Is epicanthoplasty necessary for an Asian blepharoplasty? (Photo)

Question

I'm simply looking to enhance, not change, my eyes. When I went into consult, the doctor recommended that I also get an epicanthoplasty. I got the impression that without the epi, my Asian bleph would not come out 'optimal'. Is this true in my case? My sisters told me without it, I'll have down syndrome eyes. I really do not want to get the epi, but I'm worried I cannot have one without the other. I want to avoid the epi at all costs, as the scarring and end result is so unnatural to me.

Charles S. Lee, MD, FACS · Answer

I generally avoid epicanthoplasty if it does not interfere with fold creation. I's difficult to tell by photos alone whether your case would require epicanthoplasty. In general, larger folds need epicanthoplasty.

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

You can have a cosmetically pleasing result without epicanthoplasty. It really depends on YOUR surgical goals, and not your sisters'. Be sure to have your eyes evaluated by a board certified surgeon with expertise in these procedures.

Amiya Prasad, MD - Account Suspended · Answer

In Asian eyelid surgery, you are going to find some variability in the
doctors you meet, their particular style, and what they see as optimal Asian
eyelid surgery. There are a good number of colleagues who believe strongly in
epicanthoplasty and that’s fine.

I always explain to my patients that 50% of people of Asian descent
will have a crease and 50% will not.

So when I do my surgery, I make a crease as if it was naturally made.
In evaluating patients, I take a Q-tip and roll the skin in to see where your
physical skin would give permission to create a crease. Generally, for someone
with a strong epicanthal fold, the crease flows into it. Someone with a subtle
epicanthal fold, it just goes parallel or it tapers in more softly. However, epicanthoplasty
changes the whole dynamic of the eyelids so that the crease goes in further and
more of the inner corner of your eye is seen. From my perspective, if nature
were to create a natural fold for you, there shouldn’t be a difference in the
epicanthus and the area where it is basically the inner corner of the eye. That
said, I generally don’t do epicanthoplasties because it doesn’t give a natural
appearance.

In my practice, we use a lot of advanced technology for scarring. I’ve
been a practicing oculofacial plastic surgeon for over 20 years, and I have my
own surgical technique. However, predicting someone’s healing sometimes can be
a challenge. When we’re dealing with the epicanthal area, there are risks for
more obvious scars and the appearance of something that shows you had surgery.
The goal from my perspective is staying in line with a natural look. It should
like you were born with the crease , which is my aesthetic.

It is possible not to do the epicanthoplasty as long as you understand
what the anticipated outcome would be. You should be
pleased with the results and it’s consistent with what you want to see as an
outcome.  I suggest that you meet with
additional doctors and get some more opinions about how to do this without the
epicanthoplasty. Look at what you would look like, take pictures and see what
the crease would look like in the anticipating case scenario. I hope that was
helpful, I wish you the best of luck, and thank you for your question.

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