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Should Asians Get Eyelid Surgery?: All About the Fastest-Growing Cosmetic Surgery Worldwide

Posted May 27 2011 3:42am
[Photo:  Jamie Chung, actress seen in The Hangover Part II, out today.  I have no idea if she's had blepharoplasty or not, but she is beautiful, either way!]

As reported on CNN on Monday, as China is rapidly industrializing, growing numbers of Chinese men and women are traveling to Korea to get blepharoplasty, or eyelid surgery, to make their eyes appear larger.  The procedure, which takes approximately 30 minutes, is the most common cosmetic surgery amongst Asians in the U.S., amounting to 47 percent of all plastic surgeries amongst Asian-Americans.  Unfortunately, despite its popularity, it remains hush-hush and controversial in many circles, largely due to the belief that it is conducted so Asians look “more white.”  So I’d like to spend today dispelling many of the myths surrounding the surgery, as well to explain as my own logic behind why I choose not to get the procedure.

Asian blepharoplasty tends to draw controversy because many people interpret the surgery as an attempt for Asians to look more like Caucasians.  However, as before and after photos from Kim Plastic Surgery in Atlanta demonstrate, patients’ eyes still largely maintain an exotic appearance after the procedure.  The chief difference is that the pretarsal crease above the eyelid is either created ( in 50% of patients ) or lifted by the removal of subcutaneous fat.  The other source of change is that the natural epicanthal fold, the skin fold in the upper eyelid covering the inner corner of the eye, is often also removed.   Following the procedure, the eyelid appears more open, and patients are typically very satisfied with the results because they look “more awake” and “less angry.”  They also feel more attractive, perhaps because their eyes are now more in line with the “golden ratio” of the current universally accepted standard of beauty.

Unlike other forms of plastic surgery, Asian blepharoplasty is reported to have very little downtime, and a relatively low cost ($3000-5000 in most areas, depending on the severity of the case, the experience of the surgeon, the location of the practice, etc.)  Most patients are black and blue immediately afterward, but the vast majority return to work within one week.  However, it takes up to eight weeks for the eyes to stop changing dramatically, and about six months for the eyes to settle into their permanent position, as demonstrated by this video from Meronk Plastic Surgery in Oxnard, California.

It may also be noted that blepharoplasty may be downright practical for some patients with severe asymmetry of the eyes or puffiness of the skin that occludes vision.  Some of the photos from the practice of Dr. Jeffrey Schiller, M.D. in New Jersey demonstrate these types of cases.

According a recent Medscape review of the procedure from plastic surgeon Charles S. Lee, M.D. et al., the surgical strategy for creating an Asian eyelid fold is either to recreate the dermal attachment of the levator [muscle] aponeurosis, or to prevent the fat from descending below the desired eyelid fold height.

There are three methods by which the surgery may take place:  Nonincision, incision, and hybrid.  The nonincision suture method of eyelid surgery creates a fold by recreating the dermal attachment of the levator aponeurosis using nonabsorbable sutures. The incisional method of Asian eyelid surgery recreates the fold by removing the inferior portion of the prelevator fat and sealing off this area. Typically, cutting is the method of choice for this procedure, though lasers may also be used.  A hybrid version, the semi-open method, combines aspects of both techniques by using buried nylon sutures to recreate the fold, but also removing a portion of the prelevator fat through a small incision.

Proponents of Asian blepharoplasty also note that experienced surgeons will not remove too much subcutaneous fat from the eye, preserving the Asian appearance.  A comparative study of the differences between the Asian and Caucasian eyelids from  Archives of Ophthalmology outlines these differences in detail.

If one’s reasons for getting the procedure done are purely cosmetic, perhaps now is not the time to act, with the industrialization of China influencing the rest of the world to rethink Asian beauty.  One of my favorite supermodels, Liu Wen , has only a single eyelid crease, and world-class makeup artists are illuminating it with a single color, rather than trying to create a nonexistent fold with multiple colors.  The result is elegant, beautiful, and truly novel in the fashion world, as seen in recent issues of Vogue and international ads for Estee Lauder , amongst many other places.  Although it was once hard to find great material for how to make-up Asian eyes, excellent tutorials are now available everywhere, including from YouTube .

If one’s rationale for the procedure is purely cosmetic, another alternative is double-sided eyelid tape, such as D.U.P. Wonder Eyelid Tape ($16.24, ).  The tape will typically last all day, so long as water, moisturizers, or cosmetics do not touch the area.  Unfortunately, it’s not a long-term fix, as the skin on the eyelids can become inflamed.  Your eyes may also become dry as they adjust to their new positioning.  Still, I have heard mostly great reviews of the tape, and if you’re willing to save it for special occasions, it may be the quick fix you’ve been hoping for.  If you are just learning how to use the tape, excellent instructional videos are available, including this 2010 video from cinderallaz onYouTube .

Although we’re embarking on an age in which plastic surgery is becoming more commonly adopted by all genders, ages, and races, we’re also embarking on an era in which the Asian look is more accepted, if not – dare I say it – embraced.  (I saw The Hangover Part II tonight, and I’m still making this assertion, so I must really believe it!)   Even though patients’ eyes still typically maintain their Asian appearance after blepharoplasty, I think we will come to accept smaller Asian eyes as looking less “tired” and more “beautiful” as we are exposed to more images of them in upcoming years.  Of course, if Asians keep getting blepharoplasties at such an alarming rate, this rate of acceptance may be delayed somewhat.  Yet I do believe we will learn to accept smaller eyes in the future, just as we women in the U.S. have learned to embrace our curves as the average body mass index has creeped up through the years.   I think it’s all just a matter of time – and while we wait for a more global acceptance of beauty, there are fun tricks with cosmetics to play up a single crease or to temporarily create a double one .  So why go through surgery?

Let’s discuss – what are your thoughts on the issue?  I’d love to hear from you!

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