Fix hooded eyes on monolids? (Photo)
Doctor Answers 5
You can raise your eyelash line through surgery, but it may involve a compromise of forming a deeper eyelid crease looking up
To first give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have a longstanding focus on the art of Asian eyelid surgery so I can certainly give you an idea of how I approach cases like yours.
When I evaluate a patient, the first thing I look at is whether there is the presence of excess fat or excess skin on the eyelids. Looking at your photos alone, it seems that you don’t have either of the two, and pursuing the kind of conservative appearance or fold that you desire will require a very strategic placement of sutures in order to pull and anchor the skin to achieve this look at rest.
When it comes to Asian eyelid surgery, there is certainly a multitude of articles published by very experienced surgeons that discuss the best ways of doing Asian eyelid surgery, and the reason for that is because there are still some basic principles to keep in mind.
The point at which the skin is fixated and where a crease typically forms is usually at the highest level called the tarsus, or at the junction of where the levator muscle and the tarsus crossover each other. When you look up, because there is no fat present, the form of a crease can form. For someone like yourself who has no excess skin or fat on the eyelid, I would do a non-incisional approach to the eyelid surgery. This approach creates small openings in the eyelid skin through which sutures are passed in a very strategic way to engage the levator muscle and the skin, without removing any skin.
Before performing the surgery, I try to determine what the appearance of the future crease will look like by using a small instrument to gently push the eyelid skin upwards. This is also referred to as the “toothpick test” and is just one of the ways that allows us to predict how the eyelid crease will look like if the skin were to be fixated at a certain point. Usually this anchor point would be somewhere towards the center of the eyelid or slightly lateral in order to get a nasally tapered crease.
When patients come to me for consultation and they see the amount of skin that is being revealed, they often think it is too much, and because there isn’t much skin to work with, a little fixation will cause the skin to ride up and expose too much of the eyelid. A proper physical examination is important here. I think it’s possible to create the appearance you want, but there will be some compromises - when you look straight ahead, you will be able to see the lash line and not have the skin roll over it, but when you look up, you will still probably see some degree of folding because you are creating an anchor point that suspends the skin in a way that allows the lash line to be seen.
I suggest that you meet with a cosmetic surgeon or a specialist who performs a lot of Asian eyelid surgery, and who understands the important principles and concepts of the procedure from experience. If you don’t think you would be satisfied in seeing just a little more than the lash line, then you should probably defer the procedure for now and get more opinions before you make a decision.
I hope that was helpful and I wish you the best of luck!
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Hooded Asian eyelids
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Keeping a monolid with asian eyelid surgery
You can do a very conservative surgery can be performed and you may be able to keep the monolids with just a little lash show but because of your internal anatomy you may have to create a very low crease a bit like the example I've linked below.
Best of luck
Chase Lay, MD
Asian eyelid surgery specialst.