Best double eyelid procedure? (photos)

Question

I'm 15, and I'm flying out to Korea this summer break for about a month to get my double eyelid surgery. I've read online about different procedures such as full incision and partial incision. After using double eyelid glue and tape, my eyelid skin started sagging a little. And now, on one eye, theres a crease forming, but thats not the line I want my double eyelid. So as for me, what procedure is recommended. I want a permanent result. And is it okay that I'm doing it in summer?

Chase Lay, MD · Answer

Thank you for the photographs.  Based on what you have done with the tape I would say your goals are very reasonable.Suture technique, incision technique, or some combination of the 2 may work just fine for you.  My personal preference the majority of the time is incision technique over suture technique because I feel it has better precision and results have greater longevity.  My experience in Korea is that there is some preference for suture technique over incision because it is very fast for many of the surgeons there, there is also a high demand for this technique over incision technique by patients because the healing time as faster, And there are also quite a few surgeons in Korea who are not comfortable with incision technique.The time of year doesn't really matter but you should avoid the sun during your healing process.Get more than a few consultations before proceeding.Chase Lay, MDAsian eyelid surgery specialistDouble board-certified facial plastic surgeon

Amiya Prasad, MD · Answer

I’m a cosmetic oculofacial plastic surgeon working in Manhattan and
Long Island for over 20 years and I have a particular area of specialty in
Asian eyelid surgery. I do all the different methods and techniques and I
customize these to the individual. There’s no one best method, but there is a
particular method that’s right for your individual situation.

To understand the anatomy as well as the genetics, we have to look at
some of the details of eyelid structure. It’s understood that 50% of patients
with Asian origin have an eyelid crease while 50% do not. Some may have a
partial crease or multiple creases and they want to have one defined crease.
The anatomy of the Asian eyelid is affected by the levator muscle that lifts
the eyelid. Its muscle fibers go into the skin and create a crease. Every Asian
eyelid surgical procedure, whether it’s incisional, non-incisional or partially
incisional, has to do with creating that connection.

I make a decision on whether or not to do an incisional technique
versus a non-incisional by doing a physical examination. Through that, I am
able to determine if there’s fat that’s getting in the way of the eyelid crease
or if there is extra skin that is obstructing or overlapping and preventing a
crease from forming. I also ask if there is ptosis or drooping of the eyelid.
Drooping of the eyelid is also related to the levator muscle and we need to
recognize that before doing the eyelid surgery.

For someone who is young who doesn’t have fat and extra skin, my
preferred technique is a non-incisional procedure. The term non-incisional
procedure isn’t quite accurate because by design, we are making little openings
into the eyelid skin. We strategically place openings along the natural crease
and through those openings, we pass a suture. Those sutures are responsible for
creating that connection between the eyelid skin and the underlying levator
muscle. There are techniques where you can do either a single suture or several
sutures. It’s about customization and looking at the behavior of the eyelid
when I am doing the procedure. I even ask my patients to open their eyes during
the procedure; they don’t feel anything, but it helps to position of the eyelid
as I’m doing the surgery.

Since you are starting at the age of 15, you still have many decades
ahead of you. As you get older, things do change but you’re not going to change
in your 30s, 40s and beyond. One of the concerns about the non-incisional
approach is how well those connections form and if they last a long time. There
is some variability in longevity. In my experience, our patients look good and
hold up for many years and that connection seems to work very well. However,
you have to think about different skin types in terms of thickness as well as
lifestyle, eye rubbing, allergies and other factors that contribute to whether
or not the crease holds.

Since you’re young, you have to go with your parents or guardian to
meet with doctors. Get an understanding of what’s involved and what the
procedure is like and whether you and your parents are comfortable. There have
been many patients who come to me with their parents who wanted to have this
done at a relatively young age like you, so as they got a little older, it was as
if they’ve always had the crease. It’s just seems a particular value that is
important to some people who have come with their family for this procedure. I
hope that was helpful, I wish you the best of luck, and thank you for your
question.

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Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

There are many experienced eyelid surgeons in Korea. Discuss your surgical goals with your surgeon when you meet.

Eric In Choe, MD · Answer

Based on your pictures, you have many procedure options to achieve your desired outcome. Your desired look is very realistic. What's more important than the technique is choosing an experienced surgeon who you feel confident with. Season doesn't play a role in having a good outcome.

Best double eyelid procedure? (photos)

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