I recently read an interesting article Eyes Wide Open: Surgery to Westernize the Eyes of an Asian Child.
It was about a Caucasian father (a plastic surgeon) who put his adopted Asian daughter under the knife to beautify her eyes- to create double eyelids. Basically “When she joined her new Caucasian family, her eyes, like those of many people of Asian descent, lacked a fold in the upper eyelid, and that lack was problematic—in his view—because it made her eyes small and sleepy and caused them to shut completely when she smiled. A plastic surgeon himself, he knew she did not need to endure this hardship, so he arranged for her to have surgery to reshape her eyes. The procedure, he explained, was minimally invasive and maximally effective. His beautiful daughter now has big round eyes that stay open and shine even when she smiles.”
The article basically “reexamine the paradigm that defers to parental choices concerning health care for children when the medical intervention sought addresses the social, cultural, or aesthetic preferences of the parent rather than a medical condition in the child.” It really explores and makes us think to what extent does parental decisions become an self motivation rather than for patient autonomy and children’s decision?
The ‘Asian Eye Surgery’, or upper blepharoplasty, refers to the creation of double eyelid. It is also the most popular aesthetic operation performed in the Far East. The surgery has long been popular for Korean, Japanese and Vietnamese women and now the number of surgeries for Chinese-Americans have increased. It is estimated that 40% to 60% of Asians have a single upper eyelid or an absent superior palpebral fold. Most patients prefer a natural appearing small double eyelid and not a large fold characteristic of a “Westernized” face. The popularity of the procedure is the desire to make the eye look slightly larger and leads to an appearance of youthfulness, alertness, and vitality without compromise of ethnic identity.
There are three main differences between Asians and Caucasians with respect to the upper eyelid: (1) the Asian upper lid contains more prominent preseptal fat resulting in greater lid fullness; (2) the presence, position, and depth of the superior palpebral fold (the eyelid crease) are highly variable in Asians; and (3) many Asian upper eyelids are characterized by a medial epicanthal fold. The term “double upper eyelid” refers to the presence of a discernable upper palpebral crease. This crease, when the eye is open, naturally divides the upper lid into pretarsal and palpebral (supratarsal) components, forming a “double” lid. In a single eyelid, the absence of a crease produces a smooth eyelid from brow to lash line.
Blepharoplasty performed on Westerners and Asian is significantly different. The most prominent differences between the two operations are the intended goals, surgical techniques, and the patients’ age. Asian blepharoplasty is actually a variation of the standard blepaharoplasty. Its advantage is it has more flexibility in sculpturing eyelid configuration.
Westerner
- Goal: To rejuvenate the aging upper lid.
- Surgery: Help to remove the excess skin on the upper eyelid and the puffiness in the inner corner and middle of the upper eyelid caused by the underlying buildup of fat.
- Focus: Minimal attention is devoted to reshaping the already-present crease.
- Age: Middle age group.
Asian
- Goal: Create new crease where no crease exist or enhance an inadequately defined crease.
- Surgery: Minimal skin and fat removal.
- Focus: Realignment of youthful internal eyelid structure.
- Age: Young.
The success of the operation depends on execution of the numerous details and nuances of this procedure. The complications of surgery should be reviewed, with a particular emphasis on scarring, asymmetry, and palpebral fold release, the most common problems incurred after surgery. Postoperative asymmetry is a common source of dissatisfaction after double-eyelid surgery, occurring in 13% to 35% of Asian blepharoplasty. Asymmetric lid or brow or mild unilateral ptosis (droopy lid) preoperatively is a frequent cause of this complication. The resection of eyelid skin and the creation of a double eyelid amplify even a subtle discrepancy, making this asymmetry obvious. All patients with asymmetric lids need to be counseled appropriately, because precise postoperative symmetry may be more challenging to obtain. The dermis of Asians contains a higher concentration of collagen and tends to be thicker compared with that of whites, and although infrequently seen, overactive scarring in Asians is a higher risk. Scarring and tethering of the skin to underlying tissues can produce multiple irregular folds and a deeply sunken eyelid.
