Ethnic Consideration in Asian Eyelid Surgery
Double eyelid surgery is a common procedure for patients of Asian descent that is no age related. The most frequently expressed concern is the desire to maintain a natural appearance after surgery. Unfortunately, many Asian patients come in with anecdotes of people they know who underwent eyelid surgery with poor outcomes. At this time, it is generally understood that the Asian patient does not desire Europe-anization of the eyelids, which translates into a high eyelid crease with less tissue volume over the eyes. The Asian patient typically desires a crease in the eyelid, which approximately 50%of Asians naturally have. Although there are options, such as having the crease taper directly into the epicanthal fold, or having the crease taper parallel to the fold, I have found that there is a natural tendency of the crease to form in a way that is appropriate for each individual anatomy.
This may be predicted during consultation by placing an instrument at the planned eyelid crease to push the skin inward. Very often, it is easy to demonstrate to the patient what the most natural appearance would be. The eyelid crease is lower in the Asian patient than in Caucasian patients of the same age and sex.
Many patients who desire upper eyelid enhancement will have some impression in the skin, where the eyelid creases inward occasionally, If this impression is not present, I use the height of the tarsus as a starting point although, aesthetically, the crease may need to be lower. The thickness of the skin in Asians requires careful consideration, as the transition of sub-brown skin to upper eyelid skin in Asian patients is not uniformly the same.
Many patients have thick skin all the way to the lashes while others have a more ” usual ” transition of thick skin at the sub-brow area to thinner skin at the planned crease area. The orbital septum inserts at a lower point on the eyelid. I generally incise the septum and very conservatively remove fat mainly for the purpose to provide a barrier free pathway for skin sutures to incorporate the levator aponeurosis during closure. I have had many patients who present with overresection of fat from previous surgeries, resulting in high and un-natural creases. Some of these patients have benefited from fat transplantation in the subbrow region and the anterior orbit.
My next article will be on ” ethnic considerations in African American Patients “
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