Asian eyelid surgery: Incision too high? (Photos)

Thank you for your question.

You’ve submitted several photos from 12 days after Asian eyelid surgery as you are concerned the eyelid creases are too high. You state your mother had the same procedure done, and feels the same way. You want to see just 2 millimeters of eyelid to look natural, so you are a distressed and concerned.

I can certainly give you some understanding of how a surgeon approaches Asian eyelid surgery. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I specialize in Asian eyelid surgery among several other areas, so I understand the very important concern of looking natural.

I think it’s fair to assume you chose a doctor with proficiency in performing Asian eyelid surgery, and I also expect you had a thorough discussion about what the desired outcome would be. That said, I’ll explain to you my thought process when I meet with a patient with the same concern of wanting to look natural. The question is what kind of desired outcome you want. What I do is use a simple instrument like a Q-tip to roll the skin, and I show the patient what I think they’re asking for, and what I believe aesthetically looks natural. When we have a shared understanding of the desired outcome we then discuss the approach.

In Asian eyelid surgery, there are 2 techniques I am sure you are familiar with: non-incisional and incisional. Non-incisional means little openings are made in the skin, and stitches are placed in a strategic way to engage the skin to attach it to the levator muscle. This is the muscle that lifts the eyelids, and when it lifts, it folds the skin inward. Incisional means that an incision is made and some skin is removed. In addition, if there is extra fat then you address the fat to again engage the skin with the muscle so it creates a crease. I can tell you that most surgeons who do this likely share the idea of what the patient wants, and the fixation can be relatively high in where it’s placed in the top of the backbone of the eyelid called the tarsus - it can be slightly above that or at the top part. When that fixation occurs, you can see just 2 millimeters of lid showing, but the skin has to be folded at a slightly higher place. Where it is folded is where the skin folds in, but it doesn’t mean that’s how much of the eyelid show - it is where it is anchored to the skin. How much skin overlaps is the ultimate design, so when your swelling comes down, the skin folds and overlaps.

It is extremely common for people to have significant swelling like yours at this stage. It is not unusual for patients be very conservative about the eyelid crease being high, so pre-operatively I discuss this lot. I always tell them the swelling makes the eyelid crease  look very high in the beginning.

What I also do in my practice after doing the drawing, we actually let the patient review and understand the process. We’ll even take photos and show what my planned placement is, and where the skin is fixated so we are all in the same page. This way whether there is a littleor a lot of swelling, we know what the final outcome will most likely be.

This question really is for your doctor and your doctor will likely say, “Wait.” Right now, while your skin is swollen, no one can make a valid prediction based on just the swelling, and not knowing anything else about you prior to surgery and the details of the actual surgery. No one can ever tell you where that crease will finally settle, and how much skin will be overlapping, but I think you will be impressed at how that transformation can be fairly significant in the course of a month to several months. You can anticipate swelling, but not at the same level, but swelling will be present for months afterwards. I always tell my patients to expect swelling  for at least 4 to 6 months. Technically, swelling can go on for over a year, but socially speaking, a month later, most people look pretty good, and even a week after people are able to go back to work. There are times especially with limited non-incisional procedures that patients look great in about a week. It is very individual, and in your situation that’s most likely an incisional procedure, you have a fair amount of swelling, so it is understandable why it so unsettling for you right now.

Contact your doctor and discuss this. Meet with your doctor to get a sense of where you are, and get an understanding of your doctor’s design, and wait to see what happens. I hope that was helpful, I wish you the best of luck and thank you for your question.

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I understand your concern but the truth is your crease height will definitely lower as swelling subsides over time. The question is how much will it lower. I understand it's not easy but you need toobserve for at least 3-6 months before starting to make an assessment on the outcome including the crease height.

Yes It looks high but you can't tell until all the swelling subsides. It will take at least 4 months and if the incision is high by then you can consider lowering the crease line. I do not suggest any procedure at this time.Be patient.

Based on your photos and the information provided, you're still very swollen and in the early stage of healing. Please give yourself time (up to 6 months) for the swelling to subside.  In the meantime, follow up with your surgeon to see the progress. All the best!