Asian Blepharoplasty (Double Eyelid surgery)

Double Eyelid Surgery

Creating the eye lid crease in Oriental eyelids, through Asian blepharoplasty

 

Introduction:

The term “East Asian Blepharoplasty” which is also referred to as “Double eyelid surgery”, is a type of cosmetic surgery in which the skin around the eye is reshaped – that is why the name ‘blepharoplasty’. This type of procedure is carried out in order to create an upper eyelid with a crease (i.e. double eyelid). from an eyelid which is naturally without a crease (or single eyelid).

The upper eye lid fold can range from 1 mm (0.039 in) above the eyelash line to about 10 mm (0.39 in). Several methods may be employed to create the double eyelid — including the full-incisional, partial incision and no incision methods.

Asian (Oriental) patients, with face features of Mongoloid racial descent, may have a puffy upper lid and an absent eyelid crease & may not approve of such an appearance cosmetically. The patient may report difficulty applying eyeliner because of the overhanging fat and may desire to have a crease similar in appearance to Asian friends who were born with such a crease. Patients generally do not want to change their ethnic appearance.

Epidemiology:

Nearly about 50% of people of Pacific Asian descent (eg. Chinese, Japanese, Korean) have a pretarsal crease, while 50% patients do not have an eyelid crease. In India, absence of an eyelid crease is seen in patients from the North-East of India, namely the states of Assam, Mizoram, Meghalaya, Manipur, Arunachal Pradesh, Nagaland & Tripura.

Etiopathogenesis:

The pretarsal fold represents the insertion of the levator aponeurosis muscle expansion into the eyelid skin. Supposedly, Oriental Asians have a lower insertion point than other races that leads to smaller or absent folds. Lower height of the septoaponeurotic sling in Asians permits the fat to sit lower in the eyelid which results in a smaller fold.

People who undergo Asian Blepharoplasty are:

In majority of the cases, the patient is female and presents in her mid adolescence with her mother or a female who is in her early 20s.

Occasionally, there are male patients who tend to be slightly older, in their late 20s to early 30s.

Female patients may have difficulty applying eyeliner.

In rare cases, an older patient presents having problems related to aging upper eyelid and/or the area around the orbit. He may have had a pretarsal crease placement in advance.

Management:

The surgical strategy for creating an Asian eyelid fold is either to recreate the dermal attachment of the levator aponeurosis or to block the fat from descending below the desired eyelid fold height. The non-incision suture method of cosmetic eyelid surgery creates the fold by recreating this dermal attachment using non-absorbable sutures. The incisional method of Asian double eyelid surgery recreates the fold by removing the inferior portion of the prelevator fat and sealing off this area. A hybrid version, the semi-open method, combines aspects of both techniques by using buried nylon sutures to recreate the fold but also removing a portion of the prelevator fat through a small incision. In any case, the surgeon should not remove too much fat from the Oriental Asian eye, because this results in a westernized appearance, which should be avoided.

Procedure:

Suture method:

Steps for the Surgical procedure are as follows:

Mark the patient’s eyelid crease while he or she is on the operating table. After administering intravenous or oral sedation, administer topical 4% tetracaine to the conjunctiva and inject 1 mL of 1% lidocaine with 1:100,000 epinephrine into the skin.

If a medial epicanthoplasty is planned, perform this first because the epicanthoplasty alters the medial anatomy of the skin. Total height of a V-W plasty is approximately 5 X 5 mm, with each arm of the V and W being approximately 2 mm.

After allowing the local anesthetic to take effect, use a No. 11 blade to cut each arm of the flap. Remove the subdermal muscle along with the skin, and use 6-0 nylon sutures to close the incision.

Make an incision along the lateral aspect of the upper lid marking. Remove a small sliver of orbicularis and then septum to enter the prelevator space. Ignore retro-orbicularis fat, which should not be removed. Identify pre levator fat by the glistening levator aponeurosis along the floor of the space, which also retracts when the patient opens the eyelid. Remove approximately 1-2 mL of fat.

Next, place a 6-0 nylon suture to the lash line of the upper lid for retraction. Flip the upper lid to expose the conjunctival surface, and take a 5-mm bite of tissue at the mid pupil along the superior border of the tarsal plate using double-armed 5-0 nylon.

Re-enter the conjunctiva through the same needle hole so that a full-thickness buried suture exits on the skin surface of the upper lid along the lid markings. Secure the knot and let it retract into the deep recesses of the orbicularis muscle. Place 4 sutures equidistant to each other.

Have the patient open and close his or her eye to verify that the crease extends sufficiently laterally and medially. Close the skin incision.

Incision Method:

Steps are as follows:

The preferred height of the incision for the eyelid crease has already been determined with the patient in the upright position, taking into account the patient’s forehead anatomy (larger [~10 mm] if the patient has brow ptosis) and eye globe position (smaller [~6 mm] if the patient is exophthalmic).

Place tetracaine 4% drops into each eye, and then evert the eyelid and measure the height of the tarsal plate on each eyelid. The usual height is 10-11 mm. The tarsal height yields an accurate measurement of where on the tarsal plate the skin will be affixed at a future step in the procedure. For instance, if the planned fold is at 8 mm and the tarsal height is 10 mm, the skin will be affixed to the tarsal plate 2 mm below the upper edge of the tarsal plate.

