Asian Double Eyelid Surgery

Many Asians lack a fold in the area above the eyelashes. Blepharoplasty, which creates a natural-looking crease, can treat this by creating an eyelid fold.

Asian vs. Caucasian Eyelids

Anatomically, the difference between Asian and Caucasian eyelids is in the position of the eyelid fold. Asians with a crease above their eye have very different-looking eyelids than Caucasians. The Asian eyelid typically starts at the crease very close to the eyelashes. As the crease gets further away from the nose, it gets larger and larger until the midpoint of the pupil, at which point the fold runs parallel to the eyelash origin.

A Caucasian lid crease is slightly different in both shape and size. It typically tapers closer to the eyelashes as the fold goes out laterally so that it is more of an upside-down “U” shape, rather than a parallel shape to the eyelash lid. The Caucasian lid crease is also about 20% larger than an Asian eyelid crease. The purpose of surgery is to create a natural looking eyelid crease.

Popular Asian upper eyelid procedures are:

Double eyelid surgery – Supratarsal fold creation
Mongolian fold surgery – Epicanthoplasty
Removal of excess skin– Upper blepharoplasty
Ptosis repair – Lazy eye surgery
Big Eye Surgery – Levator Advancement Surgery

Double Eyelid Surgery

There are three surgical approaches to double eyelid surgery. Full incisional/scar, Partial Incisional/scar or No scar technique (Durable Suture Technique). Each approaches has pros and cons. Dr Barnouti will explain which procedure is best for you based on numerous factors. Some of the essential factors are:

The shape and characteristics of your eyelid now.
Amount of skin needs to be removed
Amount of fat needs to be trimmed
What type of eyelid would you like to have after the surgery
Previous history of eyelid procedures and eye condition.

Comprehensive consultation and examination are essential before choosing the correct surgical approach for you.

The traditional suture method. It is a scarless procedure. It has significant advantages in terms of natural crease results, quick recovery and reproducibility. Healing time is a few days. In a suture method eyelid procedure, a crease is created by burying permanent non-reactive sutures (proline, used in heart valve surgery), pinching a bit of the undersurface of the eyelid skin to the deep tissue. It is performed under local anaesthetics. It takes 45min.

The open approach eyelid crease method

The benefit of an open approach: reliability and longevity. Drawback includes a scar on the upper eyelid. This scar aligns with the fold and tends to fade with time. It is ideal for Asian patients who prefer a dramatic and deep crease.

The most natural fold shapes are a tapered fold and a parallel fold, referring to the shape in relation to the margin of the inner half of the eyelid. The ideal size of the fold allows 2 – 3mm of skin above the eyelashes to show on a direct frontal view with the eyes open. This also usually corresponds to a crease set 10mm from the lash line when the eyes are closed (with the skin on light tension).

The modern technique for double eyelid surgery is to create a fold by repairing and fixing the orbital septum or levator aponeurosis to the skin/muscle edge. Another technique is anchor blephroplasty

The partial incision technique/small scar technique is Dr Barnouti’s favoured technique.

Animated Video Showing Eyelid Surgery

Medial epicanthoplasty (also known as Mongolian fold surgery)

The medial epicanthus is an excess fold of skin covering the eyelid’s inner corner. This creates an illusion of a narrower eye and makes the eye appear wider apart. The degree of severity can range from non-existent or mild, moderate and severe, depending on how much of the caruncle (the pink “bump” inside the eye corner) is exposed. The severe cases should be corrected; for moderate folds, correction is optional. One popular technique for correcting the fold is by augmenting the nose with a nasal implant as it takes some of the eyelid slackness away. Another way is by repositioning the fold using what is known as a jumping man flap or vy advancement flap with a double opposing z plasty technique.

Mongolian fold surgery increases the visibility of the inner corners of the eye and reduces the distance between the eyes. Thus, the eye appears larger and is less apart. For this reason, Mongolian Fold Surgery is a popular and uniquely Asian cosmetic procedure.

