Asian Eyelid Surgery in Beverly Hills
The anatomy of the Asian eyelid is quite different from that of people of non-Asian descent. Non-Asian eyelids almost always have a natural fold near the lower portion of the upper lid, known as a “double fold.” However, while some people of Asian descent may have double-fold lids, about 50 percent of the Asian population lacks the natural fold just above the lashes in the upper eyelid, creating a “single fold” upper eyelid. Depending on the aesthetics of your face, this single-fold structure can prevent you from having the bright, defined eyes you desire.
Asian Eyelid Surgery (also called double eyelid surgery) addresses the unique needs of those with single folds to provide the facial appearance you want—enhancing your natural beauty while maintaining your ethnicity.
What are the Benefits of Double Eyelid Surgery?
No Longer Looking Tired or Sleepy
The eyelid may not open if the muscle weakens or becomes disconnected from the eyelid cartilage (the “tarsus”). This condition, called ptosis (“drooping”), can either result from aging or genetics and is routinely addressed during eyelid crease surgery by reattaching the muscle more firmly to the tarsus. The result is a brighter, more alert appearance.
Reduction in Frown Lines or an Angry Appearance
When the eyelid cannot clear the upper one–third of your visual field, the frown muscles of the forehead have to kick in and help open up the remaining one–third of the visual field. These frown muscles can make you look angry and can etch themselves permanently into your forehead. Eyelid surgery will open up the eyes to increase your visual field.
Eyelashes That Point Up Instead of Down
Many people (up to 50 percent) of all ethnicities have a common condition called ptosis, in which the eyelid muscle does not fully open the eyelid. One of the signs of ptosis is downward-pointing eyelashes. During eyelid surgery, the ptosis is corrected, and the eyelid crease is set, helping to get the lashes pointing outward in the correct orientation.
Enhancing Your Appearance While Maintaining Your Unique Ethnicity
It’s essential to maintain your ethnicity when performing any cosmetic surgery. Regarding eyelid surgery, there are some essential differences between Asian and non-Asian eyelid folds. The Asian upper eyelid crease begins close to the eyelashes and gets larger until the midpoint of the pupil; after this point, the crease runs parallel to the eye. The non-Asian upper eyelid crease runs parallel to the lid margin and is 20 percent larger than the Asian eyelid crease. A thorough understanding of these ethnic differences helps Dr. Lee produce natural-looking results for his Asian Eyelid Surgery patients.
Am I a Candidate for Asian Eyelid Surgery?
Candidates for Asian Eyelid Surgery should be physically healthy and have realistic expectations of their results. Potential candidates for Asian Eyelid Surgery may also have one or more of the following issues:
- Small or non-existent upper eyelid folds,
- Uneven or asymmetric eyelid folds
- A fatigued or dulled expression due to weakness in the eyelid muscle
- Excessive eyelid skin on the inner corner of the eye (inner epi)
- Forehead wrinkles formed because of the constant raising of your brows to widen your eyes
- Eyelids that droop over the top portion of your eye
- Puffy eye appearance due to excess fat in your lids
- Fatigue or headaches
Even if you don’t have any of the above issues, you may choose Asian Eyelid Surgery simply because you wish to have your eyes appear wider or more open for aesthetic reasons.
Choosing the Right Surgeon for Asian Eyelid Surgery
Because there is a wide variety of eyelid types, not every surgeon is qualified to perform double eyelid surgery. An internationally recognized expert trained Dr. Lee in double eyelid surgery, and his experience in Asian Eyelid Surgery procedures is unmatched. Choosing a highly skilled and experienced surgeon in double eyelid surgery will maximize your chances of an excellent outcome.
Asian Eyelid Surgery FAQ
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What techniques are used in Asian Eyelid Surgery?
Asian Eyelid Surgery can be either incisional or non-incisional. Anchor blepharoplasty is an incisional method of creating a crease, giving the patient a double eyelid. To achieve this, the skin is cut, tissue is excised, and the skin is attached to a firm structure within the eyelid (tarsus, AKA tarsal plate). While many doctors simply attach the skin to the levator muscle, Dr. Lee prefers to additionally attach the skin to a deeper structure, the tarsal plate, along with the levator muscle. Whereas the levator muscle moves with the eyelid, the tarsal plate is static. Attaching the skin to both structures allows for greater precision when placing the crease and also reduces the possibility of fold failure. Medial epicanthoplasty, another incisional technique, is often used in conjunction to crease surgery to remove any excess inner fold skin (Mongolian fold) and allow the new eyelid crease to fold more smoothly.
