How Asian Double Eyelid Surgery can Open up the Eyes More Naturally than a Brow Lift

How Asian Double Eyelid Surgery can Open up the Eyes More Naturally than a Brow Lift


Thank you for your question. You stated in your question that you’re 40-years-old,
Korean female and you submitted several photos. The first photo was at rest, the second photo
with your eyebrows raised and the third photo is smiling or facial expression. And you’ve
gone to a couple of doctors and you have this desire to look, what you want is the appearance
of photo number 2. One doctor recommended eyelid surgery, the other doctor recommended
brow lift so you want to know which one is correct. And then you go on to ask about the
under eye area as well. So I will certainly give you my impression based on the photos
you submitted in the question you’re asking. And I’ll help you distinguish what you can
expect with either of these procedures. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have
been in practice in Manhattan and Long Island for over 20 years. I specialize in Asian eyelid
surgery amongst many other things that we do in our practice and this type of question
does come up a lot. And so, I will distinguish for you how I would interpret the desire that
you have to look like photo number 2. What appears to be the situation when you
show photo number 2 is that I think what you like is the impression of the shape of the
eyes when your eyebrows are raised. So if you look at the first photo, the eyelid skin
is hooded a little bit more and that shape of that hood dominates the appearance of the
eyes. When you raised your eyebrows, the shape of the skin that’s overlapping is shifted
upwards and the eye shape has a different appearance. That being said, I would ask the question
first is do you want your eyebrows higher? And that’s a very important question. From
my perspective, your eyebrows are at a natural position and where they should be. I would
respectfully disagree with the colleague who recommends the eyebrow lift because it is
my feeling that eyebrow lifts are often done too aggressively and it results in people
who have normal eyebrows looking like they’re perpetually surprised. Now that’s an aesthetic
judgement and aesthetic style. If your goal is to really have that shape,
that shape is somewhat achievable with eyelid surgery. Now that means that you and the prospective
doctor have to really agree upon how much skin you would want to leave behind in order
to get that shape. What I routinely do when I speak to patients about Asian eyelid surgery
is I use a simple instrument like a Q Tip and I’ll fold the skin inward to show what
the shape would look like. It is not uncommon for people to want to have a conservative
result with just a little bit of eyelid showing. A lot of people want a well-defined double
eyelid. Other people want a more subtle eyelid. I think that if that is the goal, then you
could probably achieve that goal with eyelid surgery. Now when it comes to Asian eyelid
surgery, the decision point is often based on the desired outcome and then the presence
or absence of excess skin, excess fat. Generally, with someone who has a fair amount
of skin but who wants a conservative approach, I’ve been able to do this procedure with
what’s called a non-incisional Asian blepharoplasty. What a non-incisional Asian blepharoplasty
means is basically little openings are made in the skin, skin is not removed and the skin
is anchored to the muscle called the levator muscle. That means then when the skin folds
at a higher place, I would suspect in this situation you’re in now, the skin doesn’t
really fold but rolls passively and therefore, the rolling of the skin goes on top of the
eyelashes and dominates the shape of the eyes. If that skin was fixated a little bit higher,
it would probably reveal the shape of photo number 2. The other option is, if there was the presence
of excess skin, it’s called an excisional or an incisional type of blepharoplasty. That
means that an incision is made and some skin is removed. Typically, it’s very conservative.
It’s no more than a few millimeters. And last but not the least, if there is any fat
which from my impression from the photos, it doesn’t look like you have, then fat
can be addressed at the same time. Now as far as the lower eyelids are concerned,
yes, when you look at photo number one, there appears to be fat pockets that are pushing
forward. So, in a situation like that, with your type of skin type, I generally do what’s
called a transconjunctival blepharoplasty. What that means is I go from the inside of
the eyelid to reduce the fat pockets that’s causing puffiness. Now to address to address skin quality, which
is part of what you are dealing with when you show photo number 3, your skin is folding
and you have some lines. Well, there are a couple of ways to address that. One is to
address the activity of the muscle which causes those lines, the orbicularis oculi muscle.
That’s a muscle around the eyes that causes, when contracted when you smile, causes these
lines often referred to as crow’s feet lines. We treat that with Botox™ and that relaxes
those muscles. We improve skin quality with a combination of platelet-rich plasma (PRP)
which is derived from your own blood and used to stimulate the collagen. And basically,
the goal is to improve the backbone of the skin, the dermis of the skin so that the skin
doesn’t wrinkle as much. Understand that you’ll always have some wrinkling when you
smile. It’s very natural and appropriate but to kind of prevent the lines from being
too deep especially when you are at rest which we refer to as static lines, a program of
Botox™ and skin quality improvement is certainly an option. In addition, there are thermal energy based
devices that help tighten the skin. And usually for someone who has Asian skin, I go towards
the radiofrequency treatments such as what we have in our office called Pelleve to help
tighten the skin but that is dependent again on where in the hierarchy of importance these
concerns fall. So I think it’s important that you have
this discussion with your doctor and look at yourself with your eyebrows raised. If
you focus not only on the shape of the eyes but at the shape of the whole facial expression
or the appearance of the facial expression, I think you won’t want to have your eyebrows
that high up. If you do, then you should certainly move forward with the brow lift but I think
you’ll probably be, most likely better off with the upper eyelid surgery as well as possible
lower eyelid surgery So I hope that was helpful, I wish you the
best of luck and thank you for your question.

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