot of the apprehension that exists today of people who would like to undergo Asian blepharoplasty involves remembering or seeing these stigmata of a bygone era just as much as we see people with bad hair plugs from the past and fear ever having that procedure done.  In any case, Asian double eyelids naturally exist in the population of all Asian races so it is not an unnatural creation that does not exist in nature.  Accordingly, this procedure is aimed to create a natural fold that is low and resembles those that exist naturally in many Asian people.

The one thing for certain is that there is a globalization of beauty today where with ongoing intermarriages of different races, the population looks more and more mixed.  Models that appear in print or on the runways look more Eurasian or mixed in someway.  The Western media that has flooded the Far East no doubt has influenced the way that the Far East looks at beauty.  However, the influence of Far Eastern beauty on the West is also unmistakable.

I think there is no easy answer on what the motivation is for every person undergoing an Asian eyelid procedure but there are three things that are certain.  First, this has become a very popular procedure across the world today.  Second, the results appear completely natural.  Third, there is a global influence on the standards of beauty that has affected many individuals who desire to undertake a double-eyelid procedure.

Follow the links to learn more about Dr Lam’s Asian blepharoplasty procedure, or other common Asian plastic surgery procedures including Asian rhinoplasty, Asian jaw reduction, and Asian lip reduction, including before and after photos, videos, forums and FAQs, or call (972) 312-8188 to schedule a consultation .