Besides surgery, lasers have also been employed in this procedure since 1984! Baker first introduced the carbon dioxide laser in blepharoplasty back then. Nowadays there are multiple lasers which aid in the surgery to reduce post operative complications. In a study by Kang, 241 women underwent double-eyelid blepharoplasty using a carbon dioxide laser. only 5 patients (2%) had superior palpebral fold release, which is substantially lower than the usual 5% to 10% rate observed in cold techniques. There were no instances of hypertrophic scar, wound dehiscence, collateral laser injury, or hematoma. Postoperative swelling, ecchymosis, and pain were subjectively improved but not quantified. Long-term follow-up suggested no difference in scar pigment or quality compared with the cold scalpel technique. Other surgeons have used the fiber-delivered contact neodymium:yttrium-aluminum-garnet laser for double-eyelid fold operations. Although they acknowledged the high cost of equipment and the need for well-trained personnel, they achieved excellent results with no short- or long-term complications. The success was attributed to preserved tactile sensation provided by the fiberoptic delivery system and to the minimal collateral laser burn damage seen with this laser. .
Beauty, however, is in the eye of the beholder and is also culturally variable. Although the entire procedure may last for just an hour, and has a short recovery time, to many Asian-American women it is not a question of cosmesis, but a loss of ethnic identity that leads many of them to reject this procedure. Probably in Asia, people do not see the procedure as ethnically altering. However in America, unlike their peers in Asia–where blepharoplasty is the No. 1 cosmetic procedure- -young Asian-American women who consider the surgery are more likely to grapple with the idea that the procedure will also alter their ethnic identities, according to Dr. Charles Lee, a plastic surgeon in Los Angles who specializes in blepharoplasty. Some extremeists have called it a form of self mutilation!
Pondering on the moralistic and ethical issues around this controversial surgery, I feel privileged to have double eyelids on my Asian eyes. While some people are comfortable with their single eyelid eyes, others do everything to achieve the ‘coveted’ look. For those who want to mimic double eyelids without undergoing the knife, you can use eyelid tapes or use a special glue and a small fork-like device to create the illusion of a crease, which I will write more about in another post on creating double eyelids for those with single eyelids, and those wishing to enhance and deepen existing double eyelids.
I recently read an interesting article Eyes Wide Open: Surgery to Westernize the Eyes of an Asian Child.
It was about a Caucasian father (a plastic surgeon) who put his adopted Asian daughter under the knife to beautify her eyes- to create double eyelids. Basically “When she joined her new Caucasian family, her eyes, like those of many people of Asian descent, lacked a fold in the upper eyelid, and that lack was problematic—in his view—because it made her eyes small and sleepy and caused them to shut completely when she smiled. A plastic surgeon himself, he knew she did not need to endure this hardship, so he arranged for her to have surgery to reshape her eyes. The procedure, he explained, was minimally invasive and maximally effective. His beautiful daughter now has big round eyes that stay open and shine even when she smiles.”
The article basically “reexamine the paradigm that defers to parental choices concerning health care for children when the medical intervention sought addresses the social, cultural, or aesthetic preferences of the parent rather than a medical condition in the child.” It really explores and makes us think to what extent does parental decisions become an self motivation rather than for patient autonomy and children’s decision?
The ‘Asian Eye Surgery’, or upper blepharoplasty, refers to the creation of double eyelid. It is also the most popular aesthetic operation performed in the Far East. The surgery has long been popular for Korean, Japanese and Vietnamese women and now the number of surgeries for Chinese-Americans have increased. It is estimated that 40% to 60% of Asians have a single upper eyelid or an absent superior palpebral fold. Most patients prefer a natural appearing small double eyelid and not a large fold characteristic of a “Westernized” face. The popularity of the procedure is the desire to make the eye look slightly larger and leads to an appearance of youthfulness, alertness, and vitality without compromise of ethnic identity.
