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East Asian blepharoplasty
East Asian blepharoplasty
	A South Korean woman, before (left) and after (right) undergoing East Asian blepharoplasty
ICD-9-CM	08
	[edit on Wikidata]

East Asian blepharoplasty, more commonly known as double eyelid surgery, is a cosmetic procedure that reshapes the skin around the eye to create a crease in an upper eyelid that naturally lacks one. Although 70-83% of East Asian women naturally have upper eyelid creases, it is estimated that 17-30% of Chinese and Japanese women lack this feature.^[1] This surgery may be performed on individuals of East Asian descent, including those from Chinese, Japanese, and Korean backgrounds. The primary goal is to enhance the eyelid's appearance, making the eyes appear larger and, according to some cultural aesthetics, more attractive due to a 'wide eyed' and expressive appearance.^[2]

Historical context

The procedure was first performed in 1896 by Dr. Kotaro Mikamo in Japan, a period marked by significant Western influence following the Meiji Restoration. Mikamo's introduction of the surgery has been interpreted in different ways. Although the majority of Japanese women naturally have double eyelids, one perspective sometimes held by Westerners is that the procedure was intended to "westernize" the eyes of Japanese women, influenced by Western beauty standards that were purportedly becoming increasingly prevalent in Japan during the Meiji period.^[3]

However, Mikamo recorded that the 82-83% of Japanese women actually have the double eyelid appearance,^[1] making it a physiologically normative feature among the population. He described the single-eyelid look as being "monotonous and expressionless," suggesting that his motivation for the surgery was rooted in enhancing natural beauty rather than conforming to Western ideals.^[4] According to this perspective, Mikamo was working within existing Japanese aesthetics and norms, aiming to accentuate a feature that was already prevalent and culturally appreciated in Japan.^[5]

Surgical techniques

Asian blepharoplasty is primarily performed using two techniques: non-incisional and incisional methods.

Non-incisional Technique (Suture Ligation)

The non-incisional method, or suture ligation, involves the strategic placement of sutures through all layers of the upper eyelid at the level of the upper tarsal margin. This technique facilitates adhesion between the subdermal tissues and the underlying levator aponeurosis, effectively creating the eyelid crease. It is less complex and has a shorter operation time, leading to a quicker recovery and fewer complications compared to more invasive methods. However, it tends to produce a static eyelid crease that does not vary with facial expressions and may diminish over time. Additionally, the underlying sutures can sometimes lead to corneal irritation.

Incisional Technique (Surgical Resection)

The incisional method, known as surgical resection, entails making an incision across the upper eyelid to remove excessive tissue, including skin, subcutaneous fat, orbicularis oculi muscle, and other anatomical components. This approach not only allows for the creation of a more dynamic and permanent eyelid crease but also can address other aesthetic concerns by removing excess skin and fat. The results are more aligned with the natural anatomy of the eye, making the crease appear more natural and dynamic. However, this method is more complex, requiring a longer operation and recovery time. One significant risk is lagophthalmos, where excessive removal of lid tissue can prevent the eyelid from fully closing.

Each of these techniques offers distinct advantages and poses specific challenges, making the choice between them dependent on individual anatomical and aesthetic considerations.

Modern trends

East Asian blepharoplasty have been reported to be the most common aesthetic procedure in Taiwan,^[6] South Korea and other parts of East Asia and is also frequently performed in Northeast Indian states such as Assam. The procedure has been reported to have some risk of complications, but is generally quite safe if done by an expert plastic surgeon.^[7] Practitioners of East Asian blepharoplasty include plastic surgeons (facial plastic and reconstructive surgeons), otolaryngologists, oral and maxillofacial surgeons, and ophthalmologists (oculoplastic surgeons). A procedure to remove the epicanthal fold (i.e., an epicanthoplasty) is often performed in conjunction with an East Asian blepharoplasty.^[8]

References

^ ^a ^b Ting, Yin lu; Kadir, Kathreena; Wei, Cheong Ngeow; Siti, Adibah Othman (Nov 2017). "The Prevalence of Double Eyelid and the 3D Measurement of Orbital Soft Tissue in Malays and Chinese". Sci Rep. 7. doi:10.1038/s41598-017-14829-4.
^ Ghali, Shadi (2016-08-01). Kalaskar, Deepak; Butler, Peter (eds.). Textbook of Plastic and Reconstructive Surgery. UCL Press. pp. 374–375. doi:10.14324/111.978191063394. ISBN 978-1-910634-39-4.
^ Shirakabe, Yukio; Kinugasa, Tetsuo; Kawata, Makio; Kishimoto, Takeshi; Shirakabe, Takehiro (September 1985). "The Double-Eyelid Operation in Japan: Its Evolution As Related to Cultural Changes". Annals of Plastic Surgery. 15 (3): 224–241. doi:10.1097/00000637-198509000-00006. ISSN 0148-7043. PMID 3909898.
^ Nguyen, Marilyn; Hsu, Patrick; Dinh, Tue (August 2009). "Asian Blepharoplasty". Seminars in Plastic Surgery. 23 (3): 185–197. doi:10.1055/s-0029-1224798. ISSN 1535-2188. PMC 2884917. PMID 20676313.
^ Lam, Samuel M. (2002-07-01). "Mikamo's Double-Eyelid Blepharoplasty and the Westernization of Japan". Archives of Facial Plastic Surgery. 4 (3): 201–202. doi:10.1001/archfaci.4.3.201. ISSN 1521-2491.
^ Liao WC, Tung TC, Tsai TR, Wang CY, Lin CH (2005). "Celebrity arcade suture blepharoplasty for double eyelid". Aesthetic Plastic Surgery. 29 (6): 540–5. doi:10.1007/s00266-005-0012-5. PMID 16237581. S2CID 11063260.
^ Chen SH, Mardini S, Chen HC, et al. (October 2004). "Strategies for a successful corrective Asian blepharoplasty after previously failed revisions". Plastic and Reconstructive Surgery. 114 (5): 1270–77, discussion 1278–79. doi:10.1097/01.prs.0000135951.55118.59. PMID 15457048.
^ Yen MT, Jordan DR, Anderson RL (January 2002). "No-scar Asian epicanthoplasty: a subcutaneous approach". Ophthalmic Plastic and Reconstructive Surgery. 18 (1): 40–4. doi:10.1097/00002341-200201000-00006. PMID 11910323. S2CID 42228889.