It is well known 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 Asians.
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 trained 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, very often, we see Westernization of Asian upper 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 (more open, but not to the Caucasian extreme). Contrary to most doctors in the world, our doctor can often use a very simple method, utilizing one to three easy stitches to fix a new crease for the patients, making the eyes brighter, and the patients more beautiful.
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. Both traditional and current wisdom would recommend formal ptosis repair surgeries in these patients. However, this maneuver might most likely be an over-kill, giving the patients more trauma with ensuing more edema, more scarring, and more recovery time. Our doctor discovered a completely different “ptosis” mechanism that is unique to this “single lid” Asian patient group. In a series of manuscripts that will be published in major journals, our doctor describes his astonishing findings about the unique ptosis mechanism in this unique subgroup of “single lid” Asians: the end of the eye opening muscle is attached to such a rather flimsy and super stretchy thin tendon that when these patients try to open their eyes, they simply cannot transmit the eye opening force to the eyelid tarsal plates, causing the eyes only open to a sub-optimal level, sometimes only halfway! Based on this surprising finding, our doctor devised a simple MAT suture method for the correction of this unique problem. For most cases, a single MAT suture can achieve both double crease formation and “ptosis” correction, avoiding most of the damages caused by traditional aggressive surgical repairs. Oftentimes, this single stitch MAT suture method can be carried with a 3 to 5 mm tiny incision on the upper eyelid. Because of the extremely ultra-minimally invasive nature of the surgery, most of our patients can enjoy great results with greatly reduced downtime.
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 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 5.5 to 7 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 three 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 easily.
The partial incision method also fits people with thin skin. It is done with one or two small incisions made on the desired crease position (much better than the so called “three-point fixation” method). The excess fat can be removed through the tiny windows. At the same time, the capsule membrane is incised and pushed upward to expose the underlying levator aponeurosis, where the MAT suture will be placed to form the creases. A very important point here is that the creases formed this way are “dynamic” or “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 true levator problem. The excess skin is removed, fat pads are either removed or repositioned, problem levator is repaired (our doctor uses a much better, modified “double-row” levator aponeurosis advancement for this true “ptosis” repair, and then the creases are created and fixed according to the design. Again, the crease formation done this way gives natural creases. Both fat grafting to the brow ridges and the internal brow lift could be added to obtain even better results.
The repair of “botched” upper eyelid surgeries is a difficult task. Because Asian blepharoplasty (double eyelid surgery) is 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 is naturally your best choice when it comes to repairing or reconstructing a person’s botched eyelid surgery.
For 20 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 15 years polishing his Asian double eyelid surgery techniques, which made him a true world master of Asian double eyelid surgery. In august 2021, Dr. Yu won the “Maverick Award” (voted by his peers) for his lecture on the topic of “Algorithm for Finesse of Asian Upper Blepharoplasty” in the Surgical Master Class at the world famous “Miami Cosmetic Surgery Conference”. This great honor is a solid proof that Dr. Arthur Yu is a respectable, world-class master in the field of upper eyelid surgeries.
