Update on Asian eyelid anatomy and clinical relevance.

Abstract

Asians make up the world's largest ethnic group, and the eyelid is one of the most prominent features of the face, regardless of race. Recent advances in Asian eyelid research have improved the understanding of its unique anatomy and, more importantly, highlighted differences surgeons should be aware of when performing Asian eyelid surgery. The most obvious characteristic of the Asian eyelid is the absent or very low lid crease and fuller upper eyelid. Caucasian eyelids typically have a double eyelid, but Asian eyelids can be categorized into three types: single eyelid, low eyelid crease, and double eyelid. Morphological variations in each layer from the different skin complexities to a taller, more circular-shaped orbital bone create a different eyelid appearance. Some components such as a submuscularis fibroadipose tissue layer and a lower-positioned transverse ligament were recently identified and found exclusively in the Asian eye. