Asian eyes: do I have ptosis, or excess skin and fat? (Photos)

Question

I'm a 30 year old Asian female and I have hooded eyes - my eyelid is puffy looking and partially obscures my field of vision. I usually lift up my eyebrows to see clearly. Is it ptosis, or is it due to excess skin and fat? Would losing weight first before going in to get a diagnosis help? Will my optometrist be able to diagnose me, or should I consult a oculoplastic surgeon or plastic surgeon? I'd like to keep my monolids instead of getting double eyelids. What kinds of options do I have?

A.J. Amadi, MD · Answer

Thank you for posting your question and excellent photos. You seem to have a classic monolid (no eyelid crease) anatomy that about 50% of Asians normally have. In this normal anatomic variation, the eyelid septum, a thin membrane that limits the forward extension of fat, inserts lower on the eyelid and so no eyelid crease is present and the upper eyelid can appear "swollen". The Asian eyelid is often slightly lower on the eye, so in these instances, the skin may get in the way of your vision.Although its possible to remove the skin without creating well formed crease to try and preserve the monolid anatomy, the eyelid scar from removing this excess skin may become visible with surgery, so I usually recommend creating a natural Asian crease to avoid visibility of the scar. This will create an eyelid crease. I have posted an example of a natural appearing crease that I've created on a 22 year old man. There are other examples on my Realself profile. I would not rely on an optometrist. I recommend seeing an Oculoplastics surgeon or facial plastic surgeon with extensive eyelid surgery experience. Good luck.

Umeng David Thao, MD · Answer

Thanks for your photos and question. You are a good candidate for blepharoplasty of the upper eyelid.  Please consult with a board certified plastic surgeon who has extensive experience with Asian eyelid surgery to discuss your options. Your surgeon will also address if ptosis repair is needed.  Best wishes!

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