Ethnic Considerations for Upper Blepharoplasty

What is upper blepharoplasty?

An upper blepharoplasty or upper eyelid lift is a surgical procedure that addresses heavy, tired appearing eyelids by removing excess skin and redistributing the eyelid fat. The eyelid skin is the thinnest in the body, therefore, it loses collagen and elastin the fastest. Heavy eyelids are often hereditary and the skin begins to stretch as early as our 20s or 30s. Patients often notice the eyelid crease has excess skin covering it or their eye makeup smudges. 

What are ethnic considerations for upper blepharoplasty?

Anatomical differences in the Asian eyelid anatomy causes a lack or obscuration of a supratarsal crease. About 50% of people of Asian descent do not have an upper eyelid crease.[1] Therefore, Asian blepharoplasty or “double eyelid” surgery is a popular procedure to create this eyelid crease. The height from your upper lash line to the new eyelid crease is customized to your preference and existing anatomy. Fat removal and excision of excess eyelid skin may also be necessary to achieve optimal results.

Additionally, many Asian patients have an epicanthal fold. This structure is described as a crescent-shaped portion of skin at the inner aspect of the superior lid that descends along the border of the nose toward the canthus and covers the inner corner of the eye. 

Am I a good candidate for “double eyelid” surgery?

You may be a good candidate for double eyelid surgery if:

  • Your eyelid drapes over too much of the upper half of your iris
  • You are unsatisfied with the shape of your eyelid
  • Your eyelids appear puffy because they contain excess fat 
  • You do not have an eyelid crease
  • Your upper eyelid folds inward when you open your and your eyelashes brush your cornea 

How is Asian blepharoplasty or “double eyelid” surgery performed?

This procedure is often done in the clinic with local anesthesia, however, the patient can have sedation or general anesthesia depending on the patient’s preference. There are several different techniques based on your anatomy and desired outcome.

Full or partial thickness incisions are best suited for patients with excess skin and fat of the upper eyelid that needs to be removed.  The surgeon then utilizes sutures to mimic fibrous attachments that are naturally present in double eyelids. Sutures are removed 5-7 days after surgery.

No incision or “scarless” method is ideal for patients that do not have excess fat or skin in their eyelids, but desire more of a crease. The main advantage is the absence of an incisional scar and minimal to absent swelling. With this technique, absorbable sutures are used to create an eyelid crease. However, this method is not as resilient as incision techniques. 

Epicanthoplasty addresses the epicanthal fold to uncover the inner corner of the eye and make the eyelid appear longer. 

Overall, ethnic considerations are taken into account when considering upper eyelid surgery. This is especially true in the case of patients of Asian-descent that desire more of a crease in their eyelid. It is important to seek out a specialist in facial plastic surgery that can customize the approach to your cosmetic desires. Dr. Nagy and Dr. Beaty are both double board-certified facial plastic surgeons with years of experience in these procedures. 

  1.  Nguyen MQ, Hsu PW, Dinh TA. Asian blepharoplasty. Semin Plast Surg. 2009 Aug;23(3):185-97. doi: 10.1055/s-0029-1224798. PMID: 20676313; PMCID: PMC2884917.

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