The Double Suture and Twisting (DST) technique is a non-incisional method of creating a crease in the eyelid. Instead of being cut, the eyelid is simply stitched together. While the DST technique requires specific conditions in the patient to work to its full potential, it is an excellent technique for younger, qualified patients, as it is less invasive and involves less swelling and a shorter recovery than incisional techniques.
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What are the limitations of DST suture-only surgery?
- 1. Small crease height. No skin is removed, so the crease will be smaller and more mobile than an incision technique. There is less control over the final size and shape.
- 2. Limited ptosis repair. If you have asymmetry of the eyes, and particularly if one eye is droopier than the other, there will be more limitation in how evenly the eyes can be matched up to each other. The resting tension of the eyelid-elevating muscle can be adjusted from the undersurface of the eyelid and incorporated into the DST procedure, but the correction is more difficult to control precisely, as can be done with an incision approach.
-
What is “fold failure” and why does it happen?
Double eyelid surgical methods can lead to fold failure for various reasons. Some incisional procedures fail because of limited dissection, while others fail because of the location where the skin/muscle is secured. For instance, the popular technique of securing the skin to the levator aponeurosis can lead to an imprecise crease and a higher rate of fold failure. This is why Dr. Lee additionally secures the skin to the tarsal plate and levator tendon when performing anchor blepharoplasty.
Similarly, traditional suture techniques often fail because the sutures are merely buried in the lid, creating the potential for the sutures to tear through the soft tissue of the upper eyelid. The DST technique resolves these issues by securing the skin/muscle to the tarsal plate to create a more permanent crease with a far lower risk of fold failure.
The two most common types of eye anatomy prone to fold failure are: 1. Deep-set eyes and 2. Patients with eyelid ptosis (weak eyelid muscle). Deep-set eyes strain the incision line and have a higher risk of breaking it. Patients with ptosis have incomplete opening of the eyelid so that the crease cannot form very firmly and is prone to breaking.
-
Does insurance cover double eyelid surgery?
If you wish to undergo Asian Eyelid Surgery for purely aesthetic reasons, it is highly unlikely that your insurance will cover the procedure. However, in some cases, corrective eyelid surgery can be covered by insurance. Patients with a condition known as ptosis have a drooping eyelid that interferes with vision, sometimes caused by a weakened levator muscle. Weakened levator muscles are often seen in younger patients with congenital ptosis. Other causes of a drooping eyelid is the dehiscence of the levator from the tarsus, which is the loosening or detachment of the eyelid muscle, and commonly occurs in older patients as part of the aging process. A visual field test can determine whether your ptosis is severe enough to have correction be covered by PPO health insurance.
-
Can BOTOX® Cosmetic help with excess forehead wrinkles and an angry look?
If the angry look is a by-product of having your upper visual field blocked, then you need to correct the eyelid surgically. BOTOX® Cosmetic will reduce the frown lines at the expense of dropping the brows and a return to a loss of your upper visual field.
-
My upper eye socket is hollow and my brows are very high. Why is this? Can I use fillers and BOTOX® Cosmetic for this?
Frequently, a retracted brow is caused by its attempt to help open a weak upper eyelid. This also creates an upper eyelid socket hollow. Correction requires adjusting the upper eyelid muscle tension and then repositioning the eye fat which, has been sucked up under the eye socket. BOTOX® Cosmetic will have the unwanted effect of drooping the eyelid; fillers will create a similar problem by making the upper eyelid heavier and burdening the already-weak eye muscle.
-
What types of eye anatomy are more difficult to operate on and at higher risk of a poor outcome?
Eyes that bulge forward are at risk for creasing at the wrong location. Similarly, patients with ptosis requiring correction at the time of crease surgery are also at risk for this. In these instances, there is not much clearance between the elevating muscle and the overlying skin. Therefore, the muscle can “catch” the upper lid skin as it is opening. For these reasons, very little fat should be removed for patients with at-risk anatomy. In some cases, fat grafting to the upper lid is necessary to create more distance between the skin and the moving muscle.
-
What is ptosis?
This is a droopy eyelid. The cause of this is related to either a weak eyelid muscle (which you are born with) or a detachment of the muscle from the tarsus (the cartilage skeleton of the lid margin), usually associated with aging. Ptosis, in Dr. Lee’s opinion, is more common in Asians, affecting as many as half the patients undergoing Asian Eyelid Surgery. Depending on the cause, the muscle needs to be reattached (if detached), or it needs to be strengthened/shortened so that the eyelid is in the proper position at rest.
