Double eyelid surgery DST or incision surgery? Low crease or medium crease? (Photo)

I’m a board certified cosmetic surgeon and I’m a
specialist in oculofacial plastic and reconstructive surgery. I’ve been in
practice for over 20 years and Asian eyelid surgery is something I do a
lot. I can give you my approach or
evaluation so that you would get an understanding of what my recommendations
are for someone like you.



With the photos you submitted, it’s difficult to
give you an exact answer because I can’t do a physical examination. To decide
between whether to do an incisional and a non-incisional approach, we have to
look at several factors like excess skin and fat. In addition, we would also
analyze if there is value in removing extra skin in order to create an eyelid
platform to create the double fold.



In your situation, assuming that you are young and don’t
appear to have that much extra skin, I would probably do a non-incisional
surgery. Non-incisional means making small entry points in the skin and
creating connections between the eyelid skin an and the levator muscle using
sutures. These sutures are tied effectively into small loops that connect the
muscle with the skin. DST is one non-incisional technique which is a continuous
threading of the suture all the way across from one end to the other.



We also decide whether to do a low or a medium crease. It’s important
to understand that in an incisional or a non-incisional procedure, there’s a
certain amount of relaxation that always happens. This relaxation can have an
effect on the height of the crease. Your question is probably more about the
way the crease naturally tapers into the epicanthal fold or whether or not you
want to go parallel to the epicanthal fold.



I recommend to patients that the goal of the procedure is to look like
you were born with the crease, as the natural crease goes into the epicanthal
fold. Very high creases look unnatural. The difference between low and medium
crease is about 1-2mm which is very small and is
something that has to be determined by physical exam. Generally, I tend to make
the crease a little bit higher because I know there is a certain amount of
resolution of swelling. When the eyes are open, there should be a decently
defined crease. The outcome has to do more with what you’re comfortable with
and what is realistic. This is where a physical examination and a discussion
about the height have to be clarified before you do the procedure.



I suggest that you meet with some doctors, learn about the options and the
potential outcomes would be and would it be right for you. There is still no perfect
solution for everybody, it’s all about getting the results that are close to
what you have in mind. I hope that was helpful, I wish you the best of luck,
and thank you for your question.



This personalized
video answer to your question is posted on RealSelf and on YouTube. To provide
you with a personal and expert response, we use the image(s) you submitted on
RealSelf in the video, but with respect to your privacy, we only show the body
feature in question so you are not personally identifiable. If you prefer not
to have your video question visible on YouTube, please contact us.

It appears your young and you have relatively thin skin.  You may be a good candidate for suture technique but my preference is usually incision technique because I get better and more reliable results using this technique.  Yes U will heal faster and a general sense from suture technique but incision typically holds up better over the long-term.  The difference in I shape and size will not change after surgery but surgery can help to reduce how noticeable these asymmetries are.  While it is up to my patients what they choose as far as their crease goes within limits of safety and good taste I tend to favor medium to low creases especially in younger patients because you can always do a little bit more.  If you go too far you are stuck.Chase Lay, MDAsian eyelid surgery expertDouble board-certified facial plastic surgeon

Based on your pictures, you may have many options regarding the techniques of double eyelid surgery. Although choosing the best technique is important, the surgeon's experience, aesthetic sense and ability to execute his technique is far more critical in achieving a great result.Regarding the size of the crease, your surgeon and you together should be able to choose the most aesthetically pleasing size and shape for your eyelids. There are more than just low, medium and high crease sizes. You want to find the best size for your eyelids.