10 Mm is Human Ideal Eyelid High According to my Surgeon, is It True? or Is It Coming from Colonial Thought? (photo)

Question

This is what I think: For the look, variation across ethnicity. Also variation within ethnicity. Serving different ethnicity and individual the same within ethnicity, based on the 10mm rule might be devoid of criticism. The values and surgical practices might be based on the criteria for Western framework, it gets easy to bury ourselves within the neocolonial paradigm. Being able to "DISCERN" is one of the most important requirements for surgeon Doctors! Anatomically, 10mm is ideal for human?

Kenneth D. Steinsapir, MD · Answer

This is honestly ridiculously high even for caucasians. Amateur eyelid surgeons dutifully read these surgical descriptions (or the professors who taught them) and do precisely what is described in the text book and then pretend that the overdone effect of surgery is what you are supposed to look like: "You looook marvelous!" Yes, the literature often describes Caucasian and Asian crease heights that are much too high. Here is the dirty secret: The natural crease in the lid is not where the crease should be placed surgically. That is precisely why one should not rely on a natural crease height to design a crease incision. The reason for this is that due to the mechanics of the upper eyelid, a crease height placed at 10 mm will heal to 11.5 or 12 mm, which is ridiculously high. Similar issue for Asian eyelids. The surgical crease generally should be at 5.5 to 6.5 mm for most. This is much lower than generally described in many reference sources. One must consider where the final crease height is needed. Of course there are several other areas where surgery can go awry. Many surgeons feel compelled to resect as much upper eyelid fold and fat as possible. This skeletonizes the upper eyelid and creates the appearance of an operated eyelid. Again, surgeons often substitute judgement with a formula for determining how much of the fold to resect. This is actually backward. It is essential for both Asian and Caucasian eyelids to preserve the upper eyelid fold. The key is to determine how much eyelid platform should be visible below the upper eyelid fold and use this as a guide for skin excision. This preserves the fold. Additionally it is critically important to anchor the eyelid platform skin and underlying muscle to the levator tendon that raises and lowers the upper eyelid. To do this, the surgeon needs to know how to accurately expose the levator aponeurosis. It may be surprising to learn that something like 98% of the cosmetic eyelid surgeons out there do not have sufficient command of eyelid anatomy to perform this dissection. For this reason, it is actually very rare to see surgeons perform anchor belpharoplasty. This is a shame because this procedure is needed to support the upper eyelid lashes. WIth the levator aponeurosis exposed, it is also possible to correct a small degree of upper eyelid ptosis that is often present. 10 mm Colonial? I think you are learning something about eyelid surgery. The good news is that with detailed upper eyelid reconstruction it is often possible to make a significant improvement on previously harmful upper eyelid surgery.

Nirmal Nathan, MD · Answer

I ran across this question and wanted to contribute  my thoughts:10 mm is based on anthropometry and consensus regarding what should be ideal. Like most things in nature, there are significant numbers of people who deviate from this average.I saw a woman in my clinic recently who arrived for consultation because she was unhappy with her blepharoplasty results performed by another surgeon. The lid to lash distance was 11 mm but looked highly abnormal and elongated on her. The incision design and amount of skin resected also pulled her brow down, which has caused her a great deal of distress. All of her measurements fell within the range of "normal".In my opinion, this is the danger of a cookie cutter approach. Understanding the anatomy of the eye is important, but equally important is understanding how the eyes relate to the rest of the face.

Chase Lay, MD · Answer

There's no such thing as ideal or perfect.  The right height of and eyelid crease is the best height for you and the look your achieving.  If you're Asian 10 mm may be waaaaaaaaaaaaaaay off anyhow.  I don't used cook books in surgery.

	 

	Best of luck

	 

	Dr. Lay

Edwin Ishoo, MD · Answer

I am afraid you are choosing to be vague and not disclose your ethnicity, gender, age etc. Your surgeon likely advised you based on his examination of your face and anatomy and determined that the 10mm height is ideal. This is indeed the case for many occidental eyes. Of course there is slight variation based on specific anatomy, skin type, age and gender. The guidelines are different for Oriental eyes. Unlike the previous surgeon, the 10 mm guideline is certainly not news to me as it is a common practice and is meant to be a guideline and not a hard and fast rule. Your surgeon is well within the norm regarding this matter.

Peter E. Johnson, MD · Answer

The 10 mm rule you mention is news to us, as there is not a fixed measurement when setting the lid fold. The height is determined by the eye shape, facial shape and ethnicity, aesthetics, and anatomy such as the height of the natural tarsus or support structure in the lid itself.

Francis R. Palmer, III, MD (retired) · Answer

I have performed Eyelid Surgery for 25 years and there are averages to where the upper eyelid crease is located.  In caucasians this is typically anywhere from 7 to 10 mm's from the eyelid margin.  However in Asian eyelids, this is much closer to 4-5 mm's.  In performing upper eyelid surgery the incisions are placed within the existing upper eyelid crease(s).  

	  If asymmetry exists between the two eyelids, these can be adjusted slkightly to compensate for this but one can't place the incision widely out of the area of the existing crease(s).  In the case of a floating upper eyelid crease as appears in ~ 30-40 % of Asian eyes, the crease needs to be created.  This is done at ~ 5 mm's above the lash margin, not 10 mm's IMO.  

	  The aesthetics of eyelid surgery as in all plastic and cosmetic surgery, IMHO, comes down to the surgeon's ability to understand and follow the proper aesthetics of facial beauty for the creation of a naturally more attractive face.

Joseph N. Togba, MD (retired) · Answer

There is no such thing as the ideal height of the upper lid crease. The position of the crease can vary from as little as 3-4 mm to as high as 10-12 mm. Most surgeons use your existing lid crease as a guide to the performing an upper lid blepharoplasty which will give you a natural appearing outcome.

10 Mm is Human Ideal Eyelid High According to my Surgeon, is It True? or Is It Coming from Colonial Thought? (photo)

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