"Blepharoplasty" is an older operation developed on and for patients of European and Occidental descent, while "double eyelid surgery" is a more recent operation developed on and for patients of Asian lineage. Many cosmetic surgeons who can perform a blepharoplasty with skill have little or almost no experience with double eyelid surgery.
The most prominent differences between the two operations relate to intended goals, ages of the patient population, and surgical techniques.
Most Occidental patients requesting blepharoplasty are in their forties, fifties, and sixties, while the vast majority of Asian patients requesting surgery are in their teens, twenties, and thirties.
In the Occidental eyelid, the primary goal of surgery is rejuvenation of the aging upper lid. For the most part, the operation is subtractive (that is, removal of stretched, weakened, or poorly positioned skin and fat). Typically, minimal attention is devoted to reshaping the already-present crease.
In the Asian eyelid, the primary goal of surgery is creation of a new crease or enhancement of an inadequately defined, asymmetrical, or unstable crease. Skin and fat removal are minimal, and, in many cases, no fat is removed at all. Instead, the procedure is focused on the re-alignment of youthful internal eyelid structure.
Trying to compare minimal-incision "suture techniques" for crease creation with blepharoplasty becomes even more tenuous. The two operations share no common features.
If a young Asian patient is approached surgically in a manner similar to that used in an aging Occidental patient, the result can appear unnatural and surgical.
Double Eyelid Surgery Incision Technique
Exact surgical technique will vary surgeon to surgeon depending upon his or her training, experience, and preferences. Likewise, variations in pre-existing patient eyelid-facial anatomy will require a customised approach in each individual.
While Dr. Kim has developed his own personal techniques for achieving different lid heights and shapes based upon a number of variables considered both pre-operatively, and intra-operatively, what follows below is a simplified overview of general principles.
Local anaesthesia with light sedation is preferred so that Dr Kim can verify the shape and position of the eyelid and crease during surgery by asking the patient to open and close his or her eyes.
Because Asian skin is said to be "more reactive," incisions are best made with a scalpel instead of the laser to minimise scarring.
The skin is incised with a scalpel at a height dictated by measurements of certain existing
anatomical landmarks. The incision may be tapered into the epicanthal fold towards the nose (if desired) and/or flared slightly upwards at its outer end (if desired).
Most typically, a small strip of skin above this initial incision is excised using scissors. The amount of skin removed varies depending upon the proposed height of the new crease as well as pre-existing anatomical conditions. In some cases, no skin is removed.
The incision is carried deeper into the eyelid through the orbicularis muscle and orbital septum until the orbital fat is exposed.
Small strips of orbicularis muscle and orbital septum are excised. The amount and location of orbital fat removed has a significant influence on the height, shape, and depth of the new crease.
In most cases, no fat is removed.
The levator aponeurosis (tendon) is identified just beneath the fat. In contrast to an older form of incisional double eyelid surgery known as "anchor blepharoplasty," the levator aponeurosis is not aggressively exposed or detached from its connection to the tarsal plate, a step that is, in our opinion, unnecessary to formation of a natural appearing crease and invites a higher incidence of serious complications such as ptosis, lid retraction, or peaking of the eyelid margin.
Wound closure employs a "deep-fixation" technique to create an attachment between the aponeurosis and the dermal layer of skin. Following suture removal, internal scars at these points of fixation act much like "spot welds."
The final crease height and shape are the result of both selective tissue removal and precise internal tissue rearrangement. The operation may be used to create tapered, parallel, lateral flare, and, rarely, semilunar shaped creases or to correct incomplete or multiple creases. The incisional approach is considered the "gold standard" in Asian double eyelid surgery.
To arrange for a consultation with Dr Andrew Kim, please call Esteem Cosmetic
Studio at 1300 378 336.
Consultation cost in Canberra and Sydney is $150 and consultation fee in Brisbane is $100.