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The Truth About Asian Blepharoplasty

I wish I could wave a magic wand and erase the term “Asian blepharoplasty” from the internet and our collective language. Why? Because it implies a single eyelid surgery that is used for all Asian people. Nothing could be further from the truth!

First and foremost, Asian is not a single group and neither are Asian beauty ideals. Growing up in Taiwan; watching my sister perfect the skill of using scotch tape to create her “double eyelids” every morning; and teaching, learning, and traveling across Asia have taught me that beauty ideals have important regional differences. Even within ethnicities, we must account for differences and, most importantly, INDIVIDUAL patient preferences.

The word blepharoplasty derives from the Greek blepharon (eyelid) + plastos (formed, molded). Successfully forming and shaping any body part requires a thorough understanding of the existing anatomy as well as the desired outcome. A 19 year old Indonesian student wanting more dramatic eyelid definition for make-up, is different from a 53 year old half-Japanese half-Irish professional wanting to look less tired, and very different from a 76 year old Korean retiree whose sagging skin is blocking their vision. What makes Asian eyelid surgery unique are the anatomic differences that require specialized techniques to achieve the patient’s desired goal.

Patient wants a visible eyelid crease aka “Double Eyelid”

Approximately 50% of Asians naturally have a monolid configuration, without a visible eyelid crease. Patients wanting a double eyelid configuration often tell me they want to be able to wear make-up better, have bigger eyes to look brighter and more alert, or to stop eyelashes from rubbing on their eyes!

An eyelid crease can sometimes be created without making a visible skin incision, using the suture method. In this method, tiny 1-2 mm entry points are created in the eyelid skin for placement of a buried suture that creates just enough of an internal anchor to form a crease. Kind of like an internal version of what eyelid tape is doing! This is the least invasive way to form an eyelid crease, which translates to less cost and recovery time. Suitable candidates are those without puffy eyelids or excess skin.

If a patient has thicker eyelid tissue that will not hold a crease unless some combination of skin, muscle, and fat are excised, an incisional or open blepharoplasty surgery is needed.

Sometimes, a patient has strong epicanthal folds (the web-like structure at the inner corner of the eyes) that prevent formation of a crease. An epicanthoplasty surgery is needed to release the pull from the epicanthal fold, and enable crease formation. The main downside of traditional epicanthoplasty is an unpredictable and unsightly scar. I’ve developed an internal epicanthoplasty technique to release the epicanthal fold without an additional skin incision, allowing patients with moderate epicanthal folds to have an eyelid crease without the scar associated with traditional epicanthoplasty.

What about complicated patients having monolids, ptosis (see my blog The 3 Types of “Droopy Eyelids”), epicanthal folds, or some asymmetric combination of the above in one eyelid but not the other?

Patients who want eyelid rejuvenation, without changing eyelid aesthetics

I have many patients who are professionals, in their 50s, who do not want anyone to know they’ve had surgery; they just want to look rejuvenated. For these patients, surgery often involves removing excess skin, gently sculpting the eyelid tissues without creating hollows, and one of my favorite techniques: the infrabrow skin excision or subbrow lift (an incision under the tail of the eyebrows). Both of these ladies are 4 months out from blepharoplasty and infrabrow surgery and the scars are barely visible.

Mature patient whose eyelids are blocking their vision

Due to typically shallow orbits and prominent eyes, the Asian eyelid tends to age with significant sagging. There isn’t a deep eye socket for the skin to tuck, and the skin is generally thicker so it doesn’t become crepe-like; it simply droops down. When the skin blocks vision, the brows reflexively rise up to try and pull the skin out of the line of sight, creating problems with headaches and muscle fatigue. Blepharoplasty in the mature Asian eyelid requires a balanced skin excision to preserve natural ethnic eyelid features.

In summary there is no one-size-fits-all “Asian blepharoplasty.” As a surgeon who performs many Asian blepharoplasties, I understand and appreciate different ethnic and individual beauty ideals. The key to success is recognizing your unique anatomic conditions and tailoring a specific plan to achieve your desired results with minimal risk and scarring. I look forward to discussing your goals and making a plan together!


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