Anatomic Factors that Determine a Natural-Looking Eyelid Crease after Double Eyelid Surgery

Someone asks how much time is needed between Asian eyelid surgery and a revision of the surgery. They say that the eyelid crease two weeks after surgery is smaller than they hoped, and there isn’t much swelling after surgery. They also know that size of the eyelid crease will decrease a little more since the surgery was very recent. They ask how soon they can have another surgery to increase the height, and about any potential complications if there is a second surgery over the initial incision.

New York Oculofacial plastic surgeon Amiya Prasad, MD reviews the question in this video, and reviews different scenarios of Asian double eyelid surgery:

1:37- Dr. Prasad’s experience in complex eyelid surgery and revision surgery, with samples of his work
2:00 – Samples of Dr. Prasad’s work with Asian eyelid surgery, which is also a practice-focus
2:16 – The importance of how an Asian eyelid surgery technique was chosen: incisional or non-incisional, the type of crease, and if an epicanthoplasty is desired
3:05 – Dr. Prasad’s general goal of Asian eyelid surgery is to create an eyelid crease that looks like it was naturally there to begin with, as only half of Asians have a natural eyelid crease
3:19 – Differing factors for Asians with a natural eyelid crease, from skin thickness, genetics, and fullness of the eyes and eyelids
3:39 – How Dr. Prasad simulates an eyelid crease before surgery
4:04 – How individual anatomy determines what kind of eyelid crease can be created through surgery
4:35 – The typical height range of Asian eyelid creases, and non-Asian eyelid creases
4:49 – How low an Asian eyelid crease can really be, and the likelihood the low crease is caused by swelling above the crease
5:12 – How the overlap of skin may be an issue over the height of the crease
5:28 – How the backbone of the eyelid called the tarsus is usually the same height as the eyelid crease, so surgeons are likely to put the crease at that height, but may also be conservative in removal of eyelid skin
6:00 – Why a certain amount of eyelid skin needs to be present for skin to overlap and look natural
6:20 – How incisional eyelid surgery can have temporary swelling above the crease that can make the skin overlap look more pronounced
6:33 – How Dr. Prasad does revisions after swelling has resolved, and surgical wound healing is at a more predictable stage, which is as early as 3 months, but more common around 6 months
7:22 – How Dr. Prasad measures Asian eyelid surgery results at about 6 months after surgery
7:47 – The possibility of additional skin being removed for more satisfactory results
7:57 – The possibility of having a non-incisional procedure done to improve results
8:31 – How the original doctor is familiar with differences in eyelid crease height, and can come up with a plan to improve results