Written by Dr. Julian De Silva
In many parts of Asia, double eyelid surgery, also known as Asian blepharoplasty, is the most common cosmetic procedure. London as an exciting multicultural city, has a high demand for Asian Blepharoplasty. The popularity of double eyelid surgery has grown rapidly in the last decade, as a defined eyelid crease has long been valued because it is seen as an attractive and expressive appearance.
Asian blepharoplasty is a surgery of finesse and detail, even 1mm difference between the two eyelids can be readily seen. The variability in appearance of the Asian eyelid has underlying anatomical and cultural differences that need to be considered with Asian blepharoplasty. Dr De Silva believes that eyelid reshaping requires a balance in considering the natural shape of the eyelid, consideration of a crease if present, tapering of the natural crease and the presence of an epicanthic fold.
Dr De Silva is a facial cosmetic surgeon specializing in the face only, he is known for natural looking results and uses the most innovative and contemporary techniques from Beverley Hills and New York. Blepharoplasty is the most common cosmetic surgery he performs, Asian blepharoplasty is considered to be technically a difficult procedure, which is why some cosmetic and plastic surgeons do not perform the procedure.
What is Asian blepharoplasty?
The anatomy of the Asian eyelid is unique and approximately 50% of Asians have no defined eyelid crease. The eyelid crease divides the upper eyelid into two segments known as a double eyelid shape. The majority of Asian patients who seek cosmetic Asian blepharoplasty do not want to look “Westernized,” they would like to keep their ethnicity and have more open eyes and a natural looking eyelid crease.
Why are Asian Eyelids Different?
The below images are taken from Dr Julian De Silva’s chapter on Asian blepharoplasty from the book titled The Complete Guide to Blepharoplasty and Eyelid Surgery.
In the figure below of the Caucasian eyelid the anatomy of the muscle that lifts your eyelid (termed the levator muscle) is marked with green arrows and this attachment forms the eyelid crease.
What is a double eyelid crease?
The eyelid crease is a naturally occurring fold in the upper eyelid skin that dived the upper eyelid into two parts. Although half of the Asian population have a crease it is often poorly defined or positioned low. Asian blepharoplasty enables reformation of a new more defined and higher crease.
Why have Asian blepharoplasty?
Common reasons for undergoing double eyelid crease surgery are to have a more open and attractive looking eyes. Motivations for surgery are specific to each person and other reasons include ability to apply make-up without smudging, improve symmetry, reduce fullness of upper eyelid and to replace the need for eyelid taping.
Dr De Silva’s Blepharoplasty Technique
Dr De Silva tailors each eyelid surgery to the individual patient. Key to a successful surgery is achieving each individual’s expectations. There is considerable variation in request for Asian blepharoplasty and Dr De Silva advises patients with specific requirements to bring photographs of eyelids they like. Dr De Silva utilises advanced techniques to ensure a natural long lasting result.
In the figure below, in an Asian eyelid there is an absence of the levator muscle attachments resulting in an absence or faint crease, the Asian post-septal fat is marked with a blue arrow, this results in making the eyelid appear fuller and the eye look smaller.
What are the different types of Asian eyelid creases?
There are a variety of naturally occurring shapes to the upper eyelid crease in Asians. Dr De Silva tailors his surgery to the patients’ own anatomy and their preference. The goal of the surgery is to achieve the patients’ expectations which commonly involves the creation of a natural Asian crease or a more open Caucasian crease.
- Parallel crease- The eyelid crease is in parallel to upper eyelid
- Temporal flare crease- The eyelid crease has an increased height from the eyelid towards the ear
- Nasal slant crease- The eyelid crease has increased height from the eyelid towards the nose
What does Asian Blepharoplasty involve?
Asian blepharoplasty is usually completed as an outpatient procedure under sedation anaesthesia. The procedure takes approximately one and half hours and patients are reviewed after 1-week when a stitches are removed. Shaping the eyelid is an intricate procedure as every Asian eyelid is unique in skin type, thickness, presence of epicanthic folds and relative fullness. Dr De Silva uses both skin-incision method and stitch method depending on a patient’s specific anatomy and expectations from surgery. Dr De Silva uses suture and micro-refinement techniques to maximise the result, uses the most innovative facial plastic surgery techniques to maintain a natural appearance. Dr De Silva has previously written book chapters on Asian blepharoplasty techniques.
Dr De Silva and patient safety
Patient safety is of key importance for all facial plastic surgery. The intricate anatomy of the eyelids requires precision and care. Dr De Silva is a keen advocate of patient safety and has championed the need for patient safety on Sky news.
What does Asian Blepharoplasty surgery involve?
There are over twenty differently reported techniques on Asian eyelid surgery which can be divided into three principal methods: the suture method, the partial-incision method and the skin-incision method.
The Skin-incision Method (Trans-Cutaneous Approach)
This method of Asian Blepharoplasty is the most effective long term, it involves making a skin incision in the natural crease of the skin, which is usually invisible in a few months. Eyelid surgery can result in swelling and bruising that takes several weeks to settle. The benefit of the skin-incision methods is that it enables a natural looking fold to be created that is long-lasting.