-
Will I end up sleeping with my eyes open?
This is not likely to happen unless you have ptosis requiring significant shortening of your eyelid muscle. In many such cases of ptosis repair, the eyes will be able to close over time.
-
Is Asian Eyelid Surgery painful?
Pain is minimized during the procedure by placing you under IV anesthesia, which makes you sleepy and comfortable. Post-operatively, the minimal pain is controlled with simple TYLENOL®.
-
What other risks are associated with Asian Eyelid Surgery?
The chances of a poor outcome decrease with the skill and experience of the surgeon. Asymmetry or an unnatural look are the most common complications, but an experienced surgeon can point out whether your anatomy is more difficult than the typical patient’s. Patients with ptosis or protruding eyes are at higher risk for revision surgery. Certain patients have poor healing characteristics, especially those who bruise easily, smoke, or have very distensible joints.
-
What scars should I expect from Asian Eyelid Surgery?
If Dr. Lee uses the non-incisional method, you will not have scars after your double eyelid surgery. The incisional method does leave scars, but they are very small and hidden in the natural creases of your eyelids. Incision scars may appear pink or noticeable initially but will fade quickly as they continue to heal.
What techniques are used in Asian Eyelid Surgery?
What techniques are used in Asian Eyelid Surgery?
Asian Eyelid Surgery can be either incisional or non-incisional. Anchor blepharoplasty is an incisional method of creating a crease, giving the patient a double eyelid. To achieve this, the skin is cut, tissue is excised, and the skin is attached to a firm structure within the eyelid (tarsus, AKA tarsal plate). While many doctors simply attach the skin to the levator muscle, Dr. Lee prefers to additionally attach the skin to a deeper structure, the tarsal plate, along with the levator muscle. Whereas the levator muscle moves with the eyelid, the tarsal plate is static. Attaching the skin to both structures allows for greater precision when placing the crease and also reduces the possibility of fold failure. Medial epicanthoplasty, another incisional technique, is often used in conjunction to crease surgery to remove any excess inner fold skin (Mongolian fold) and allow the new eyelid crease to fold more smoothly.
The Double Suture and Twisting (DST) technique is a non-incisional method of creating a crease in the eyelid. Instead of being cut, the eyelid is simply stitched together. While the DST technique requires specific conditions in the patient to work to its full potential, it is an excellent technique for younger, qualified patients, as it is less invasive and involves less swelling and a shorter recovery than incisional techniques.
Close
What are the limitations of DST suture-only surgery?
What are the limitations of DST suture-only surgery?
- 1. Small crease height. No skin is removed, so the crease will be smaller and more mobile than an incision technique. There is less control over the final size and shape.
- 2. Limited ptosis repair. If you have asymmetry of the eyes, and particularly if one eye is droopier than the other, there will be more limitation in how evenly the eyes can be matched up to each other. The resting tension of the eyelid-elevating muscle can be adjusted from the undersurface of the eyelid and incorporated into the DST procedure, but the correction is more difficult to control precisely, as can be done with an incision approach.
Close
What is “fold failure” and why does it happen?
What is “fold failure” and why does it happen?
Double eyelid surgical methods can lead to fold failure for various reasons. Some incisional procedures fail because of limited dissection, while others fail because of the location where the skin/muscle is secured. For instance, the popular technique of securing the skin to the levator aponeurosis can lead to an imprecise crease and a higher rate of fold failure. This is why Dr. Lee additionally secures the skin to the tarsal plate and levator tendon when performing anchor blepharoplasty.
Similarly, traditional suture techniques often fail because the sutures are merely buried in the lid, creating the potential for the sutures to tear through the soft tissue of the upper eyelid. The DST technique resolves these issues by securing the skin/muscle to the tarsal plate to create a more permanent crease with a far lower risk of fold failure.
The two most common types of eye anatomy prone to fold failure are: 1. Deep-set eyes and 2. Patients with eyelid ptosis (weak eyelid muscle). Deep-set eyes strain the incision line and have a higher risk of breaking it. Patients with ptosis have incomplete opening of the eyelid so that the crease cannot form very firmly and is prone to breaking.
Close
Does insurance cover double eyelid surgery?
Does insurance cover double eyelid surgery?
