There are a variety of techniques for Asian eyelid, or double-eyelid surgery (Asian Blepharoplasty), and each has advantages and disadvantages. Dr. Jen Chow is familiar with several different techniques, including suture ligation methods and external incision methods, which are described below.
One popular set of double-eyelid surgery methods involves using suture ligation (stitches) with little or no incisions in the skin in order to create the double fold. In its simplest form, this can simply involve placing several (usually three) stiches through the various layers of the upper eyelids (skin, muscle, the “levator aponeurosis,” Müller’s muscle, and even a tiny amount of conjunctiva) to create the fold. Variations of this technique generally involve alterations in the type of suturing performed, the use of tiny incisions with suturing, and even the use of additional instruments specificially designed for eyelid suture placement. The advantages of the suture ligation method is that it is relatively non-invasive and has less swelling after the procedure. The main disadvantage is that the crease has a higher likelihood of disappearing with time. The disappearance rate is higher in those who have thicker eyelid skin or who have excess fat underneath the eyelid skin (and possibly muscle).
The other major category of double eyelid, or Asian eyelid (Asian blepharoplasty) techniques involves the use of an incision (or set of small incisions) in the upper eyelid during surgery. There is considerable variation within this set of techniques, allowing the surgeon to treat a wide variety of eyelids. Skin, muscle, and/or fat may be removed during the procedure in order to enhance the appearance of the eyelid. The skin may then be sutured to the levator aponeurosis or the upper tarsus in order to form a crease. The sutures used may be permanent and buried beneath the skin or removed after 5-7 days following surgery. One advantage of the incision techniques is that there appears to be more predictability and permanence with this approach, with a long-lasting crease that does not appear to fade over time. Of course, for those who have too much skin, muscle, or fat, these tissues can be trimmed during the procedure in order to provide a more pleasing final result. The main disadvantage of these techniques is that there is relatively more swelling and a higher probability of bruising after surgery as compared to suture ligation techniques.
In most cases, Dr. Chow prefers the incision technique, as he has found this method to result in more reliable, beautiful, long-lasting double eyelids. He is also able to adapt the procedure to a wide range of eyelids from individuals of different ages, ethnicities, gender, and cosmetic preferences. However, Dr. Chow will develop a plan specific to your aesthetic goals and concerns.
During your initial consultation and on any subsequent visits, Dr. Chow will perform a complete history and physical examination of your face and eyes to ensure that double-eyelid surgery will be as safe and effective as possible. He will take the time to discuss your cosmetic concerns and answer any questions you may have.
Before having any cosmetic surgery, you should always review the medications, supplements, vitamins, and foods that you consume. Many of these can cause problems during your procedure because they thin your blood, making you more likely to have heavier bruising or complicating the procedure with excessive bleeding. Others may overly enhance or otherwise interact with the numbing anesthetic used during your double eyelid surgery.
At the Chow Center for Plastic Surgery, your full medical history will be reviewed, especially any eye conditions you may have, such as dry eyes. Use of eyeglasses, contacts, and eye medications should be recorded. For example, the use of contact lenses has been associated with the loss of double eyelids over time. If you are seeing an ophthalmologist, or eye doctor, for any reason, you will likely need to have this physician clear you for an Asian blepharoplasty prior to surgery. Previous surgeries, especially eyelid surgeries, must also be known, as they could affect your final outcome.
Please be sure to avoid the use of make-up on the day of surgery. Before the procedure begins, Dr. Chow will meet with you to discuss any last minute questions you may have. He may also take some measurements and occasionally make some markings while you are in the sitting position to aid in accurate fat removal during surgery.
In approximately two-thirds of his double-eyelid surgeries, Dr. Chow performs the double eyelid procedure at an outpatient surgery facility with an anesthesiologist, or doctor of anesthesia, present. This is because many patients prefer to be comfortably sedated during the procedure through the use of IV (intravenous) medications in addition to local anesthetic. In the other one-third of cases, patients prefer to be fairly awake, taking medication by mouth for relaxation and then undergoing the procedure after having their eyelids fully numbed by local anesthetic. This is a choice that you should make after having a thorough discussion with your facial plastic surgeon.
Once the procedure begins, you will have numbing eye drops placed, followed by thick contact lenses called corneal protectors in order to enhance safety. Your eyelids will be remeasured and marked, possibly a second time, before numbing local anesthetic is injected. Dr. Chow will then perform either a suture ligation or incision double eyelid blepharoplasty. You will be asked to open and close your eyes during the case, though your vision will be impaired by the corneal protectors. You will also be asked to look upwards from time to time. Once the procedure has been completed, your vision may be temporarily blurry from ointment.
You will have a period of recovery afterwards, while a nurse, or team of nurses, watch(es) over you with physician supervision.