There are three main differences between Asians and Caucasians with respect to the upper eyelid: (1) the Asian upper lid contains more prominent preseptal fat resulting in greater lid fullness; (2) the presence, position, and depth of the superior palpebral fold (the eyelid crease) are highly variable in Asians; and (3) many Asian upper eyelids are characterized by a medial epicanthal fold. The term “double upper eyelid” refers to the presence of a discernable upper palpebral crease. This crease, when the eye is open, naturally divides the upper lid into pretarsal and palpebral (supratarsal) components, forming a “double” lid. In a single eyelid, the absence of a crease produces a smooth eyelid from brow to lash line.
Blepharoplasty performed on Westerners and Asian is significantly different. The most prominent differences between the two operations are the intended goals, surgical techniques, and the patients’ age. Asian blepharoplasty is actually a variation of the standard blepaharoplasty. Its advantage is it has more flexibility in sculpturing eyelid configuration.
Westerner
Asian
The success of the operation depends on execution of the numerous details and nuances of this procedure. The complications of surgery should be reviewed, with a particular emphasis on scarring, asymmetry, and palpebral fold release, the most common problems incurred after surgery. Postoperative asymmetry is a common source of dissatisfaction after double-eyelid surgery, occurring in 13% to 35% of Asian blepharoplasty. Asymmetric lid or brow or mild unilateral ptosis (droopy lid) preoperatively is a frequent cause of this complication. The resection of eyelid skin and the creation of a double eyelid amplify even a subtle discrepancy, making this asymmetry obvious. All patients with asymmetric lids need to be counseled appropriately, because precise postoperative symmetry may be more challenging to obtain. The dermis of Asians contains a higher concentration of collagen and tends to be thicker compared with that of whites, and although infrequently seen, overactive scarring in Asians is a higher risk. Scarring and tethering of the skin to underlying tissues can produce multiple irregular folds and a deeply sunken eyelid.
Besides surgery, lasers have also been employed in this procedure since 1984! Baker first introduced the carbon dioxide laser in blepharoplasty back then. Nowadays there are multiple lasers which aid in the surgery to reduce post operative complications. In a study by Kang, 241 women underwent double-eyelid blepharoplasty using a carbon dioxide laser. only 5 patients (2%) had superior palpebral fold release, which is substantially lower than the usual 5% to 10% rate observed in cold techniques. There were no instances of hypertrophic scar, wound dehiscence, collateral laser injury, or hematoma. Postoperative swelling, ecchymosis, and pain were subjectively improved but not quantified. Long-term follow-up suggested no difference in scar pigment or quality compared with the cold scalpel technique. Other surgeons have used the fiber-delivered contact neodymium:yttrium-aluminum-garnet laser for double-eyelid fold operations. Although they acknowledged the high cost of equipment and the need for well-trained personnel, they achieved excellent results with no short- or long-term complications. The success was attributed to preserved tactile sensation provided by the fiberoptic delivery system and to the minimal collateral laser burn damage seen with this laser. .
Beauty, however, is in the eye of the beholder and is also culturally variable. Although the entire procedure may last for just an hour, and has a short recovery time, to many Asian-American women it is not a question of cosmesis, but a loss of ethnic identity that leads many of them to reject this procedure. Probably in Asia, people do not see the procedure as ethnically altering. However in America, unlike their peers in Asia–where blepharoplasty is the No. 1 cosmetic procedure- -young Asian-American women who consider the surgery are more likely to grapple with the idea that the procedure will also alter their ethnic identities, according to Dr. Charles Lee, a plastic surgeon in Los Angles who specializes in blepharoplasty. Some extremeists have called it a form of self mutilation!
Pondering on the moralistic and ethical issues around this controversial surgery, I feel privileged to have double eyelids on my Asian eyes. While some people are comfortable with their single eyelid eyes, others do everything to achieve the ‘coveted’ look. For those who want to mimic double eyelids without undergoing the knife, you can use eyelid tapes or use a special glue and a small fork-like device to create the illusion of a crease, which I will write more about in another post on creating double eyelids for those with single eyelids, and those wishing to enhance and deepen existing double eyelids.