Modern Advances in Asian Blepharoplasty

Abstract

Asian upper eyelid blepharoplasty can be a challenging procedure for the cosmetic eyelid specialist. The surgery has the potential to change an individual’s ethnic appearance which can be quite shocking to patients. It is critical to thoroughly discuss patient desires before surgery and prepare a plan to meet these needs. Asian eyelid anatomy is unique and differs from that of the Caucasian lid in specific ways. The orbital septum in the Asian eyelid inserts on the levator aponeurosis at a lower position than in the Caucasian eyelid. This allows eyelid fat to descend and potentially blunt levator attachments to the orbicularis muscle and skin. This, in turn, creates a “fuller” eyelid with a less distinct or absent crease. An understanding and knowledge of this fundamental characteristic of Asian eyelid anatomy is a critical and necessary step toward performing surgery appropriately. Traditional upper eyelid blepharoplasty, in general, has involved more aggressive excision of skin, muscle, and fat. In Asian lids, this has resulted in a “Westernized” appearance with a high and arched crease. Upper eyelid blepharoplasty has evolved to a more restorative than subtractive procedure over the last decade. In Asian lids this has translated to a more conservative excision of eyelid tissue, maintenance of eyelid fat, and correctly placed low crease fixation. This has led to a more natural and youthful appearance after surgery. Adhering to these principles will improve overall outcomes and keep patient satisfaction high.