Abstract
Increasing numbers of Asian patients of varying ethnicity are expressing preferences and expectations for a specific aesthetic appearance following double eyelid surgery. Those of Northern Mongolian ethnicity (Northern Chinese, Japanese, or Korean heritage) generally prefer a narrow crease, whereas those of Southern Mongolian ethnicity (Indonesian, Filipino, or Malaysian) prefer a wider fold. Older techniques performed until the mid-1990s resulted in a deep fold, giving the patients a more "Western" appearance. In this article, the author describes a modified technique of placing the suture in the subdermal layer, which allows for variety in the width of the fold, enabling the surgeon to retain anatomical aspects that are typical of each patient's ethnicity. With this technique, an Asian patient may now choose the width of fold that he or she prefers, resulting in a more ethnically natural look.
Highlights
Increasing numbers of Asian patients of varying ethnicity are expressing preferences and expectations for a specific aesthetic appearance following double eyelid surgery
An Asian patient may choose the width of fold that he or she prefers, resulting in a more ethnically natural look
The earliest publication about double eyelid surgery was from Mikamo in 1896,1,2 who described a closed technique employing 3 spaced silk sutures passed from the skin to the palpebral conjunctiva and tarsus and back, and ligated outside the skin
Summary
Does the patient prefer a small, medium, or wide fold? How much pretarsal show does the patient want?. After the skin is excised, a 2- to 3-mm strip of orbicularis muscle is excised along the superior margin of the lower incision, from the lateral end to the medial end (Figure 6). After this step, the septoaponeurotic sling and the pretarsal fat come into view when downward traction is placed on the lower incision with a skin hook. As the needle exits the tarsal plate, it is passed through the levator aponeurosis with a final 2-mm bite to the dermal-subdermal layer (Figure 14), after which the suture is tied. Oral paracetamol is usually sufficient as a postoperative analgesic and no antibiotics are needed
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