Upper Lid Blepharoplasty in Asian Patients

For the last few years, I have seen more and more Asian
patients asking for an "occidental" lid crease in the upper
lid and that is why I developed a specific technique for
these patients. Moreover, most Asian patients are very
specific and concrete about their desires and expectations.
Some of them do not have any lid crease at all and just
want a (typically) low Asian fold in the upper eyelid: they
desire a double eyelid without changing the ethnic
character of it. Other patients want a complete
occidentalization with a high lid crease and a resection of
prolapsing orbital fat pockets. Indeed they frequently
complain of lid heaviness. Furthermore there is a third
group of patients with a true blepharoptosis, i.e. with a
real lower lid margin that (partially) covers the pupil.
These patients may just want their eyelids to be lifted
without altering the character of the lids. Here the skin
incision must be lower, either in a preexisting crease or,
if the patient does not have a crease at all, no higher
than 4 to 5 mm above the lid margin. Also the contralateral
lid crease incision must be measured and reproduced
exactly. So the procedure must be individualized for each
patient and his desires must be discussed before surgery.
It is also important that the patients know the limitations
of the intervention; on the other hand in most cases small
changes will already give excellent results. So I recommend
only subtle, very natural changes in the height and contour
of the upper lid crease.

With the patient in upright position the upper lid incision
and skin resection is demarcated. Then the patient is put
in supine position and a subcutaneous infiltration with
anesthetic is performed. All incisions are done with a
Radiosurgical unit because in this way the incision is
pressureless and that gives the best results especially for
the delicate skin of the upper eyelid.. Moreover,
Radiosurgery limits the bleeding and swelling during and
after the surgery what results in faster recovery. Asian
patients may have greater propensity for hypertrophic
scarring and that is another reason to use Radiosurgery
instead of a scalpel or a CO2 laser. Contrary to
conventional surgery I do not begin the intervention with a
deep skin-muscle resection but only perform a very
superficial skin excision. After that, I switch to a
different radiosurgical wave , not only to contract the
underlying orbicularis muscle to accentuate the lid crease
but also to push the fat pockets back into the orbit. Only
in very rare cases the orbicularis muscle is incised to
perform a conservative fat resection.. The muscle is
sutured with a few absorbable Vicryl 6/0 sutures. The skin
is closed with separate Prolene 6/0 sutures that can be
taken out after 6 days. We put a cooling mask on the eyes
to prevent swelling and eventual postop bleeding. The
surgery itself only takes about 45 minutes. The patient
stays in our recovery room for another 30 minutes and then
returns home. Patients acceptance of this type of surgery
is excellent and because in most cases the muscle does not
need to be incised, the risks and complications of the
Radiosurgically assisted upper lid blepharoplasty are
minimal.

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Peter Raus MD is the head of Miró, a centre for
Ophthalmology, Oculoplastic Surgery and Aesthetic Medicine
of the face. Peter was trained in Belgium, Spain, Egypt and
the USA and is an expert in dry eyes therapy and surgery.
http://www.dry-eyes-therapy.com