Essential factors for successful Mongolian Fold Surgery are:

The shape and characteristics of your Mongolian Fold
Amount of Mongolian fold needs to be removed & repositioned
Whether you would consider having double eyelid surgery at the same time
What type of eyelid would you like to have after the surgery
Previous history of eyelid procedures and eye condition.

Comprehensive consultation and examination are essential before choosing the correct surgical approach for you.

Removal of Excess Upper Eyelid Skin, Upper blephroplasty.

With the aging process, the skin of the upper eyelid tends to sag. This not only appears aesthetically displeasing but also makes one appear old and tiredsome. In severe cases, it places gravitational pressure on the eyelashes hence makes the eye look and feel tired as well as obscure vision.

Upper eyelid surgery to remove excess upper eyelid skin is a simple procedure:

performed under local anaesthesia with twilight sedation
excess skin is trimmed, muscles tightened and excess fat trimmed
60-minute procedure
sutures are removed in 7 days.

Lazy Eye Surgery (aka Ptosis Correction Surgery)

Droopy eyelids are caused by a functional weakness of the eyelid opening mechanism called the Levator. Lazy-eye surgery corrects droopy eyes by tightening the levator.

Big Eye Surgery

“Big Eye Surgery” is a surgery that is becoming more and more popular in Asian countries.

Unlike Caucasians, Asians’ eyelid anatomy dictates their smaller eye dimensions. Double eyelid surgery and Mongolian Fold correction surgery make the eye appear bigger and more open, but they do not increase the dimension of the eyelid. Despite these efforts, one’s eye may still appear small. In this selected group of patients, “Big Eye Surgery” can help by actually increasing the size of the eye opening.

“Big Eye Surgery” is a procedure that shortens/tightens the upper lid opening mechanism, Levator. The upper eyelid margins are pulled more open as the Levator is shortened and tightened. Hence, the eyelid is rested at a more open position, and more of the eye is visible. Hence the name “Big Eye Surgery”.

Asian Lower eyelid surgery

Muscle weakness, excess fatty tissue and lax skin are some of the factors that lead to baggy lower eyelids in Asians.

There are two solutions to this problem:

Non-surgical lower eyelid surgery. This is achieved by skin tightening by laser or peel and volume restoration of the eyelid by soft tissue fillers or fat injection

Surgery. The excess fat is removed or redistributed through a small incision hidden on the inside surface of the eyelid or just under the eyelashes.

Asian eyelid anatomy differs from that of Caucasians. Asian eyelids are characterised by a “severe form” of lower eye bags directly resulting from excess fatty tissue and dark circles from a younger age. For this reason, eye bag removal is a popular Asian Cosmetic Procedure in all age groups, whereas lower eyelid surgery for wrinkle removal and skin tightening tends to be more popular in middle age and above.

The most popular lower eyelid procedures are:

Lower eyelid bag removal. This often requires surgery
Lower eyelid skin tightening and wrinkle removal.
Lower eyelid non surgical skin tightening with peel or Laser

Surgery: Lower eyelid bag removal. There are 2 surgical approaches to this procedure

Internal approach – a small incision is made inside the lower eyelid (no visible external scar) and through this incision fat is removed.
External approach – an incision is made just under the eyelashes and through this incision, fat can be removed, loosened muscle can be tightened and the excess skin can be trimmed and tightened.

Soft or Non-surgical treatment of lower eyelid skin can produce a great outcome in some cases. One method of improving the appearance and tone of the lower eyelid skin is to use lasers or skin peels. Unlike surgical procedures, there is little downtime.

Consultation, examination and clinical analyses by Dr Barnouti is essential before choosing the correct surgical approach for you. Call 1300 004 008 or 02-9561 0200 to book for a consultation

What are the risks associated with this procedure?

Plastic surgery, like any surgical procedure, carries inherent risks and potential complications.

Please read our Risks and Complications of Plastic Surgery page.