The eyelid area is divided into the brow, the upper eyelid, the lower lid, and the medial epicanthus. The brow and the upper eyelid play a very dynamic role in relation to each other. The brow position will affect the upper eyelid appearance and vice versa. To optimize results, a thorough pre-operative consultation and examination is important.

Upper Eyelid Fold

The majority of patients seeking double eyelid fold surgery (sometimes referred to as double eyelidplasty, supratarsal fold creation, or oriental blepharoplasty) want a small, natural-looking fold without the stigma of surgery. A good candidate for this procedure is a young patient in his or her teens to twenties. Although there are wide variations of upper eyelid appearance and skin elasticity, a good result can be achieved with most.

Many patients actually possess a fold that can only be appreciated by manually elevating the brow. The most attractive fold in Asians starts medially very close to the lash line and slowly enlarges laterally until it achieves the fold size. Some patients need to have fat removed while others lack upper eyelid fat.

Upper eyelid fold surgery can be performed through either incision or non-incision techniques by making a cut approximately 7 millimeters above the eyelashes, across the upper eyelid. Then small dissolving stitches are placed from the levator muscle to the skin. This will assure accurate and even fold dimension. The non-incision technique is achieved by placing three tiny incisions on the upper eyelid and securing them with dissolving stitches. However, this technique has a high rate of fold loosening.

Medial Epicanthal Fold

The medial epicanthal fold is a veil of skin draping in the inner segment of the eye. A large fold gives the illusion of being cross-eyed and makes the eyes look farther apart. Medial epicanthoplasty is done by removing a wedge of skin at the inner portion of the eyelid. This can dramatically open up the eyes and greatly improve the appearance. However, the resultant scar can be prominent and so this procedure is reserved for severe cases.

Brow Lift

This is the single best plastic surgical procedure for the Asian patient.
Often a patient who requests double eyelid surgery may already have an existing adequate fold that is hidden. Due to sagging eyebrows or an eyebrow that is positioned very low, the fold is not visible. Restoring the eyebrow to its proper position through brow lifting surgery will result in a brighter and cleaner look to the upper eyelid area.

Asians possess a relatively flat frontal bone and a very shallow eye socket. Often, the brows tend to sag much faster and impact the upper eyelid appearance. The falling eyebrow can further exaggerate the puffy appearance of the upper eyelid area. Brow lifting brings out the natural fold and rejuvenates the upper lid area while taking away the forehead wrinkles.

Eyelid Wrinkles

Some patients have eyelids that look tired simply from the wrinkles around the eyelid area. As the skin ages, the upper and lower eyelids may accumulate excess skin. Removing extra skin from the upper eyelid will result in rejuvenating the eyes. However, some patients have a hollowed appearance of their eyes due to loss of fat with a sunken upper eyelid. The injection of fat into this region can restore a youthful look. Similarly, lower lid skin is removed if wrinkles are prominent. If lower lids sag and the youthful curvature of the eyelid is lost, then lateral canthopexy can be done to tighten the corner of the eyes, resulting in improved eyelid tone.