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Double Eyelid Surgery, An Eye-Opening Procedure

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Double Eyelid Surgery, An Eye-Opening Procedure
July 26
11:39 2016

In recent years, an eye-opening surgery has been making waves throughout Asian communities across the globe. Sought after by patients who want bigger peepers or a more alert, wide-eyed look, Asian blepharoplasty, also known as upper eyelid surgery, constructs a crease in the upper eyelid, transforming it from a single to a double.

Dr. Thomas Buonassisi, a facial plastic surgeon at 8 West Cosmetic Surgery clinic in Vancouver who specializes in the double eyelid procedure, said that the surgery is done for completely esthetic purposes.

“It makes absolutely no difference to the patient’s ocular function,” he expounded. “Just like wearing extensions on your eyelashes, what it does is make the eyes look bigger, because that’s what somebody might want esthetically. Keep in mind that 50 per cent of Asians have a crease. It’s a very normal feature for some of them, and for some of them, it’s not. It’s just like with someone who has a nasal feature, like a hump. Fifty per cent of people have a hump on their nose and 50 per cent don’t. And it seems as though the 50 per cent that have a hump don’t want it.”

Before the surgery is conducted, the surgeon decides where the crease will lie. The placement of the crease is not arbitrary, but rather is determined in terms of where it is likely to form.

“We can’t strong arm Mother Nature with surgery, we have to work with Mother Nature,” Dr. Buonassisi elaborated. “There’s a height at which a crease is going to naturally form in any individual eyelid and that’s based on the height of a tiny little cartilage that’s just underneath the skin of the eyelid, called the tarsal plate. Usually what happens is that the height of the tarsal crease determines where the lid naturally wants to fold. The crease that forms as a result of that plate is called the supratarsal crease. And that’s the crease we want to make form.”

Dr. Buonassisi noted two main methods for the double eyelid surgery: the incisional technique and the suture technique. With the incisional technique, an incision is made in the skin all the way across the lid, and your surgeon will usually remove a bit of skin. Then, they will make attachments between the skin, the edge of the tarsal plate and a little muscle that opens up the lid, called the levator.

Double Eyelid Surgery, An Eye-Opening Procedure

Double Eyelid Surgery, An Eye-Opening Procedure

When undergoing the procedure through a suture approach, your doctor will make a tiny incision in the skin, which is so small that it doesn’t even have to be closed, Dr. Buonassisi observed.

“It’s like a little prick in the skin, and then we actually use a suture underneath the skin to hold the skin up against the tarsal plate and the levator. That stitch is a tiny, tiny little stitch that’s left behind, and it just stays there and everytime the person opens their eye, the crease works.”

Dr. Buonassisi utilizes both methods in his practice. The approach he applies depends on a patient’s request, as well as their anatomy.

“I would say that for someone who has very, very thick skin it’s unlikely that the suture is going to be strong enough to form a crease in the skin. I usually tell people that if you’ve got really thick skin, you’re probably better off with an incision. And if you have lots of extra skin hanging down on the upper lid, then you’re probably better off with an incision as well,” he explained.

Dr. Buonassisi mentioned that the suture technique, which is done under a local anaesthetic, has a higher failure rate than the incisional technique, so sometimes it doesn’t work; but when it does, the recovery is very fast.  He added that most people look good when they leave the office and they often go back to work or school the following day.

The most common complication with the suture approach is that the suture can break and then, the crease falls out again, and the patient might have to repeat the procedure. On the other hand, the recovery time with the incisional technique is longer, but the results are also longer-lasting, Dr. Buonassisi sustained.

“What I always have to be very diligent about is the education process for patients when they come to see me, is that the results are not immediate at all, especially with the incisional technique.”

Dr. Buonassisi stated that medical or cosmetic complications could potentially arise after the surgery. Medical complications could include difficulty closing the eyes or weakness of the muscles that open the eyes afterwards, but Dr. Buonassisi reassured that this is quite uncommon and that if it did happen, that it would be temporary. The most common cosmetic complication is that the crease height is a little higher on one side than the other, which is partly because the anatomy is a little bit different on both sides. If the eyes are very much outside of being symmetric, then they do request revisions, clarified Dr. Buonassisi.

The procedure is safe when performed by a qualified, board-certified surgeon. Given the delicate nature of the operation however, Dr. Buonassisi recommended seeking a surgeon who conducts the surgery on a regular basis.

“I think ultimately it’s a very safe surgery when done by someone experienced. The results are good but it’s tricky to do for sure, it’s not an easy surgery,” Dr. Buonassisi acknowledged. “It’s very tricky. We’re talking about very, very tiny anatomy, we’re talking about the eyelids and that’s not something that you could cover with a sweater if it doesn’t look good. But worldwide there’s probably hundreds of thousands of procedures like this done every year very safely. I think it’s reasonable in the scope of the grand scheme of things. You know, relative to other cosmetic surgeries, I think it’s a pretty reasonable thing.”

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