Am I a good candidate for double eyelid surgery?

Question:

I have a mono eyelid and used liquid glue, I used that double eyelid liquid glue and it’s been almost 2 years now, even though I know it’s not good for my eye. Please answer me as soon as possible.

Answer from Dr Amiya Prasad:

Thank you for your question. You submitted a single full-face photo and you are asking if you’re a good candidate for eyelid crease surgery and that you’ve described that you’ve spent the past two years, using a glue to create the crease even though you’re aware that it’s not the best thing for your skin. So with the photo you submit it appears that you’re very young and just to answer the question on whether or not you’re a good candidate is really more of an anatomic question and I’ll share with you my approach when I meet patients like yourself in my practice.


I’m a practicing cosmetic ocular facial plastic surgeon in Manhattan and Long Island for over twenty years and a particular area specialty in my practice is Asian eyelid surgery. So you’ve probably done a lot of research and you’ve learned that approximate fifty percent of people of Asian origin have an eyelid crease while fifty percent don’t. And it’s been my observation over many years of doing this that there are people who have variable levels of crease as well.

There are people who have multiple folds or one crease is defined and then there is several little folds next to it. So there is some variability there. So when you don’t have an eyelid crease.  Essentially, the anatomy that is necessary to exist in order to create an eyelid crease that you are trying to mimic with glue. And another popular alternative is tape, is to try to create some stiffness between the eyelashes and the platform of the eyelid where typically you’d apply eye shadow and to try to force the skin to fold in, in a certain way. What’s absent for those who don’t have a crease are these fibers that comes off of a muscle called the levator muscle. The levator muscle is like the word elevator. It lifts the eyelid and when there are connections between the levator muscle in the skin. It creates a crease.

So in the decision-making process when someone comes to our practice, we decide based on certain basic anatomic issues whether or not they are a candidates for a crease and then what type of surgery is optimal for them. As you probably are aware there is a incisional surgery and then there’s non incisional surgery. And although both procedures still involve making openings, essentially an incisional surgery implies that there is a need remove extra skin as well as often the case to address some fat, which is interfering with the muscle ‘s ability to create a connection. And so whether we take the excisional approach or non- incisional approach you have to make a connection between the levator muscle and the skin.

 

So when we make this determination. We also look at the desired type of crease. There is two types that when we’re were looking at the relationship of the epicanthal fold or the little web that is natural and Asian eyelids. There are those who have a more subtle type of fold and there are more who have a more defined fold.

And so we can call it a nasally tapered fold or a parallel crease. And what I try to do is determine what nature would have created if that was the case that the person was going to be born with. And then usually what I do, is I just kind of place either a Q-tip or a special eyelid crease instrument that pushes the skin inward and it almost folds in as if nature would’ve created that and I usually advocate for something that looks very, very natural as if you were born with the crease.
So to answer your question, I believe if you have been successful with the glue as many patients who come to us do first, is they try tape of different kind, types, and what I often do is I’ll have them actually wear the tape, and it gives me a guide to where I should place my stitches or how high they’d like their increase. If that’s been the case where you’ve been satisfied with that, then you are probably a candidate of the surgery.

The question is, is when is the right time for you?

And to determine that you have to meet with cosmetic surgeons who performed this type of surgery.  The approach that we have in our practice is, we do these procedures under local anesthesia with light intravenous sedation. That means that during this twilight state that allows us to make the areas numb and will be comfortable and then we’ll do the procedure and actually sometimes have you open your eyes to see how things look. And whether or not these connections are being made effectively.

Patients never feel any pain, but they’re just aware that I’m asking them to open their eyes and it sometimes helps to have that additional information during the procedure. When you are young and you don’t have extra fat or a need to remove additional skin then a non- incisional procedure is usually the preferred method. It avoids any long incisional type of scar and it allows for minimal trauma and minimally invasive and it’s often associated with the faster recovery.
So again, I think that my approach for a typical younger Asian patient without extra fat or extra skin would be a non-incisional approach, but I think that it’s important that you meet with doctors and discuss the plan and the approach and the style in which you’d like the crease to form. And once you’re comfortable with that then move forward. So I hope that was helpful. I wish you the best of luck and thank you for your question.