It well knows that 50% of the Asian population does not have crease formation on the upper eyelids (double creases), which makes the eyes appear much smaller and sometimes not so friendly. Hence, it is no wonder that double eyelid surgery ranks the highest among all the cosmetic surgery procedures in Asian countries.
Due to the complicated anatomical differences between Asians and Caucasian upper eyelids, it is imaginable that a plastic surgeon who is only trained in Caucasian upper eyelid surgery should be extra careful when deciding whether to perform double eyelid surgery. Asian double eyelid is not simple copying of the Caucasian eyelid creases. Rather, almost all the internal anatomical structures are different. Without knowing own limitations, a Western plastic surgeon could easily Caucasianize an Asian person’s upper eyelids, which could prove to be a disaster–wide creased eyelids housed in shallow eye sockets will not glorify an Asian’s appearance, it would only be rather destructive. Unfortunately, even in Asian countries, including Japan, China, Korea, Vietnam, Thailand and Singapore, most plastic surgeons are trained with Western textbooks, not knowing how to deal with Asian eyelids. As a result, we see very often Westernization of Asian eyelids by Asian country doctors.
Contrary to Caucasian eyelids, Asian eyelid anatomy could vary widely from person to person. while some may have well-developed creases, others may have absolutely no crease, very little creases, or unstable creases. For the people who have creases, they may want to have the creases somewhat wider (but not to the Caucasian extreme). These different people will have the levator aponeurosis fibers inserted at the skin at completely different levels from or at the tarsal plate. Often times, people with single eyelid appearance also have levator aponeurosis being so poorly developed that they appear to have levator muscle weakness, resulting in very small eyes.
Then there is also the “Mongolian folds”(medial epicanthal folds), which most Asians have, but does not exist in normal Caucasians. Some people may wish to keep their ethnicity, while others may wish to have the Mongolian folds removed to make the eyes look even bigger.
Our doctor’s approach to Asian double eyelid surgery is most up to date as compared to other plastic surgeons. Your concerns will be heard and thoroughly discussed. During the consultation, the anatomy will be carefully analyzed to form a final treatment plan. The surgical markings will be made while the patient is in a sit-up position, and then confirmed again on the OR table. The width of the creases will be discussed again and again with the patient, so the patient’s desire is met. For a typical Asian female, the crease width is usually 5 to 6.5 mm, whereas, for the Asian male, it is usually 3 to 5 mm. All measurements made on the person will be reconfirmed on the photos to avoid any discrepancy.
Double eyelid surgery can be done using thee different approaches: suture method, window methods (partial incision), and open incisional method (full incision).
The suture method involves burying a very fine permanent suture to form the creases. it is a method that fits people with thin skin and no excess eyelid skin. The benefit is the surgical trauma being smaller. But the drawback is also obvious: very high failure rate at the one-year point. Additionally, some people may develop swelling that does not go away for years.
The partial incision method also fits people with thin skin. It is done one or two small incisions made on the desired crease position. The excess fat can be removed through the windows. At the same time, the capsule membrane is incised and pushed upward to expose the underlying levator aponeurosis, where the future will be placed to form the creases. A very important point here is that the creases formed this way are “dynamic live” and natural creases, instead of “fixed” or “dead” creases.
The full incision method works well for people with excess skin, or when it appears that there is a levator problem. The excess skin is removed, fat pads are either removed or repositioned, problem levator is repaired, and then the creases are created and fixed according to the design. Again, the crease formation done this way gives only natural creases. Both fat graftings to the brow ridges and the internal brow lift could be added to obtain even better results.
Because blepharoplasty (eyelid surgery) is so frequently done by unqualified surgeons, at least 30% of the people may need to have revisional surgery done to have their surgical defects corrected (failed Asian double eyelid surgery). And an essential part of the repair demands that the surgeon could restore the patients’ original anatomy and then go from there to perform the required repairing steps. Dr. Yu has a profound understanding of the Asian eyelid anatomy and knows the inside, and out of every single minute details as to what could go wrong when it comes to restructuring the damaged anatomies, he could be your best choice when it comes to repairing or reconstructing a person’s botched eyelid surgery.
For 19 years, our Award Winning Board Certified Plastic Surgeon Dr. Yu has been deeply involved in perfecting the surgical procedures for Asian double eyelids. After finishing his plastic surgery training at Mayo Clinic, he followed Dr. Robert Flowers, the then world-class master of Asian eyelid surgery. At the time, Dr. Flowers’ technique was without a doubt state of the art in the field of Asian double eyelid surgery. However, Dr. Yu did notice some major limitations and many grounds for improvement. Afterward, he spent the next ten years polishing his Asian double eyelid surgery techniques, which made him a true world master of Asian double eyelid surgery.
