Anatomy of the Asian Eye

The goal of Double Eyelid Surgery is to achieve a natural crease and fold that is commonly seen in normal Asian anatomy

The goal is not to reconstruct a Caucasian or “Western” eyelid, but rather to achieve the natural crease and fold that is commonly seen in normal Asian anatomy. The major differences of the Asian eyelid include, a single lid or lack of “supratarsal crease,” the amount and location of periorbital fat, and the presence of a defined epicanthal fold. In most cases, the Asian eyelid is substantially fuller than the Caucasian lid, due to a higher fat volume; but it is important to minimize the fat excision, if needed at all, in order to minimize risk of a hollow upper eyelid/brow region (superior sulcus). The orbital fat is located at a lower position in the upper eyelid and as a result creates a “puffier” appearance to the eyelid platform. This thicker subcutaneous fat layer also makes it more difficult for a natural crease to form. 

The lateral canthal (outside corner of the eye) position is slightly higher, the medial canthus (inside corner of the eye) often has an “epicanthal fold” which is a fold of skin that extends as a continuation of the upper eyelid crease/fold to the medial canthus and sometimes the lower eyelid. This can create an “overhang” of skin that hides the inner part of the eye, making the eye seem smaller horizontally. Finally, and most importantly, the Asian eyelid crease/fold is lower (closer to the lashes) than in the Caucasian eyelid. Knowing this anatomy is quite possibly the most important part of creating a natural Asian crease/fold. 

Some people of Asian descent, about half in some studies, will have a well-developed eyelid crease, whereas others have none at all, and still others a combination. Even within the Asian population, there are variations to the crease: tapered nasally towards the epicanthal fold versus parallel to the eyelid margin. 

 

Medial Epicanthoplasty 

The medial epicanthal fold plays a distinct role in the formation and appearance of the eyelid crease. In some cases some of the medial epicanthal fold may be removed to allow for a natural outfold crease to form without tension and scarring. A medial epicanthoplasty is commonly performed together with double eyelid surgery. The goal of a medial epicanthoplasty is to release or partially release and excise the medial epicanthal fold, which is a fold comprised of excess skin present in the inner corner of the eyes. The removal of some of this skin can make the eye appear more open and awake. Alternatively, sometimes skin removal is not necessary, and a subtle, elegant repositioning of skin will achieve the needed result with minimal visible scarring. However, almond-shaped eyes seen in people of Asian descent is partly due to the formation of the epicanthal fold, therefore it is up to you how much or how little of this fold is removed.  

Anatomy of the Asian Eye Procedures
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