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

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.

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.

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