My Strategy for Asian Upper Eyelid Blepharoplasty

There are three principal methods for creating a so-called “double eyelid”, or upper eyelid crease in an Asian patient: the suture method, the partial-incision method and the full-incision method. I have tried all three over the years but have found that the full-incision method has been the most versatile, natural, and durable of all three.

I spent many months training in Asia with many prominent surgeons to learn the art and craft of Asian cosmetic surgery. The product of my travels was the book I produced, Cosmetic Surgery of the Asian Face (2nd Edition). I have concluded that as many practitioners of the art of Asian cosmetic surgery that exist so do the variations on techniques. However, by categorizing Asian blepharoplasty into three main categories, we can evaluate the pros and cons of each type of procedure despite these subtle variations that may exist.

The Suture Method
The suture method is the most popular one in Japan. It is very appealing because there is no incision except for a few stab entries with the crease held together by a suture that travels in and out of the skin to wind up buried as a permanent suture underneath. The major benefit of this method is the limited recovery time. Someone can be looking pretty good within a few days to a week following the procedure. The major limitation that I have encountered is that about 98% of results fall out or are at least partially lost over a period of one to two years following the procedure. For the reason of this limitation, I have chosen to abandon performing the procedure at all.

The Partial-incision Method
The partial-incision method held a great degree of appeal to me during the early years of my practice. It was a nice hybrid approach that was situated between the suture method and the full-incision method. It had relatively short downtime of only a week or two, sometimes for several weeks. It was also attractive selling someone that there would only be a very small incision of approximately 1.5 cm. The real problems with this method were twofold. First, I had a tremendous percentage of fold loss over a period of a year but less so than the suture method. Second, because the incision was short, when someone closed his or her eyes there was a good chance of seeing some puckering right at the incision line that gave away the unnaturalness of the result.

The Full-incision Method
I have been performing full-incision Asian “double eyelid” blepharoplasty for many years now and find it to be the best method in my hands to accomplish what I would like for a patient. The major limitation is the period of time of swelling. For the first week the swelling can be significant and the result very unnatural. Even for the first 3 to 6 weeks, there can be residual swelling that can make the result not appear 100% natural. It can take several months before the result looks excellent and one year for all the minor degree of swelling to resolve completely.

Despite this major limitation, it offers so many advantages that override this one limitation. First, it creates the most durable fixation with a very low incidence of fold loss. Second, it creates the most beautiful and natural looking fold that I have seen since the adhesion is uniform and across the entire length of the eyelid. Third, it is flexible allowing me to work with young and old patients and individuals with both thick and thin skin, excess or normal fat, and pre-existing folds or lack thereof, and the ability to design any shape and contoured fold that I please. Also, scarring has really not been an issue just as much it has not been one for my Western patients who have a standard upper-eyelid procedure. The reason for this is that I only take out 2 to 3 mm of skin so there is no tension on the incision hence no widening. This stands in contrast to the traditional upper-eyelid blepharoplasty in the Asian and the non-Asian in which a tremendous skin is removed. In the Asian, removal of slight skin is beneficial but the incision is more important for access and for creating the most uniform adhesion of levator to skin. For all of these reasons, I have relied on the full-incision method as my workhorse method for Asian “double eyelid” blepharoplasty.

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