PRIME Journal Vol. 11 Issue 4

DOUBLE EYELID SURGERY JesperThulesen explainswhysomepatients request the Asianblepharoplastyor doubleeyelidprocedure, the techniques availableand the results ABSTRACT Double eyelid surgery is a cosmetic procedure to treat monolid—a condition in which there’s no natural fold in the upper eyelid between the eyelashes and the eyebrow. The double eyelid is a desirable physical feature especially among the Asian population, which is now increasingly popular and demands modern up-to-date aesthetic operations for its formation. The author describes strategies for types of double eyelid operations, and the advantages, disadvantages, and indications for these methods are briefly evaluated and discussed. A SIAN BLEPHAROPLASTY, COMMONLY termed double-eyelid surgery, refers to surgery designed to place a crease in Asian eyes that do not have a supratarsal fold in the skin. Patients typically desire to look more bright- eyed and want to make applying eye makeup easier. Patients also seek to remove the puffy and tired look associated with a fatty upper lid and may wish to have a crease similar in appearance to Asian friends who were born with such a crease. Asian patients may also seek to westernise their appearance, although this is controversial. In the eyelids of the caucasian, the eyelid crease is determined by the insertion of tissue extensions from the deeper connective tissue of the levator aponeurosis to the skin 1 . The eyelid crease and fold are important aesthetic landmarks and are a vital feature of the upper eyelid appearance. The Asian eyelid has more fullness of the upper eyelid, no crease (‘monolid’) or lower‑lid crease on one or both sides, and narrow palpebral fissures (‘smaller eyes’) 2 . History The earliest reference to upper lid fold creation appears in Japanese literature in the late 1800s 3 . The surgeon created a fold in the second eye of a female patient born with a fold in only one eyelid. In English literature, the first surgical case was described in the early 1950s 4,5 . The hallmark of the modern double eyelid operation and probably the most common technique of incisional double eyelid surgery was described in 1960 6 . Frequency Approximately 50% of people of Pacific Asian descent KEYWORDS Double eyelid surgery, Asian blepharoplasty, Supratarsal crease, Eyelid surgery, Oculoplastic surgery JESPER THULESEN, MD, PHD, DR. MED. SCI., FEBO is an Oculoplastic Surgeon at Hovedstadens Eye Clinic ( ), and an Aesthetic Medical Physician at Clinic Aesthetica Kongens Nytorv ( ). Store Kongensgade 36, 4., 1264 Copenhagen K, Denmark, email: (e.g., Korean, Japanese, Chinese) have an eyelid crease—either one or on both sides ( Figure 1 ). The fold represents the insertion of profound tissue fibre expansions from the levator aponeurosis into the dermis (deep skin layer) 1 . Presumably, Asians have a lower insertion point than in the Caucasian eyelid, leading to smaller or absent folds. The lower height of the sling inAsians allows the fat to sit lower in the eyelid, leading to a smaller fold. In Asians with a fold, the height of the normal lid fold lies 6–8 mm from the lash line with the skin gently stretched. From the nose, it begins close to the lash line and then reaches a maximum height at the mid pupil. It stays at this height, extending to the bone rim at the side. In contrast, folds in non-Asians tend to be larger due to the height (8–12mm) and have less fat or fat pads located higher upward than Asians 2 . Patients Traditional approaches to placing a crease involve suturing the dermis to a more profound plate of connective tissue in the eyelid—either the so-called aponeurosis or the tarsal plate. Most commonly, the patient for this procedure is female and presents in mid- adolescence or is female and is in her early 20s. Male patients, seen occasionally, tend to be slightly older, aged in their late 20s to early 30s. Female patients may report difficulty applying eyeliner. Not infrequently, females may apply cellophane tape to create a fold as part of the daily makeup ritual; the patient desires surgery to spare herself this inconvenience ( Figure2 ). Occasionally, an older patient presents to report problems related to the ageing upper eyelid and/or periorbital area. AESTHETIC FEATURE | BLEPHAROPLASTY | 32 September/October 2021 |