Many Asians do not have the crease above their upper eyelid as seen in most Caucasian people. In addition, some Asian eyelids are fuller than the eyelids of Caucasians and have a fold of skin which runs along the central portion of the eye, called an epicanthal fold.
Asian eyelids can be made to look more attractive through Asian eyelid surgery which creates a fold over the eyelid, and in certain cases removes the epicanthal fold and excess eyelid fat. Dr. Jane has had vast experiences with specialized techniques. In certain cases she can perform the surgery with the 4 points design using special instrument (10 Smile) without minimum downtime and no scar. Dr. Jane has been trained by prominent cosmetic surgeons in Korea to create most natural looking and beautiful Asian double eyelids. In certain cases she performs the surgery with very minimal incisions using the suture technique. This produces the upper eyelid crease with very minimal scarring and little downtime. Patients usually look great within a week.
Double-eyelid surgery is the most popular cosmetic surgical procedure in Korea. Whereas most surgeons in the United States perform cutting-type double eyelid surgery, Asian women prefer non-incisional techniques. The non-incisional techniques for creating double eyelids are either technically complex or did not produce lasting results.
Dr. Jane uses the suture technique to create double eyelids in Asian patients. She says the non-incisional procedure is “simple, durable, and virtually scar free.” The method uses only one or two sutures on each upper eyelid, with the durability explained by the areas of ties that result in more secure and therefore longer-lasting results.
(1) 10 Smile double fold Method:** non-incisional Method 4 point Suture Method.
The surgical strategy for creating an Asian eyelid fold is either to recreate the dermal attachment of the levator aponeurosis or to prevent the fat from descending below the desired eyelid fold height. The non-incision suture method of eyelid surgery creates the fold by recreating this dermal attachment using non-absorbable sutures
10 Smile double fold Method is the most sophisticated of the suture (non-incision) methods of double eyelid surgery. The traditional suture method has been criticized for its relatively high breakage rate and indistinct folds, which fade over time. The 10 Smile methods addresses these disadvantages while maintaining the benefits of a suture technique, such as the virtually scar-less fold, a supreme naturalness to the crease, the potential reversibility and the quick recovery, which takes just a few days instead of weeks. In a suture method eyelid procedure, a crease is created by burying permanent non-reactive sutures (prolene, used in heart valve surgery) pinching a bit of the undersurface of the eyelid skin to the deep soft tissue of the eyelid.
The best candidates for this technique have: A) thin skin that is not excessive and do not have a lot of upper lid fat, have not had prior eyelid surgery; B) whose brows are not low or heavy; C) who do not have complex eyelid problems such as ptosis (“sleepy eye”) or retraction (overly pulled upper lid). Other candidates for the procedure include A) men, who generally cannot conceal the incisions with makeup, B) smokers (more than ten cigarettes per day), who are at higher risk of prominent scar. C) Patients with a fear of incisional surgery. D) Those in need of quick recovery period (a few days not weeks). E) Those who are in their 30’s and 40’s with double fold or triple folds but want to have a little higher and more prominent double fold to open their eyes bigger
** For matching exactly same location on tarsal plate and conjunctiva, 10 Smile has been invented Dr. Jeong who is leading plastic surgeon in South Korea. The device can help result the upper eyelid crease with no scarring and very little downtime (1-2days). Patients usually look great within a week.
(2) Quick Eyelid Surgery: Partial Incision Method.
Thick eyelid skin or fatty eyelid can be done with this method. With very minimum size of opening, Dr. Jane can trim out extra fat or muscle to make natural looking Asian double folds.
The majority of our patients have been referred by friends who have had successfully done procedures in our clinic.
We consider the Quick Eyelid Surgery technique the procedure of choice for the ideal candidate, as described below. The best candidates for this technique have: A) thin skin that is not excessive and do have some upper lid fat, have not had prior eyelid surgery; B) whose brows are not low or heavy; C) who do not have complex eyelid problems such as ptosis (“sleepy eye”) or retraction (overly pulled upper lid). Other candidates for the procedure include A) men, who generally cannot conceal the incisions with makeup, B) smokers (more than ten cigarettes per day), who are at higher risk of prominent scar. C) Patients with a fear of full incisional surgery. D) Those in need of quick recovery period E) Those who want to have distinctive double fold.
(3) Incisional Technique
Risks of surgery Debate continues regarding the preference of incisional vs. suture method crease formation. Although suture techniques are sometimes disparaged as inferior surgery, patients resistant to the incision technique know something on an instinctive level – that the risks of an incisional surgery are more significant. The main risk of suture technique is fold failure. This is an annoying, embarrassing, but ultimately a readily correctable problem. The significant major risk of incisional surgery, on the other hand, is damage to the levator mechanism, which can result in ptosis (sleepy eye) or retraction (lid stare). Inexperienced surgeons can also create havoc by over removing fat and/or skin, resulting in an uncorrectable, permanent deformity.
In any case, the surgeon should not remove too much fat from the Asian eye because this results in a westernized appearance, which should be avoided.
(4) Medial epicanthoplsty
The nasal area of the fold bears a variable relationship to the medial epicanthus. A fold may begin on the undersurface of the epicanthal fold or on the visible outer surface. These are referred to as an “inside” fold or an “outside” fold, respectively. When the fold is set relatively high, the crease usually folds on the outside.
The medial epicanthal fold can be variable in configuration. The Flowers classification is based on the how much of the caruncle is visible. In type I, the caruncle is visible and resembles a white person’s anatomy. In type II, the caruncle is partially obstructed, while in type III, the fold is prominent and has an inversus component. Type IV resembles type I, except that the medial epicanthal fold is thick. A medial epicanthoplasty is recommended for patients with type III or IV and is optional for patients with type II.
Before and After Pictures
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*Individual results may vary.
FREQUENTLY ASKED QUESTIONS
The Best Height and Shape for the Asian Eyelid Crease
Of course, attempting to call the “best” height and shape for an Asian crease is risky since it comes down to at least partially a matter of personal opinion and sense of aesthetics. Some people prefer no crease at all. Besides considering what appears “natural,” the other main variable that plays into the equation is patient intent.
A low crease is the most natural, period. In those of Asian descent who are born with a crease, it’s almost always in the low range. If you’re now set on going high, try to come down to medium. If you’re now thinking about going medium, give a low crease your consideration. If you finally decide upon something higher, it’s your call. Just remember that lowering a crease later is a major undertaking that doesn’t always work.
Why? It’s because of the epicanthal fold in the inner corner. An epicanthal fold is present on almost every Asian lid. Simply put, a tapered shape respects the fold’s existence and yields the most harmonious final appearance. A parallel crease, while popular, does not. Unless you are of mixed Occidental and Asian lineage, of Filipino descent, or have an unusually long face with a very high brow, there is little reason to consider the semi-lunar shape.
Even though we almost always recommend a low tapered crease, about half of our patients (for the ladies, slightly more than half; for the men, less so) settle in on a medium parallel crease. Does the final outcome appear odd? Not at all. The higher platform of the parallel crease allows for the efficient application of makeup, but men like it, too. Is it the most natural crease (meaning the look that comes closest to what occurs minus any surgery)? No, but it also does not stand out as fake.
In summary, there is no perfect crease height and shape that is appropriate in every case. As in all operations on the face, however, it’s always prudent to stay within the confines of what most observers looking at you will take to be a non-surgical state.