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Female voice: I had blepharoplasty surgery but it is still not symmetrical. Do I need more surgery? I want it corrected but I don't want my eyes open while sleeping. Please advise on what I can do about it. Thank you so much.
Dr. Amiya Prasad: Thank you for your question. You submitted a single photo where you state in your question that you had blepharoplasty surgery, and that you are concerned that your eyes are not symmetric. In addition, you're concerned that any revision surgery may result in your eye staying open, or not being able to close at night.
So let's discuss for a moment a couple of things that are important to understand when it comes to Asian Eyelid Surgery. First of all, I am assuming that the surgery that you had is more than six months in the past. In other words, you've gone through enough of the swelling phase, where the eyelids are pretty much stable, and one side has a pretty nice crease, and the other side doesn't appear to have any significant crease at all.
The other thing to establish is that whether or not you had an incisional versus an excisional procedure. I'm assuming, based on your question, that you had an excisional procedure where a thin strip of skin was removed, and the skin was closed in a way to try to create a crease. However the crease did not form.
With that scenario in mind, I can tell you how we approach this in our practice. I've been a cosmetic Oculofacial Plastic Surgeon for 20 years, and certainly, Asian Eyelid Surgery is sometimes a little bit more involved than it could appear initially.
There are factors such as skin thickness, the way someone heals, the natural anatomy. I mean, there are, there are so many factors that can result in some asymmetry or lack of definition of the eyelid crease.
If there is no need to remove any more skin, then an option you can consider is a non-incisional procedure. Now with the non-incisional procedure, what's basically done is through small entry points in the skin, a stitch is placed that connects the muscle, the Levator muscle.
The Levator muscle is like the word elevator, and it's the muscle responsible for lifting the eyelid. And in addition, the crease that is natural is formed from fibers that come off of the Levator muscle and go to the orbicularus and the skin of the eyelid.
So essentially, when we're doing crease forming surgery, we're kind of artificially creating that connection. By doing a non-incisional procedure, and doing the suture technique, many times we're able to create that crease, not remove skin and ultimately get a better result.
So I think it's best that you discuss this with your original surgeon. Most likely, when you made the decision to have the surgery, you chose a surgeon who was experienced with Asian Eyelid Surgery, and I am sure that your doctor has experience with this type a scenario.
Once you discuss your concerns about not being able to close your eyes, then I think that as you are having this discussion, you can ask about non-incisional development of a crease, so that way you are not worried about too much skin being removed.
Asian Eyelid Surgery is not about skin unless you're dealing with an older person who has a lot of extra skin. Usually with people who are younger, there is a very limited amount of skin that can be removed to create a crease. And that's part of the decision tree of making a decision on which approach to use. But that's a separate discussion altogether.
So I hope that was helpful. I wish you the best of luck. And thank you for your question.
Dr. Amiya Prasad: Thank you for your question. You submitted a single photo where you state in your question that you had blepharoplasty surgery, and that you are concerned that your eyes are not symmetric. In addition, you're concerned that any revision surgery may result in your eye staying open, or not being able to close at night.
So let's discuss for a moment a couple of things that are important to understand when it comes to Asian Eyelid Surgery. First of all, I am assuming that the surgery that you had is more than six months in the past. In other words, you've gone through enough of the swelling phase, where the eyelids are pretty much stable, and one side has a pretty nice crease, and the other side doesn't appear to have any significant crease at all.
The other thing to establish is that whether or not you had an incisional versus an excisional procedure. I'm assuming, based on your question, that you had an excisional procedure where a thin strip of skin was removed, and the skin was closed in a way to try to create a crease. However the crease did not form.
With that scenario in mind, I can tell you how we approach this in our practice. I've been a cosmetic Oculofacial Plastic Surgeon for 20 years, and certainly, Asian Eyelid Surgery is sometimes a little bit more involved than it could appear initially.
There are factors such as skin thickness, the way someone heals, the natural anatomy. I mean, there are, there are so many factors that can result in some asymmetry or lack of definition of the eyelid crease.
If there is no need to remove any more skin, then an option you can consider is a non-incisional procedure. Now with the non-incisional procedure, what's basically done is through small entry points in the skin, a stitch is placed that connects the muscle, the Levator muscle.
The Levator muscle is like the word elevator, and it's the muscle responsible for lifting the eyelid. And in addition, the crease that is natural is formed from fibers that come off of the Levator muscle and go to the orbicularus and the skin of the eyelid.
So essentially, when we're doing crease forming surgery, we're kind of artificially creating that connection. By doing a non-incisional procedure, and doing the suture technique, many times we're able to create that crease, not remove skin and ultimately get a better result.
So I think it's best that you discuss this with your original surgeon. Most likely, when you made the decision to have the surgery, you chose a surgeon who was experienced with Asian Eyelid Surgery, and I am sure that your doctor has experience with this type a scenario.
Once you discuss your concerns about not being able to close your eyes, then I think that as you are having this discussion, you can ask about non-incisional development of a crease, so that way you are not worried about too much skin being removed.
Asian Eyelid Surgery is not about skin unless you're dealing with an older person who has a lot of extra skin. Usually with people who are younger, there is a very limited amount of skin that can be removed to create a crease. And that's part of the decision tree of making a decision on which approach to use. But that's a separate discussion altogether.
So I hope that was helpful. I wish you the best of luck. And thank you for your question.
Revision Asian Eyelid Surgery Must Not Remove More Skin
Dr. Amiya Prasad details the non-incision approach to revise a previously performed Asian double eyelid surgery to ensure that no additional skin is removed, but a more defined crease can still be created.
