Asian eyelid surgery – Asian blepharoplasty

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.


Dion Paridaens Operating in ELZA
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Augeninstitut ELZA
4.8
Based on 107 reviews
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Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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