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This patient underwent double eyelid
surgery (Asian blepharoplasty).
a. How does the upper eyelid of the East Asians differs from that of
the Caucasians?
The eyelids of the East Asian differ
from the Caucasians in the following ways:
• Upper eyelid skin crease: In East Asian, the skin crease is lower or
non-existent. This is explained by two anatomical differences in the
East Asians:
i. The orbital septum fuse with the levator at a lower level resulting
in the presence of orbital fat in the upper eyelid that prevent strong
adhesion between the levator and the upper eyelid.
ii. Absence of strong natural adherence between the front of the
tarsal plate and the back of the skin created by fibrous connections
that pierce the orbicularis muscle.
• Upper eyelid fullness: The Asian upper eyelid appears fuller or
puffier than the Caucasians because in the former there is downward
extension of the orbital fat, a weaker orbital septum, an eyebrow fat
pad that is thicker and projects lower into the eyelid and a much
thicker subcutaneous fat layer below the skin.
• Epicanthal fold: The presence of a small crescent of skin between
the inner eyelid corner and the nose in the East Asians. This is
usually absent in Caucasians.
• Eyelashes: The eyelashes of East Asians tend to point downward
whereas the eyelashes of the Caucasians tend to point upward or
horizontally.
• Tarsal plate: The Asian plate tends to be shorter.
• Vertical palpebral aperture: Asians have the widest vertical
palpebral aperture at the junction between medial and middle third. In
the Caucasians, the widest vertical palpebral aperture is at the
centre of the lid.
b. What are the two main methods of creating an upper eyelid skin
crease in East Asians?
Suture method and the incision method.
The principle of the suture method is based on the development of
adhesions or cicatricial changes between the skin and deeper tissue
that are induced by the suture material. The advantages of this method
are that it is simple to perform and the patient recovers faster. The
ideal candidates are young people with taut skin with relatively
little or no orbital and submuscular fat as this method does not
remove the orbital fat. The main disadvantage of this technique is
that the skin crease is more likely to disappear than one created
using the incisional technique.
In the incisional method, the skin crease is created at a desirable
height through removal a sliver of skin and the orbicularis oculi. And
depending on the degree of puffiness, the orbital fat may be removed.
The skin crease is created by skin-levator-skin suture.
c. What are the main complications of Asian blepharoplasty?
The most common complications are:
• Asymmetrical eyelid skin creases. This results from unequal skin
crease marking prior to surgery.
• Excessively high or low skin creases. This results from
inappropriate skin crease markings.
• The skin crease is too short or discontinuous. This is usually
caused by inadequate adhesion between the skin and the levator.
• Multiple skin creases and this is usually related caused by the
creation of a skin crease which is too high.
• Supratarsal depression from excessive removal of orbital fat.
Reference:
Chen SH, Mardini S, Chen HC, Chen LM, Cheng MH, Chen YR, Wei FC, Weng
CJ. Strategies for a successful corrective Asian blepharoplasty after
previously failed revisions. Plast Reconstr Surg. 2004
Oct;114(5):1270-7.
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