If you wish to undergo Asian Eyelid Surgery for purely aesthetic reasons, it is highly unlikely that your insurance will cover the procedure. However, in some cases, corrective eyelid surgery can be covered by insurance. Patients with a condition known as ptosis have a drooping eyelid that interferes with vision, sometimes caused by a weakened levator muscle. Weakened levator muscles are often seen in younger patients with congenital ptosis. Other causes of a drooping eyelid is the dehiscence of the levator from the tarsus, which is the loosening or detachment of the eyelid muscle, and commonly occurs in older patients as part of the aging process. A visual field test can determine whether your ptosis is severe enough to have correction be covered by PPO health insurance.
Close
Can BOTOX® Cosmetic help with excess forehead wrinkles and an angry look?
Can BOTOX® Cosmetic help with excess forehead wrinkles and an angry look?
If the angry look is a by-product of having your upper visual field blocked, then you need to correct the eyelid surgically. BOTOX® Cosmetic will reduce the frown lines at the expense of dropping the brows and a return to a loss of your upper visual field.
Close
My upper eye socket is hollow and my brows are very high. Why is this? Can I use fillers and BOTOX® Cosmetic for this?
My upper eye socket is hollow and my brows are very high. Why is this? Can I use fillers and BOTOX® Cosmetic for this?
Frequently, a retracted brow is caused by its attempt to help open a weak upper eyelid. This also creates an upper eyelid socket hollow. Correction requires adjusting the upper eyelid muscle tension and then repositioning the eye fat which, has been sucked up under the eye socket. BOTOX® Cosmetic will have the unwanted effect of drooping the eyelid; fillers will create a similar problem by making the upper eyelid heavier and burdening the already-weak eye muscle.
Close
What types of eye anatomy are more difficult to operate on and at higher risk of a poor outcome?
What types of eye anatomy are more difficult to operate on and at higher risk of a poor outcome?
Eyes that bulge forward are at risk for creasing at the wrong location. Similarly, patients with ptosis requiring correction at the time of crease surgery are also at risk for this. In these instances, there is not much clearance between the elevating muscle and the overlying skin. Therefore, the muscle can “catch” the upper lid skin as it is opening. For these reasons, very little fat should be removed for patients with at-risk anatomy. In some cases, fat grafting to the upper lid is necessary to create more distance between the skin and the moving muscle.
Close
What is ptosis?
What is ptosis?
This is a droopy eyelid. The cause of this is related to either a weak eyelid muscle (which you are born with) or a detachment of the muscle from the tarsus (the cartilage skeleton of the lid margin), usually associated with aging. Ptosis, in Dr. Lee’s opinion, is more common in Asians, affecting as many as half the patients undergoing Asian Eyelid Surgery. Depending on the cause, the muscle needs to be reattached (if detached), or it needs to be strengthened/shortened so that the eyelid is in the proper position at rest.
Close
Will I end up sleeping with my eyes open?
Will I end up sleeping with my eyes open?
This is not likely to happen unless you have ptosis requiring significant shortening of your eyelid muscle. In many such cases of ptosis repair, the eyes will be able to close over time.
Close
Is Asian Eyelid Surgery painful?
Is Asian Eyelid Surgery painful?
Pain is minimized during the procedure by placing you under IV anesthesia, which makes you sleepy and comfortable. Post-operatively, the minimal pain is controlled with simple TYLENOL®.
Close
What other risks are associated with Asian Eyelid Surgery?
What other risks are associated with Asian Eyelid Surgery?
The chances of a poor outcome decrease with the skill and experience of the surgeon. Asymmetry or an unnatural look are the most common complications, but an experienced surgeon can point out whether your anatomy is more difficult than the typical patient’s. Patients with ptosis or protruding eyes are at higher risk for revision surgery. Certain patients have poor healing characteristics, especially those who bruise easily, smoke, or have very distensible joints.
Close
What scars should I expect from Asian Eyelid Surgery?
What scars should I expect from Asian Eyelid Surgery?
If Dr. Lee uses the non-incisional method, you will not have scars after your double eyelid surgery. The incisional method does leave scars, but they are very small and hidden in the natural creases of your eyelids. Incision scars may appear pink or noticeable initially but will fade quickly as they continue to heal.
Close
Before & After Photos
Patient Testimonials
I wanted to take this time to express my deepest gratitude to your for the epicanthoplasty you did for my eyes. It takes such tremendous precision, skill and experience to do what you did and I am truly pleased with the results. Not only are you one of the world’s finest surgeons, you are also compassionate. I admire your keen eye and mastery as a surgeon…