Top Lid
Top Lid
Upper Lid Blepharoplasty in Asian Patients
Since a few years I see more and more Asian patients asking for an “occidental” lid crease in the upper lid and that is why I developed a specific technique for these patients.
Moreover, most Asian patients are very specific and concrete about their desires and expectations.
Some of them do not have any lid crease at all and just want a (typically) low Asian fold in the upper eyelid: they desire a double eyelid without changing the ethnic character of it.
Other patients want a complete occidentalization with a high lid crease and a resection of prolapsing orbital fat pockets. Indeed they frequently complain of lid heaviness.
Furthermore there is a third group of patients with a true blepharoptosis, i.e. with a real lower lid margin that (partially) covers the pupil. These patients may just want their eyelids to be lifted without altering the character of the lids. Here the skin incision must be lower, either in a preexisting crease or, if the patient does not have a crease at all, no higher than 4 to 5 mm above the lid margin.
Also the contralateral lid crease incision must be measured and reproduced exactly.
So the procedure must be individualized for each patient and his desires must be discussed before surgery.
It is also important that the patients know the limitations of the intervention; on the other hand in most cases small changes will already give excellent results. So I recommend only subtle, very natural changes in the height and contour of the upper lid crease.
With the patient in upright position the upper lid incision and skin resection is demarcated.
Then the patient is put in supine position and a subcutaneous infiltration with anesthetic is performed.
All incisions are done with a Radiosurgical unit because in this way the incision is pressureless and that gives the best results especially for the delicate skin of the upper eyelid..
Moreover, Radiosurgery limits the bleeding and swelling during and after the surgery what results in faster recovery. Asian patients may have greater propensity for hypertrophic scarring and that is another reason to use Radiosurgery instead of a scalpel or a CO2 laser.
Contrary to conventional surgery I do not begin the intervention with a deep skin-muscle resection but only perform a very superficial skin excision.
After that, I switch to a different radiosurgical wave , not only to contract the underlying orbicularis muscle to accentuate the lid crease but also to push the fat pockets back into the orbit.
Only in very rare cases the orbicularis muscle is incised to perform a conservative fat resection.. The muscle is sutured with a few absorbable Vicryl 6/0 sutures. The skin is closed with separate Prolene 6/0 sutures that can be taken out after 6 days.
We put a cooling mask on the eyes to prevent swelling and eventual postop bleeding.
The surgery itself only takes about 45 minutes. The patient stays in our recovery room for another 30 minutes and then returns home.
Patients acceptance of this type of surgery is excellent and because in most cases the muscle does not need to be incised, the risks and complications of the Radiosurgically assisted upper lid blepharoplasty are minimal.
About the Author
Peter Raus is an internationally known oculoplastic surgeon. He was trained in Belgium, Egypt,Spain and the US.
Peter in the director of Miró, a center for Ophthalmology , Oculoplastic Surgery and Aesthetic Medicine of the face.
If you want to read more, you can visit his website www.dry-eyes-therapy.com
How do you put eyeliner on the top lid?
I have tried the pencil and the liquid kind, but neither of them have worked for me; it always comes out too thick or smears. Any tips?
Liquids and pencils usually leave a really harsh line, which is sometimes unflattering. If you're going to use them, pull your eye lid to the side (eye closed) and try to smudge the liner into your lash line. Use a Q-Tip to smooth the liner so its not as harsh and creates a smokey kind of look (so hot right now).
Liquids are tricky. You have to have a fairly steady hand as they do not smudge well.
THE BEST IDEA: get a small angle brush and use EYE SHADOW! If you wet the brush and dip it in your chosen shadow color and smudge it into your lash line. Otherwise, use a dry brush and the line will again be less harsh and you have more color options!
Good Luck!
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