Often times, when you do an Asian Eyelift (Aesthetic Facial Plastic Surgery in Bellevue, WA) you can create tension at the middle part of the eye where the epicanthal fold is located.  When the crease is made higher than lower, the tension that the higher fold creates can place tension on the epicanthal fold and lead to what is commonly referred to as the round eye deformity.  The appearance is an eye that looks round because it has increased its dimension in the superior and inferior direction but has remained the same in the horizontal dimension.  In this case, an epicanthal fold can relieve this tension and create a more pleasing appearance to the eye by reshaping the epicanthal fold. There are four types of epicanthal folds.  Type on is where there is no extra fold of skin that covers the fleshy part of the middle part of the eye called the lacrimal lake.  When the epicanthal fold covers the top part of the fold and partially covers the lacrimal lake like the picture below a type 2 epicanthal fold exists.  When the fold totally covers the fold a type 3 epicanthal fold is present.  When the fold is reversed and is mainly originating from the lower eyelid, a type 4 epicanthal fold is diagnosed.  Below shows a very common way to reshape the epicanthal fold.  Point B is where the epicanthal fold transitions into the lower eyelid. Point A is the medial most point of the lacrimal lake. There is another point on the other side of the epicanthal fold that is called point D coinciding with the surface representation that is Point A.  Point C is the extension of the marking from Point A that meets with the double eyelid crease markings that comes from Point E where the epicanthal fold meets the upper eyelid transition.  Lines AB, BD, and AC are all equal.  Simply put, the triangle EAC is excised and after cutting DBA, the flap DBA is moved to ECA used to be.  The lines BD and AB are sutured together.  Here is video on Asian Blepharoplasty and Medial epicanthoplasty.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

I wanted to talk about the various terms that people are using when they consider Asian Blepharoplasty (Seattle’s Dr Young).  One is Pretarsal show. Essentially this is the height of skin that is exposed under the crease when the eye is opened.  See the picture below.  You measure or assess this when the patient’s eye is open and the height that is measured from the crease to the eyelid margin where the eyelash is located is the height of the pretarsal show when the eyes are open.  This is different from where the crease actually begins which could be, and usually is, much higher underneath the fold of skin that folds over where the crease begins.  When you determine where you put the crease, the amount of skin you take will affect the pretarsal show.  I usually use a metal pointer to stimulate where I will make the crease and have the patient open up there eyes.  At that point, I will ask the patient if the pretarsal show is high enough.  But I usually ask whether the “crease is high enough”. Usually the crease is set between 6 and 8 mm for a small fold.  If the pretarsal show is not high enough after placing the metal pointer at 8 mm I usually then think of taking more skin.  Then depending on how high the patient wants I usually estimate how much higher and then I multiply that by two which determines how much skin I take.

The other question I ask patients is whether they want they crease to end medially with an inside or outside fold. The picture below shows an inside fold.  An outside fold would be end closer to the nose and closer than the fold of skin where the epicanthal fold is located.  The epicanthal fold is just the extra skin that covers the fleshy part of the medial part of the eye (which is called the lacrimal lake).

To maintain you ethnicity, I usually like to make the pretarsal show no higher than 3mm and the medial part of the crease is usually an inside fold.

The epicanthal fold is another area that you can treat.  Through a different techinque you can make the epicanthal fold more open by transposing the tissue of the epicanthus more medially.  This can open up the eye and improve the results of an Asian Blepharoplasty.  I use Dr Park’s Z epicanthoplasty for most of my epicanthoplasty procedures. You can read my other blog on Dr Park’s Z epicanthoplasty that I like to do.  Here is video on Asian Blepharoplasty and Medial epicanthoplasty.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

There are many options with Asian Double Eyelid Crease Formation (Dr Young Seattle) including whether to use incisions or not, how to fixate the crease, how high the incision should be, whether an inside the fold or outside the fold crease is desired, if an epicanthoplasty should be done.  This particular blog will focus on how we do the internal fixation.  Most surgeons, greater than 90%, use the external fixation sutures to make the crease.  Essentially what we do is first make the incision and then we have to make our way down to the orbital septum.  It is essential to be very careful in doing this because you don’t want to start too low and enter the orbital septum below where the orbital septum and levator come together.  If this is done you could injure the levator and cause ptosis which is when your eyelid is lower in relation to the iris and you essentially look like you aren’t opening your eyes as big as before.    After we reach the orbital septum we then enter into the “post” septal space and elevate the post septal fat and find the levator. Traditionally at this point  the skin is then tacked to the levator with sutures and this is what causes the crease to form.  These sutures are then taken out 7 days later.  Usually this is enough to cause enough scarring to last a long time.  Another way of doing this is to tack the orbicularis muscle as shown in the photo below to the levator with orbicularis-levator fixation sutures.  These are internal fixation sutures that stay in there permanently.  In addition to these sutures, I also do the external sutures for extra assurance that the fold will stay for a very long time if not indefinitely.  The internal sutures have the benefit of acting more like the natural action that the levator has on the skin that is in front of the tarsus.  Here is video on Asian Blepharoplasty and Medial epicanthoplasty.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington