This is one of the most common procedures performed by plastic surgeons in Asian countries. About 50% of those of Asian descent have a single or fold-less upper eyelid. Commonly there is also excessive fullness in the area between the eyebrow and eyelashes and a fold of skin that overhangs the inner corner of the eye. Other characteristics include an eye that is not as deeply set, and an appearance that the eyelashes are short due to the overhanging and full upper eyelid skin. The goal of women and men who have this characteristic is to improve the appearance of their eyelids by creating an eyelid crease while still maintaining the ethnic characteristics of the eye and surrounding region. Most of the time the goal is to simply produce an eyelid crease, less commonly it is to dramatically reduce the fullness of the upper eyelid to make a more Caucasian appearing eyelid.

Other ethnic groups can also have some of these anatomic features that can be corrected using any one of the many techniques that are used specifically for Asian eyelids.

The simplest procedure involves using buried permanent sutures placed in a loop underneath the skin to hold the skin down to the deeper structures. The advantage of this technique relatively simple and works well in cases where there is not a significant “heavy” appearance to the upper lid. The disadvantage is that sometimes the sutures are visible through the very thin eyelid skin.

Asians typically have a fat pad that extends down almost to the lash line. In most other ethnic groups the fat pad is smaller and reaches down just to the level of the eyelid crease. There are also small attachments between the skin and deeper structures which create the actual eyelid fold. A more direct surgical approach to creating an eyelid crease involves carefully removing only the redundant fatty tissue that is below where the eyelid crease is desired, and attaching the skin to the underlying muscle. This creates a thinner eyelid between the lash line and eyelid crease. In addition it gives the appearance that the lashes are longer as they are no longer concealed.

Some patients are also concerned about webbing over the inner corner of the eye. This is partially corrected by the procedures just mentioned, if the webbed appearance is modest. In cases where it is more prominent a procedure called a z-plasty or w-plasty is used where the skin is rearranged in a way that reduces the tethering that is creating the web. The downside of this additional procedure is that it creates small scars in this region.

In summary there are a wide variety of procedures that can be performed alone or in combination with others to produce the result that the patient desires. We have also found these techniques to be very useful in other ethnic groups, and in revisional surgeries.