Fix hooded eyes on monolids? (Photo)

Thank you for your question. In your question, you describe your eyelids as monolids with some hooding. When you look straight; and when you look upwards, you get the appearance of a fold as seen in the photos you submitted. You’d like to know if it’s possible to perform conservative surgery on your eyelids so you can see more of the lash line, but you are happy with your monolids, so you are not really looking for double eyelid surgery.

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!

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.

Thank you for sharing your question. A strip of skin can be removed to improve the visibility of your lashes. If over-corrected, you will change the natural appearance of your eyelids which you feel strongly about maintaining. See an eyelid specialist with extensive experience in Asian eyelid surgery for detailed evaluation and discussion of treatment plan.Good luck,

Aiers, it is possible to perform a surgery that maintains the "monolid" (aka no crease).  In order to do this, the amount of skin removal needs to be minimal so that the remaining skin drapes over the incision line up to the lash line.  Before you have this procedure performed make sure this is what you want because you do have "double" lids when you look upwards.  Hooding is another term for dermatochalasis.  Hope this helps. Cheers