Asian Double Eyelid Surgery: Do I have Ptosis? Or just excessive skin/fat on my eyelids? (Photos)

Thank you for your question. You are 25-years-old, and want to have bigger and more alert looking eyes, and are looking into Asian double eyelid surgery. Your ophthalmologist and oculoplastic surgeon have both stated you don’t have ptosis, but maybe pseudoptosis, but they don’t have experience with Asian eyes, so you are looking for the opinion of specialists.
I can certainly help you based on your photos alone, and give you so guidance in the absence of a physical exam. I’m Dr. Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship-trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I’m well known for my work with Asian double eyelid surgery for both primary and revisional surgery, as well as epicanthoplasty, and ptosis surgery.
You do not have ptosis as your upper eyelids are not drooping, and are not covering your pupil. Ptosis is caused by a weak, stretched, or poorly developed muscle that lifts the lifts the upper eyelid called the levator muscle. Ptosis sufferers usually have the drooping eyelid cover their eyes, and often partially cover their pupil, which affects vision. Eyelid ptosis doesn’t seem to be an issue in your case.
Since you are still young, and judging from your pictures alone without a physical exam, you likely do not have excess eyelid skin and fat, so for more open eyes, I would lean towards a non-incisional Asian double eyelid surgery. With this procedure, eyelid skin is not excised, and fat over the upper eyelid is not removed. Instead of an incision, small openings are made in the eyelid skin, where a suture is passed through to connect the eyelid skin with the levator muscle. The connection between the levator muscle and the eyelid skin is what forms the crease, or the double eyelid fold. I perform this procedure with the patient under local anesthesia, with LITE IV sedation, so the patient is relaxed and comfortable, and complications, discomfort, and prolonged healing time associated with general anesthesia are avoided. Patients who undergo non-incisional double eyelid surgery generally recover more quickly than incisional eyelid surgery patients, and many patients look pretty close to their final results within a month.
To open your eyes more, we may also consider a epicanthoplasty. An epicanthoplasty involves the excision of the fold of skin in the inner corners of your eyes to open the up more. This would be done at the same time as double eyelid surgery.
I suggest you meet with cosmetic surgeons who are well experienced in Asian double eyelid surgery. Look at their results through before and after pictures to determine their experience, as well as their aesthetic to see if it suits your own goal for double eyelid surgery. I hope you found this information helpful. Thank you for your question.

Hi - thanks for your question. "Ptosis" in Asian eyelids has often been used to describe the lower height of the eyelid margin relative to your iris. This is within the natural limits and doesn't interfere with sight.  Your eyes appear to have a variant of lower crease height ("hidden" or "inner" creas) and likely have more preseptal tissue near the eyelid margin.  The thickness is hiding the crease.  These need to be addressed if you are looking for the change similar to the photographs with the skin pulled up. 
If you are interested in a subtle change of appearance, I recommend a discussion with a surgeon who understands the unique Asian anatomy is essential.  I hope you find this helpful. 

hi
based on your pictures, you do not have ptosis.  if you desire to have the look with your fingers pulling up the upper eyelid, you can slightly cinch the muscle while doing the double fold surgery.  so a true ptosis repair is not medically necessary for you.  for Asian double eyelid surgery, you should seek a plastic surgeon who does a lot of this kind of surgery.  hope this helps.