Asian Double Eyelid Surgery (“Asian Blepharoplasty”)

Approximately 50% of Asians have a single upper eyelid without a crease. Some individuals with a single eyelid prefer the look of double eyelids. Eyelid plastic surgery, or blepharoplasty, can create a double eyelid from a single one. This procedure involves adding a crease to the single eyelid to mimic the appearance of a double eyelid. Dr. Boonipat trained in Asia during his fellowship, specializing in incisionless methods to create a natural-looking double lid crease using only sutures. 

Purpose and Benefits:

Asian eyelid blepharoplasty aims to enhance eye shape for attractiveness. Single eyelids without creases may appear small or droopy (a condition called ptosis can also occur occasionally). Excess skin can impact appearance and vision. Creating a fold or removing surplus skin can make the eyes look more open. The objective is to achieve a balanced Asian double-eyelid appearance that harmonizes with other facial features without creating a Westernized eye shape. 

FAQ: Asian Double Eyelid Surgery

How is an Asian double eyelid surgery performed?

This depends on your anatomy and your goals. For most younger patients, the incisionless suture technique is the best option to create the double crease. There are practically no scars, and very minimal swelling or bruising afterward. The recovery is short, typically 1-2 days. The sutures recreate the fibrous attachment that naturally exists in people with natural double eyelids (between the tarsal plate and the soft tissue structures of the levators and skin). The result usually lasts 5-15 years. 

In cases where more fat removal is needed, a small incision (5-6mm) might be required. The recovery will be longer, around 3-4 days. 

For older patients with excess fat and skin, skin removal is necessary. This involves creating an incision to remove the excess skin. The incision heals very well, and after a few months, most incisions are hard to see at a conversational distance. Healing typically takes about one week. 

The surgery is performed under local anesthesia, and you may sit up and look at yourself during the procedure. General Anesthesia can also be added if preferred. 

Am I a good candidate for Asian double eyelid surgery?

• Your eyelid covers a significant portion of your iris (the darker part of your eye), or you are displeased with its shape. 
• There is surplus fat in your eyelids, resulting in a puffy appearance. 
• When you open your eyes, your upper eyelid folds inward, leading to eyelash contact with the cornea, causing irritation and potential damage. 

What to expect after double eyelid surgery?

Post-surgery, most patients report minimal discomfort. Swelling varies depending on the procedure performed, with those involving fat and skin removal causing more swelling. Stitches for incisional methods are typically removed within 4-6 days. Bruising usually subsides around the 1-2 week mark. Return to desk work is generally possible after 1-4 days. Driving can typically be resumed within 1-2 weeks. Gradual resumption of physical activities is recommended 2-4 weeks post-surgery. 

What are the risks of double eyelid surgery?

Major complications are extremely rare. Some degree of asymmetry between the two sides is expected, but any major asymmetry is unlikely as the surgery is performed with local anesthesia, and you can sit up and look at yourself during the procedure. Revision surgery might be needed, particularly in patients with ptosis or protruding eyes. Minor eye irritation and the temporary need for eyedrops may occur. Your eye may need 1-2 weeks to adjust to the new eyelid position. You will still be able to close your eye when you sleep, but in cases of ptosis repair, you might need eye ointment for 1-2 weeks while your eye slowly closes over time. Infection is very rare. Bruising is usually minimal. Bleeding is very rare but can occur and might require another procedure. Blindness is exceedingly rare. 

What is ‘fold failure’ and why does it happen?

Double eyelid surgeries may result in fold failure due to various reasons. Incisional methods may fail due to limited dissection or improper skin/muscle attachment. Dr. Boonipat addresses this by securing the skin to the tarsal plate and levator tendon in anchor blepharoplasty. Traditional suture techniques can fail because sutures can tear through soft tissue. Eye anatomies prone to fold failure include deep-set eyes and patients with eyelid ptosis. Deep-set eyes strain incision lines, increasing the risk of breakage. Ptosis patients have difficulty forming a firm crease, making it prone to breaking. 

What is ptosis?

A droopy eyelid can result from either a congenital weak eyelid muscle or muscle detachment from the tarsus, typically due to aging. Ptosis, particularly among Asians, affects around half of patients undergoing Asian eyelid surgery. Treatment depends on the cause: reattachment of the muscle if detached or strengthening/shortening the muscle to position the eyelid correctly at rest. 

Cost?

Please contact us about the cost as the exact procedure needed is tailored to your goals and anatomy. Insurance typically does not cover Asian eyelid surgery for cosmetic reasons, but it may cover corrective procedures in certain cases. Ptosis, a condition where a drooping eyelid affects vision, can qualify for insurance coverage. Ptosis may result from a weakened levator muscle, common in congenital ptosis in younger patients. Another cause is levator dehiscence from the tarsus, often occurring in older patients due to aging. A visual field test can assess the severity of ptosis and determine if insurance covers corrective surgery.