Asian Eyelid Surgery – Challenge of Changing the Epicanthal Fold after Previous Surgery

Asian Eyelid Surgery – Challenge of Changing the Epicanthal Fold after Previous Surgery


Thank you for your question.
You’re 52 years old and you state that you had Asian Eyelid Surgery done about 10 years
ago. And you were never happy with the result of your right eye compared to your left eye.
You inquired with your physician about this and you had an explanation that had to do
with the epicanthal fold. And you’re asking is there something you can do at this point
in time. Well, I can certainly assist you with this
question. I’m a board certified cosmetic surgeon and fellowship-trained oculofacial
plastic surgeon and Asian Eyelid Surgery has been a focus in my practice for over 20 years
and it is certainly something I have a lot of experience with. And I can give you some
guidance as to your situation. So to begin with, the – it’s very important
to have a definition of the terminology that’s being used. So let’s start with the term
epicanthal fold. The word epicanthal, epi, over and canthus, corner; means that the – what
is being described is the fold of skin that goes over the inner corner of the eye. Now
that epicanthal fold can be – could be very minimal. It can be just starting at the top
and then fading away. Or it can actually be equal from the top to the bottom. And then
the rarer cases actually can be reversed or narrow in the top and wide in the bottom.
So there are different types of epicanthal folds. Now in your situation, as far as the
two eyes are concerned, the epicanthal fold to me look pretty much the same.
So what is causing the two eyes to look different? From my perspective, we have to look at the
inner corner, as you’ve described it more from the perspective of how the crease blends
or interacts with the epicanthal fold. On your right eye, the crease travels over and
is – goes past the epicanthal fold. This is often referred to as a parallel crease.
On the left eye, the upper eyelid crease actually flows into the epicanthal fold. And that’s
referred to as a nasally tapered crease. That being said, what you’re – the challenge
before us is that on the right side, you see more of the eyelid in terms of the space between
the margin and the crease than it do on the left side. Now that’s a challenge because
it is – it is most likely had some type of skin removal. Which means that there is
relatively probably not enough skin to allow the – this – the crease to flow inward.
What do we do – okay, I’m going to just have you – just use B-roll. But I’m going
to repeat that last part. When you look at your upper eyelid crease,
the right side, the parallel part goes past the epicanthal fold. In other words, it’s
going across the upper eyelid and it just goes – fades inward and leaves you with
the wider margin between the – or space between the margin and the eyelid crease.
On the left side, it looks like the eyelid crease flows into the epicanthal fold. Which
means that the space between the margin and the crease is actually narrower.
In my – from my perspective, I tend to favor the natural crease where it follows and flows
into the epicanthal fold as it does in your left eye. But the challenge here is that you
don’t – you probably don’t have enough skin to try to create that same result as
you have on the left side. When people come to our practice, a lot of times they actually
liked the look of the right eye that you have and one in the left eye.
When people come for a consultation who have had no surgery, then this is where the opportunity
is to really customize to the patient’s desire. A lot of times the fixation of the
crease – and this is a technical statement. But when you move the fixation away from the
epicanthal fold, it tends to flow inward towards the epicanthal fold. And as you move it more
towards the nose, you can create more of a parallel crease. But that also depends a lot
on factors such as fat, the skin tone, the amount of skin. And with a lot of situations
where we do non-incisional Asian Eyelid Surgery which is where we’re not removing skin but
rather anchoring skin strategically then creating this type of nasally tapered crease is really
very straightforward; because you can actually not take away skin and leave out one more
variable. And by anchoring the skin in this sweet spot, in the area at the upper eyelid,
it’ll create that fold. So that’s all – it’s still all by customization.
Bottom line with you is that if you don’t want the left eye to look like the right eye
which obviously you don’t, I think that additional surgery is not likely to be your
– to benefit you because you may – you’ve just probably don’t have enough skin.
Now technically could there be release of scar tissue and release in trying to get the
skin to fold, yes; but that tends not to be that predictable. So I would probably dissuade
you from doing any kind of procedure. Now of course this is in the absence of a physical
exam. So you may want to just get additional opinions and see what the feasibly is to try
to get the other side to look the left side – or the right side to look more like the
left. But I don’t – but I still think that it is not likely to be as predictable
as you would like. So I hope that was helpful. I wish you the
best of luck. Thank you for your question.

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