The Oriental Eyelid Crease
The eyelid crease is an important landmark in eyelids. Its presence, height and contour can dramatically alter the way an eyelid appears. Half of patients of Oriental descent lack an eyelid crease, whilst the remaining half do have a crease of some description.
Because of the way the presence of an eyelid crease changes the appearance giving the impression of two parts to the eyelid i.e. above and below the crease, some have termed eyelids with creases as 'double eyelids' and those without creases as 'single eyelids'.
The cultural significance of an eyelid crease in Oriental society
For many Oriental societies, the presence of an Oriental eyelid crease is seen to be cosmetically desirable and indeed this is reflected in modern day culture with many Chinese/Japanese pop icons & models undergoing surgery or using eyelid glue/taping to achieve a skin crease.
Asian blepharoplasty, also known as double eyelid surgery, is the most commonly requested cosmetic surgery by oriental patients worldwide. The term blepharoplasty just means 'eyelid refashioning'. The term 'Asian Blepharoplasty' arose from the US, but probably a more accurate term would be Oriental blepharoplasty.
This type of cosmetic eyelid surgery is performed on many types of patients of both oriental and mixed oriental descent and is now the most commonly performed cosmetic procedure on patients of Oriental descent.
A normal child of Oriental origin. Notice the variation in eyelid shape even within the same patient. She has no skin crease over her right eyelid and a skin crease over her left. Even though her left eye is as open as her right, the presence of the skin crease gives the impression of it being larger.
There are many Oriental patients with different variations of eyelid shape seeking Asian blepharoplasty e.g. without an eyelid crease, with a poorly defined eyelid crease, with an eyelid crease but with hooding, etc.
Most Oriental patients requesting blepharoplasty surgery seek better definition of an eyelid crease or to create a new eyelid crease. This can often lead to differences in how the patient is perceived and how the patient feels in him/herself. Just the presence of an eyelid can give the impression that the patient is more awake, more alert, more expressive with a softer, more attractive eye appearance.
Many Oriental women comment on how they can wear make-up properly after Asian/ Oriental blepharoplasty surgery/ double eyelid surgery due to better definition of their eyelid and exposure of the eyelashes that were previously hidden by eyelid skin.
Asian/Oriental blepharoplasty (Double eyeld surgery) is NOT Westernisation Surgery
It is very important to recognise that the Oriental eyelid is very different to the Western occidental eyelid with very different anatomy. Similarly, it is also crucial that the surgeon recognise that there are many different variations of normal Oriental eyelids, both in those with eyelid creases and those without, depending on the patient's family origin.
Most Oriental patients do NOT wish to look like their Western/Occidental colleagues. Indeed, a standard blepharoplasty designed for an Occidental/Western eyelid would look very strange and disharmonious with the rest of the face in a person of Oriental descent.
Instead, most Oriental patients seek better eyelid crease definition i.e. to create an Oriental looking double eyelid.
The surgery to create an Oriental looking eyelid crease is therefore very different to a conventional Occidental/Western blepharoplasty. Counselling a patient for an Asian/Oriental blepharoplasty (double eyelid surgery) during the preoperative visit is probably just as important as the surgery itself, since it is during the preoperative visit that the important decisions about the design of the eyelid crease are made such as where to set the height and shape of the new eyelid crease.
The Occidental/Western eyelid crease is very different with a semilunar shape with greater exposure of the eyelid itself (eyelid show) due to its higher position.
Caucasian/ Western/ Occidental Eyelid Typical Anatomy
Note how the lower half of the eyelid is thin as it comprises of cartilage (tarsal plate) with skin and muscle (orbicularis oculi) on top.
Note how the levator aponeurosis attaches into the skin and muscle forming the skin crease.
Oriental/ East Asian Eyelid Anatomy without Skin Crease
Note how the Oriental eyelid is often bulkier due to the orbital fat coming forward more and being lower down on the eyelid than its Caucasian counterpart.
Note also how the levator aponeurosis does not attach into the skin and muscle - hence there is no skin crease.
The ultimate aim of an Asian/ Oriental blepharoplasty (double eyelid surgery) is to create a skin crease to enhance the appearance of the eye, yet at the same time, preserve the features of Oriental ethnicity for the patient. It is therefore very important that when seeing a patient for the first time for their eyelid surgery, that time and meticulous attention is spent to ensure that both patient and surgeon are clear about what the desired eyelid configuration since there are so many variations of Oriental eyelid creases with varying skin crease lengths, shape (tapered, flared, parallel) and amounts of upper eyelid show.
There are two basic methods for creating an eyelid crease:
Worldwide, the closed thread is the more population operation largely because of its simplicity and the minimal training required to perform the procedure. Indeed in some parts of world the operation isn't even performed by surgeons at all e.g by beauticians. The recovery time is marginally quicker due to the operation being less invasive. The closed thread/suture technique is more suitable for patients eyelids with minimal fat in their pretarsal/ pretarsal eyelid i.e. with a higher orbital septum. This operation works by plicating a fold into the eyelid and is largely dependent on the sutures within the eyelid staying intact. Hence the fold may disappear if the internal sutures break.
Although, Mr Cheung can offer both techniques, Mr Cheung prefers the latter open incision technique since it allows for excellent intricate design and construction of a natural looking eyelid crease, is much more likely to be permanent due to the creation of stronger attachments to the deeper eyelid structures. It also allows for additional procedures to be carried out at the same time if required e.g. medial epicanthoplasty, fat debulking, muscle debulking, ptosis correction, orbital septum repositioning, etc.
The operation is usually done as a day case procedure under local anaesthetic injections and is very well tolerated. Each operation usually takes about an hour to do both upper eyelids. Recovery time is usually very quick with minimal bruising/swelling that rapidly reduces over a few weeks. In most patients, 80% of the maximal postoperative swelling typically dissipates within 2 weeks.
There are several types of patients who request Asian/ Oriental blepharoplasty/ Double Eyelid Surgery:
Case 1: 23 year old female- Incisional Asian Blepharoplasty. This lady did not have an eyelid crease at all and sought one
Case 2: 35 year old female- Incisional Asian Blepharoplasty with medial single anchor point epicanthoplasty. Although this lady had an eyelid crease, she requested improved exposure of the eyelid and eyelashes, thus improving the effect of eyeshadow and mascara, whilst still retaining a typically oriental appearance to the eyelid. (Click image to see gallery)
Case 3: 22 year old lady - Incisional double eyelid surgery with single anchor point medial epicanthoplasty. This lady was born with quite low skin creases. She requested increased eyelid show to allow her to wear eye shadow and mascara but still wished to look very much Oriental in origin. (Click image to start gallery)
Case 4: 28 year old female - incisional double eyelid surgery. This lady wanted improved eyelid crease definition. She complained that her eyelids looked untidy with multiple skin creases and multiple folds. (Click image to start gallery)
Case 5: 28 year old female - incisional double eyelid surgery to right upper eyelid only. This lady was born with a skin crease in her left upper eyelid but no crease on her right. She complained that her right eye looked smaller and she preferred the appearance on the left. Double eyelid surgery was therefore performed on her right upper eyelid to make it match the left.