Skin markings are then made. The height is set at the mid pupil, with the rest of the marking continuing at the same height laterally until reaching the orbital rim. Medially, the marking tapers smaller toward the caruncle but stops approximately 2-3 mm above the lash line.

An incision is made with the knife, and 1-2 mm of skin is excised if necessary. A sliver of orbicularis muscle is removed, and the orbital septum identified. Gentle pressure on the globe helps verify the presence of prelevator fat just beneath the septum.

The orbital septum is entered laterally, and the prelevator fat is allowed to herniate out. The presence of this fat defines the septoaponeurotic junction (or “sling”). The Iris scissors are introduced, and the septoaponeurotic sling is opened. Keep in mind the direction of this sling. It runs parallel to the lid margin when the eyes are open, but when the eyes are closed, the sling travels away from the lid margin. Failure to recognize this fact is a frequent cause of iatrogenic ptosis.

The pretarsal orbicularis muscle is thinned to expose the underlying pretarsal aponeurosis. Some of this muscle must be preserved because it assists in lid closure. At this point, the filmy soft tissue lying above the tarsal plate is excised. If the levator aponeurosis is completely removed from the tarsal plate, the advantage being less pretarsal edema and perfectly smooth pretarsal skin, tremendous precision is required to reattach the aponeurosis to the tarsal plate. If, however, some of the aponeurosis has been preserved, the risk of creating problems with the levator mechanism is reduced.

The incision is the closed taking a bite of dermis, tarsal plate, and levator aponeurosis in one ligature.

Cost of Asian eyelid surgery:-

India has seen tremendous growth in its medical tourism in the last decade. The inflow of patients to India from all parts of the world for the best medical services for almost all diseases has increased exponentially. There are several reasons for this scenario. Not only the medical professionals in India are considered to be the best in the world, but the cost of the medical treatment is substantially low in comparison to many other places.

The double eyelid surgery or the Asian eyelid surgery is performed for cosmetic reasons. However many people who want to opt for this surgery hesitate from undergoing this procedure beacsue of the cost of the Asian eyelid surgery. The procedure is definitely surgical therefore the incurred cost for asian eyelid surgery is very high in many countries. And because the procedure is cosmetic not all insurance companies cover the cost of the Asian eyelid surgery. If the treatment is done in India, the cost of the Asian eyelid surgery can be very affordable as compared to other countries.

 Dr. Debraj Shome is one of the best oculoplastic surgeons in India performing this surgery successfully for many years and he has treated patients from all corners of the globe.

Getting Asian double eyelid surgery done

If the upper area of the eyes does not have a crease, then choosing to go for double eyelid surgery can create one. A lot of people of Oriental origin, as those from the North Eastern parts of India like Sikkim, Manipur, Mizoram and Assam do not have a crease on the upper part of their eyes and they are choosing to go for Asian double eyelid surgery to create one. Going for a plastic procedure is something that a lot of people are choosing to do and this is a procedure that is getting more and more attention.

50% of people of Oriental origin do not have the crease over their eyes. This may cause cosmetic problems though it rarely causes any medical issues. The inability to apply eye makeup is one of the cosmetic problems that many Oriental women complain about. That is why knowing double eyelid surgery cost is a good thing, because it helps one decide whether or not to go for it. 

Deciding to go for Asian eyelid plastic surgery

Having a crease or fold just above the eyes is a desirable feature and most Orientals who do not possess one, desire it. An Asian eyelid plastic surgery cost creates a fold that shows when the eyes are open. It is important to understand that this procedure should be done in a way so that the fold appears to be natural looking. This is a feature that is wanted also because it makes the eyes appear a lot less tired and haggard. It is important to always opt for natural looking results because if that does not happen, then the result may end up looking too artificial. That is why consulting and getting operated by a top Oculoplastic surgeon like Dr. Debraj Shome at The Esthetic Clinics in Mumbai, India, makes all the difference! 

Are you a candidate for Asian double eyelid surgery?

Before trying to find out the cost for Asian double eyelid surgery, it is important to know whether or not you are actually a candidate for the procedure. Age is a huge factor for this procedure for the simple reason that the older the person is, the less chances of the procedure becoming a success is. If you are below the age of 25 and do not have the crease or upper fold in your eyes, then you may well be a candidate for Asian double eyelid surgery. Of course, if you are older, you can want to know the cost of this procedure but the method of the surgery will be different. 

Asian double eyelid plastic surgery cost

So what is the cost of this plastic surgery? Well, the cost of the Asian double eyelid plastic surgery differs from country to country but the cost will usually be in the range of $3000-$4000. It is a good idea to ask your doctor about the cost of this plastic surgery on your first consultation because that will give you a better idea of whether or not you should go forward with it. 

Asian eyelid plastic surgery cost is something more and more people want to know because it is something they want to get done. Plastic procedures with top surgeons like Dr. Debraj Shome increase a person’s self confidence and this procedure is certainly one of them.