Asian Eyelid Surgery
An asian blepharoplasty, or "double eyelid" procedure, is creation of a upper eyelid crease in an individual who either has a pre-existing low or non visible crease. There are limitations on how high a crease can be made that are dictated by each individual's peri-orbial anatomy, soft tissue thickness, amount of upper eyelid fat, and overall skin quality and thickness. Many asians also have a weakened levator muscle attachment and this results in a "sleepy" look of the upper eyelid, called ptosis. If ptosis is present, this can be corrected at the time of the procedure and adds an additional level of time, difficulty, and recovery.
How is it performed?
The overall result will differ from patient to patient, even if the same technique is used and is based on the above mentioned qualities. There are two common methods, incisional or suture method. Recovery from a suture method is faster and is an option for the right candidate. An incisional methods requires creating an full length incision at the desired height, dissection down to the level of the levator aponeurosis and fixation of the dermis to this structure or the superior aspect of the tarsal plate. In asians there frequently is an extra fatty layer prohibiting the attachement of the dermis to the tarsal plate and levator, and the thickness of this fatty layer is variable from person to person and even from the right to left eye. In an anchor blepharoplasty, this amount of excess tissue can affect the sharpness of the crease. This fatty layer is necessary and creates a smooth glide plane for the layers of the upper eyelid. Too much removal can lead to build up of scar tissue and altered mechanics of the eyelid itself and additional creases above the incision. Peri-orbital fat can be removed safely without impeding the overall upper eyelid mechanics and can be done if there is fat protrusion. This should be done with caution in the younger patient to prevent pre-mature hollowing and aging of the upper eyelid.
What can I expect in my consultation?
In your consultation Dr. Kim will review your anatomy to determine what crease height will be natural and reasonable. She will help you understand the expected outcome as well as the recovery process. Some patients will require an additional procedure, an epicanthoplasty, at the inner corner of the eye to help with crease formation. The procedure can be done under local or with sedation and Dr. Kim will help determine which option would be most beneficial. Your medications will be reviewed and Dr. Kim will help you determine which additional vitamins and supplements are safe to continue. All non-essential supplements and vitamins should be discontinued two weeks prior to your surgery. Many herbal supplements and even continued NSAID useage can lead to prolonged bruising and bleeding during the procedure and are discouraged pre-operatively.
Asian Eyelid Surgery Recovery
Post operatively full instructions will be given to you along with pressure dressing placement. There should be little to no pain, but a tight sensation is very often noted.
While the eyes can heal very quickly, they also can swell considerably as an asian blepharoplasty is a much more complicated procedure in a a very small space. To help the recovery process there is a pressure dressing applied that we recommend keeping on the for the first 24 hours followed by icing for the next 2-3 days. It is best to take it easy with no heavy activity during this time and your sutures will be taken out between 5-7 days after the procedure. Until the sutures are removed it is not unusual to feel a tight feeling, especially when squinting. For this reason we recommend staying out of direct sunlight or making sure to wear dark sunglasses. This will help you feel more comfortable and also help your incisions heal well.
The eyes tend to swell again after the sutures are removed, so do not be surprised if you leave more swollen again.
The vast majority of swelling resolves by week 2 to the point that many people would not be able to tell any surgery has taken place. You should expect small amounts of residual swelling above and below the incision for several months after. These smaller areas of swelling are due to the placement of anchor sutures deeper in the eyelid which can alter how excess swelling leaves the upper eyelid. This can lead to minor asymmetries for up to 6 months after the procedure that are imperceptiple to others.
Frequently Asked Questions
The simple answer to this is everyone’s eye anatomy is different, from the shape of the globe (eyeball), whether it protrudes or is deep set, how thick the excess fatty tissue is beneath the muscle, to how thick the skin is. You are not a cookie cutter replica of anyone else, and so your surgical result will be different from everyone else’s.
You will have visible sutures for 5-7 days as well as bruising. Many people go back to work after the first week, some people go to work with the sutures still in place.
I recommend refraining from working out for at least 3 weeks after surgery. The simple reason is prolonged swelling after surgery can lead to a build up of scar tissue. It is also imperative to stay out of the sun for at least 3 months. We normally recommend biocorneum applied to the incision after the sutures are removed as this is a great silicone based scar treatment with SPF.