The Suture Method
The suture or stitch method avoid any incisions in the skin, except for the passing of the stitches. The suture method is appealing as it avoids significant incisions in the skin and the stitches are buried underneath soft tissues and the recovery from surgery is fast. Dr De Silva uses a customised suture method for Asian blepharoplasty where the recovery is usually only a few hours. The limitation with this method is that the sutures have relatively short effect compared to the other methods as the effect is completely dependent on the stitches, which can weaken with time.
The Partial-incision Method
The partial-incision method is a hybrid approach between the suture method and the full-incision method. Patients like this method as it has a relatively quick recovery of 1-2weeks with a small 1.5cm incision. The main disadvantage is that in some individuals there may be loss of the skin crease with time, that may be a few months to years depending on the person. The long-term effects are however better that the stitch technique alone.
What are epicanthic folds and magic epicanthoplasty?
The epicanthic fold is the name given to the fold of skin that is on the inner aspect of the upper eyelid that drops down to the lower eyelid concealing the inner aspect of the eye in many Asians. Traditional surgery to open up this part of the eyelid resulted if the use of plastic surgery flaps that could result in visible scars.
When indicated Dr De Silva uses a newer and innovative hidden incision technique that hides the incisions along the natural eyelid lines, termed “magic epicanthoplasty”. Epicanthus surgery in Asian blepharoplasty is intricate and millimetres determine the final result. The magic epicanthoplasty technique does speed up recovery and reduce the risk of scarring.
Dr De Silva uses this technique for specific patients to open up the eyes, minimise scars and achieve the double eyelid surgery while maintaining a natural enhancement.
What type of anaesthesia is used?
Sedative anaesthesia, also known as “twilight anaesthesia,” which is combination of local and sedative medications. At the centre we have developed our own specialised form of twilight anaesthesia, based on practices in the USA. This sophisticated sedation uses tiny amounts of four to five sedation medications that cumulatively give a relaxing and safe experience avoid the risks and side effects of general anaesthesia. A much shorter recovery period than general anaesthesia, with most patients able to leave 30 to 60 minutes following the procedure. These are the most advanced sedation techniques available, and the optimal option for patients considering Asian eyelid surgery.
For more information on sedation anaesthesia please see this link:
What is the ideal height of your eyelid crease?
The height of the eyelid crease is determined by your eyelid anatomy, the height of the rigid plate in your upper eyelid that gives it its tensile strength, termed the tarsal plate. The tarsal plate has an important function in enabling the eyelid to be effective in blinking and protecting the eye. The height of the tarsal plate varies (on average is between 6.0 and 7.5 millimetres) and is unique to each person. Dr De Silva measures the height of your eyelid tarsal plate during the procedure, and the final height of your eyelid crease is determined by the tarsal plate and your specific requirements. Key is not too low or too high to keep a natural looking enhancement
When can I return to social activities and work after Asian blepharoplasty?
The recovery from Asian Blepharoplasty is dependent on the method used for surgery. Most patients take one to two weeks off work and social activities. Approximately 80-90% of the swelling has resolved at this time. Residual bruising can be covered with cosmetics and mascara after ten days. As a result of normal swelling the upper eyelid may look to high immediately after the surgery, as the swelling reduced the skin crease height comes down. There are surgical techniques that Dr De Silva takes to minimise swelling and bruising, and there are steps that patients can take to improve the recovery period including avoiding medications and foods that encourage swelling and the use of cold compresses after surgery.
Before and After Photos
Asian blepharoplasty patient experience
What are the risks of Asian blepharoplasty?
The risks are similar to upper blepharoplasty, described in a previous chapter. Key to a good outcome is relative symmetry of the eyelids, this requires meticulous attention to detail in the eyelid crease position, and volume of fat reduction in the upper eyelids. A conservative amount fat is reshaped in the upper Asian eyelid to reduce eyelid fullness. Essential to a natural looking result is avoidance of over-removal of fat that results in a hollower appearance of the upper eyelid. Asian blepharoplasty is technically more demanding that Caucasian blepharoplasty and revision rates have been reported between 5 to 20%.
Will I have a visible scar after surgery?
Dr De Silva uses his own customised technique to achieve Asian blepharoplasty, the advantage over are the methods include a rapid recovery with minimal swelling less 1-week after surgery. The shape, contour and design of the eyelid crease is of paramount importance in hiding the scar from Asian blepharoplasty. The customised technique utilises the newly formed crease to hide the scar, although no scar is invisible, this hides the scar in a natural line. Any scar in the skin maybe slightly red and elevated immediately after surgery then with normal healing the scar remodels to become flat and difficult to see. The eyelid scars are usually relatively hidden and difficult to see after surgery.
Can Asian blepharoplasty be combined with other procedures?
Dr De Silva frequently combines Asian upper eyelid surgery with other facial procedures:
- Asian Blepharoplasty
- Lower eyelid surgery for puffiness (eye bags)
- Asian Rhinoplasty (enhance bridge and narrow features of nose, more definition to nasal tip)
- Chin augmentation and facial balance
- Facelift (deep plane, natural facelift)
Revision Asian Blepharoplasty
Asian blepharoplasty is regarding a challenging aspect of eyelid surgery as the degree of detail is fine and aspects including asymmetry are often present. Over 30% of all Dr De Silva’s patients have undergoing previous surgery and are termed revision procedures. Although more challenging than primary surgery often with Dr De Silva’s advanced techniques the overall appearance and symmetry of the eyelids can be improved.
More information on Blepharoplasty: