Asian blepharoplasty and the eyelid crease by W. Chen

By W. Chen

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Removal of an excessive amount of preaponeurotic fat also can cause an unnatural crease. When all the fat pads are removed from the preaponeurotic space, the result is a hollowed eye or ‘famined’ look that appears incongruous on the relatively flat face of an Asian2 (Fig. 3- 17). For Caucasians, the same complete excision of preaponeurotic fat pads used to be a necessary step in the performance of a total cosmetic blepharoplasty. It is important to recognize that there is a high degree of variation in the anatomy of the upper eyelids of Asians.

Sutures of 6/0 nylon or polypropylene are passed from the first stab incision through levator aponeurosis and some Müller muscle. The suture material is then passed a short distance along the proposed level of the crease before being returned on the skin side through the second stab incision (Step 1). The other end of the suture is repassed subcutaneously to join the first half of the suture in the second stab incision; it is then tied and buried subcutaneously (Step 2) (Fig. 5-5). Mutou and Mutou20 used two of these sutures to form the crease (see Appendix 2).

Arch Ophthalmol 1977;95:1437–1441. 8. Collin JR, Beard C, Wood I. Experimental and clinical data on the insertion of the levator palpebrae superioris muscle. Am J Ophthalmol 1978;85:792–801. 9. Cheng J, Xu Feng-Zhi. Anatomic microstructure of the upper eyelid in the oriental double eyelid. Plast Reconstruct Surg 2001;107: 1665–1668. 10. Morikawa K, Yamamoto H, Uchinuma E, Yamashina S. Scanning electron microscopic study on double and single eyelids in Orientals. Aesth Plast Surg 2001;25:20–24. 11.

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