The anatomy of the upper eyelid in Asian patients tends to have some differences relative to patients of other ethnicities with regards to a few aspects. One concerns the appearance, depth and height of the upper eyelid crease, or the supratarsal crease. In patients with a distinct crease, there exists a strong connection between the skin and underlying levator aponeurosis as the distal ends of the muscle interdigitate with the dermis of the skin. In these patients, as the levator lifts open the eyelid the skin folds predictably and reliably along this connection to create the appearance of the upper eyelid fold. In traditional upper blepharoplasty these patients as they age will develop an increase in excess skin above the upper eyelid crease, thereby covering the amount of visible pre-tarsal skin. This results in a tired and aged appearance, and also decreases the amount of eyelid to place eye liner and eye shadow.
During traditional blepharoplasty an incision can be made along the crease, excess skin and fat removed, and the skin re-approximated without much consideration for stabilizing or reinforcing the upper eyelid crease. Since the levator aponeurosis has such a strong and adherent connection to the skin, the supratarsal crease will continue undisturbed. For Asian patients, there exists a variable connection between the levator and skin, resulting in a fold that may be well-established and stable, or an upper eyelid fold that may only intermittently be present, or may present at different heights and shapes depending on a patient’s condition. This unpredictability will lead some patients to utilized eyelid tape or eyelid glue to more reliably establish a consistent height and shape to the upper eyelid or “double eyelid”.
Asian patients undergo a similar aging process in terms of developing excess skin and sagging of that excess skin along the upper eyelids, sometimes with the development of pseudoherniation of orbital fat causing fullness in the upper eyelids. In a similar manner then, the eyelid surgery specialist must take into account addressing any excesses in skin and fat to account to optimize symmetry between the two eyes, just as in traditional blepharoplasty. Where the surgery diverges relates to the establishment of the supratarsal crease, upper eyelid crease or “double eyelid” with anchoring sutures placed between the tarsal plate or levator aponeurosis and the dermis of the skin. The size, shape and height of the crease can have dramatic effects on a patient’s appearance, therefore detailed and comprehensive discussion of the desired aesthetic during consultation and prior to surgery is critical to a successful outcome that is pleasing to the patient and surgeon alike.
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