Asian eyelid surgery – Asian blepharoplasty

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This article is a quick guide to the anatomical differences between East Asian and Caucasian eyelids – and how this impacts on eyelid surgery (blepharoplasty).

The basic, anatomical differences in Asian and Caucasian eyelids

Anatomically speaking, there are a number of subtle differences in the upper eyelids of East Asians compared to the eyelids of Europeans and Sub-Saharan Africans. While some East Asians have an eyelid crease and some do not, there is also a large variation in the skin fold position of the upper eyelid in East Asia. The position of the upper eyelid skin fold can vary from 1 mm above the lash line to approximately 10 mm, but when people come to the ELZA Institute for oculoplastic surgery, the changes they desire is very individual, but usually the goal is to obtain a more energetic, youthful and natural look.

The upper eyelid is a complex structure that primarily has the task of protecting the eye, but also has a great influence on the patient’s appearance (e.g. they look energetic, or tired). The tarsus gives firmness to the upper eyelid and has contains the Meibomian glands which provide the tear film on the ocular surface with an oily substance (sebum), which is important for lubrication. The levator and Müller muscles ensure that the eyelid can be lifted. The eyelashes protect against dust and debris and the skin gives general protection at the front of the eye. The sphincter muscle (M. Orbicularis) enables active eye closure and runs just below the skin. The orbital septum is an important barrier against infection, and also stops a bruise from going to the orbit.

Cross-section through Asian upper eyelid. Notice the purple line, which represents the connective tissue sheet (septum orbital), which continues towards the eyelash base; the fat behind this sheet extends downwards towards the eyelid lashes.

Cross-section through Caucasian upper eyelid. The purple line (connective tissue shot or septum orbital) inserts on the tendon of the eyelid lifter (levator muscle). At the level of this insertion, there are fibers between this tendon and the skin, resulting in a fold (crease), usually 8-10 mm above the lash line.

Asian eyelid surgery – what is it?

The most commonly performed eyelid surgery in people from East Asia is sometimes referred to as “double eyelid surgery”, and is a cosmetic surgical method that reconstructs the skin of the upper eyelid. Often oculoplastic surgeons also partially remove any skin surplus, which is a natural consequence of ageing. We oculoplastic surgeons can also create an eyelid crease – something that is naturally missing in people from East Asia (which is sometimes referred to as a “mono-lid”).

Asian upper eyelid – without skin fold. Preoperative image. Epicanthal folds on nose side upper eyelid.

Asian upper eyelid – with skin fold. Postoperative image.

Asian upper eyelid without skin fold (left) versus Caucasian upper eyelid (with skinfold) right

Importance of experience and training

It is important that the doctor performing this procedure has special expertise in this area. Oculoplastic surgeons are ophthalmologists who specialize in eyelid surgery and who – like no other – understand the complex relationship between the eye and the eyelid. For example, an assessment of the different aspects of the eyelid such as eyelid height (the position of the lash line relative to the pupil), the amount of skin, the presence or absence of a so-called eyelid crease (the line above which the skin fold forms), the shape of the epicanthal fold, and the position and shape of the eyebrow should all be made preoperatively. It is also important to look for signs of dry (or wet) eyes, as this helps to prevent eye complaints after the procedure.

A natural look

Photos from the past (around the age of 20–25 years) can give a good indication of the natural look of the eyelids and eyebrows – if too much tissue is removed, then it results in eyelids with an unnatural look.

After careful evaluation of the upper eyelids and the eyelid features on old photographs, combined with a comprehensive understanding the wishes of the patient, marks are made on the eyelids at the desired location. Careful attention is paid to achieving symmetry between the upper eyelids, with dimensions being measured at this point in the procedure. This is followed with several injections in the eyelids under monitored anaesthesia.

The eyes remain closed during the procedure. The skin surplus is surgically removed, and careful coagulation of the blood vessels is performed to prevent blue discoloration (bruising) of the skin after the procedure. If a skin fold needs to be accentuated or made, this is done with soluble sutures. The skin is then closed with a continuous suture which can be removed after 5–7 days.

Duration of surgery

The operation of both upper eyelids takes about 45 minutes, but with the marking, explanation and postoperative cooling, the patient will be in the clinic for about 2 hours in total.

Perioperative care

The ELZA surgical team creates a pleasant and a relaxed atmosphere, where the client feels comfortable, and we attach a great deal of importance to ensure patients are relaxed and pain free in the perioperative period (just after surgery) in particular. This might sound slightly disturbing; it isn’t. To put this in context, after the surgery, many people comment that they actually preferred to undergo eyelid surgery than to visit their dentist.

Experience with eyelid surgery and ELZA

The ELZA Institute in Zurich, Switzerland has extensive experience of all types of eyelid surgery, including Asian eyelid surgery. Dr. Paridaens, ELZA’s consultant oculoplastic surgeon, has performed more than 35,000 oculoplastic procedures, and patients around the world have sought his help for surgical eyelid correction. He is also often asked by ophthalmologists and plastic surgeons to perform reconstructive operations following failed corrections elsewhere.

The ELZA team are happy to advise you further – click here to arrange a quick chat about the procedure.

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Asian eyelid surgery – Asian blepharoplasty

The basic, anatomical differences in Asian and Caucasian eyelids

Asian eyelid surgery – what is it?

Importance of experience and training

A natural look

Duration of surgery

Perioperative care

Experience with eyelid surgery and ELZA

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