Commentary on: Visual, Physiological, and Aesthetic Factors and Pitfalls in Asian Blepharoplasty.

Abstract

Upper blepharoplasty (or double eyelid surgery) is one of the most commonly performed cosmetic surgical procedures for Asians.1 Just like any other cosmetic surgical procedure, careful evaluation of patient anatomy, proper selection of the procedure, precisely performing the procedure, and suitable postoperative care are key for an optimal outcome after Asian upper blepharoplasty.2 This Special Topic article, entitled “Visual, Physiological and Aesthetic Factors and Pitfalls in Asian Blepharoplasty,” is a good example of an article written by an experienced Asian blepharoplasty surgeon.3 It starts by emphasizing the importance of upper eyelid anatomy in Asian patients, followed by analyzing some of the common problems in Asian upper blepharoplasty, including the less optimal height of the upper eyelid skin crease, the wrong placement of non-absorbable suture in the upper eyelid that changes its normal anatomy, and the careless closure of the upper eyelid incision, causing functional and anatomic disturbance of the upper eyelid. In general, the upper eyelid is a 7-layer structure that contains skin, orbicularis muscle, orbital septum, preaponeurotic fat pads, the levator muscle, the Mueller's muscle, and upper tarsus, and conjunctiva. One should always pay attention to the differences between Asian and Caucasian upper eyelids in terms of the anatomy, especially preseptal fat, which does not exist in Caucasians.2,4 A schematic diagram clearly demonstrates the distinctive anatomy of the Asian upper eyelid in comparison with that of a Caucasian (Figure 1). Figure 1. A schematic diagram showing the differences of anatomic structures between Asian and Caucasian upper eyelid. Adapted from Park DD.2 We agree with the author that levator function should always be evaluated as one of the important preoperative evaluations for any potential Asian upper blepharoplasty patients. As a matter of fact, levator plication during an open Asian upper blepharoplasty may enhance cosmetic …