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- Asian Eyelid Surgery Done Too Young — Can It Be Reversed?
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Male: Can I get my Asian eyelid surgery reversed? I'm half Asian and had multiple surgeries when I was 11 to turn my almond eyes round. I was wondering if there was a possible ways to make my eyes go back to being almond-shaped. Now that I'm older, 20 years old, I regret getting the surgeries.
Dr. Prasad: Thank you for your question. You're posing an interesting question, because you've had surgery at a fairly young age, at the age of 11, to change the intrinsic structure of the shape of your eyes, and the photo you submitted is helpful, and certainly I can offer you some opinion about ways to change the shape of the eye, but at the same time, there is a limitation, and that limitation is doing a physical examination, but let's start with what I perceived from the photo that you submitted.
For one thing, the outer corner of the eyes appears to have been pulled outward. Where you were at 11 versus where you are at 20, as your face has grown, it's possible, that as the bones grow, that the corners, which were fixated, have shifted outward. So that's one aspect that may be potentially addressed. Two, the lower eyelids appear to be rounded and, therefore, it may appear to be looking a little bit over rounded for your facial features and structure. So it may be a strategy to consider is correction of the outer corner as well as vertical correction of the lower eyelid. We refer to this in other situations, and actually yours as well, as a relative lower eyelid retraction.
Now, here's why I can't tell you definitively what I'd recommend is that in order to be able to do a repair or a reconstruction of the eyelid structure, we have to determine what of the elements, of the anatomic elements of the eyelid, need additional tissue. The lower eyelid position is dependent on the lateral canthal tendon, which is a tendon that stabilizes the lower eyelid and is attached to the bone, the lower eyelid retractors, and the skin and muscle, the orbicularis oculi muscle and the skin. All of these factors play together in a way that results in eyelid position.
Now, if there's a shortage of skin, then you need skin grafting. If there is a shortage of support, I think of the lower eyelid in terms of not just the outer and inner corner, but also of the lower eyelid retractors, which the anatomy is such that it can actually work as pillars that hold the lower eyelid in place. A lot of plastic surgeons try to pull the lower eyelid up, and without any support vertically, and end up creating just a bowed look, and it doesn't really work out. So usually, when someone has lower eyelid retraction, I have to do some type of grafting, something like a material like Enduragen or human acellular dermis. This structural benefits, or grafts, need to be placed on the inside to give them vertical support.
Now, if there's a skin shortage, then there may require skin grafting, which then leads to, of course, the next question, which is is there a benefit to doing that much surgery aesthetically, for you or can you accept waiting and seeing how your face matures over the next several years. And it might be the most practical decision. If there's a shortage of tissue, then you will have to go through a lot of work in order to create the restoration of those structures. Now, I didn't even talk about the upper eyelids, but the upper eyelids are dependent on how much available skin there is.
We do a fair amount of Asian eyelid surgery and we have patients who come for a revision surgery and one of the most common reasons they want a revision is that, as they got older, their eyelids got more hollow and they ended up getting a little peak and so what we will do is actually do fat grafting, take fat from one part of the body and place it into the space just below the brow, as well as some just in the orbital space, the space around the eye, to try to restore some volume in that area.
Again, in the absence of a physical exam, I can't tell what the elasticity of the skin is and how much skin is available, but I think it would be fair for me to conclude that, as a young person, you don't have a lot of skin and you don't have a lot of skin laxity, because you're still young. So in a way, it limits the amount of stretch that any type of surgery would be able to use in order to move tissue from point A to point B.
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Dr. Prasad: Thank you for your question. You're posing an interesting question, because you've had surgery at a fairly young age, at the age of 11, to change the intrinsic structure of the shape of your eyes, and the photo you submitted is helpful, and certainly I can offer you some opinion about ways to change the shape of the eye, but at the same time, there is a limitation, and that limitation is doing a physical examination, but let's start with what I perceived from the photo that you submitted.
For one thing, the outer corner of the eyes appears to have been pulled outward. Where you were at 11 versus where you are at 20, as your face has grown, it's possible, that as the bones grow, that the corners, which were fixated, have shifted outward. So that's one aspect that may be potentially addressed. Two, the lower eyelids appear to be rounded and, therefore, it may appear to be looking a little bit over rounded for your facial features and structure. So it may be a strategy to consider is correction of the outer corner as well as vertical correction of the lower eyelid. We refer to this in other situations, and actually yours as well, as a relative lower eyelid retraction.
Now, here's why I can't tell you definitively what I'd recommend is that in order to be able to do a repair or a reconstruction of the eyelid structure, we have to determine what of the elements, of the anatomic elements of the eyelid, need additional tissue. The lower eyelid position is dependent on the lateral canthal tendon, which is a tendon that stabilizes the lower eyelid and is attached to the bone, the lower eyelid retractors, and the skin and muscle, the orbicularis oculi muscle and the skin. All of these factors play together in a way that results in eyelid position.
Now, if there's a shortage of skin, then you need skin grafting. If there is a shortage of support, I think of the lower eyelid in terms of not just the outer and inner corner, but also of the lower eyelid retractors, which the anatomy is such that it can actually work as pillars that hold the lower eyelid in place. A lot of plastic surgeons try to pull the lower eyelid up, and without any support vertically, and end up creating just a bowed look, and it doesn't really work out. So usually, when someone has lower eyelid retraction, I have to do some type of grafting, something like a material like Enduragen or human acellular dermis. This structural benefits, or grafts, need to be placed on the inside to give them vertical support.
Now, if there's a skin shortage, then there may require skin grafting, which then leads to, of course, the next question, which is is there a benefit to doing that much surgery aesthetically, for you or can you accept waiting and seeing how your face matures over the next several years. And it might be the most practical decision. If there's a shortage of tissue, then you will have to go through a lot of work in order to create the restoration of those structures. Now, I didn't even talk about the upper eyelids, but the upper eyelids are dependent on how much available skin there is.
We do a fair amount of Asian eyelid surgery and we have patients who come for a revision surgery and one of the most common reasons they want a revision is that, as they got older, their eyelids got more hollow and they ended up getting a little peak and so what we will do is actually do fat grafting, take fat from one part of the body and place it into the space just below the brow, as well as some just in the orbital space, the space around the eye, to try to restore some volume in that area.
Again, in the absence of a physical exam, I can't tell what the elasticity of the skin is and how much skin is available, but I think it would be fair for me to conclude that, as a young person, you don't have a lot of skin and you don't have a lot of skin laxity, because you're still young. So in a way, it limits the amount of stretch that any type of surgery would be able to use in order to move tissue from point A to point B.
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Asian Eyelid Surgery Done Too Young — Can It Be Reversed?
Dr. Amiya Prasad details the specialized surgeries involved in reconstructing eyelids that were pulled down from surgery performed at a very young age.
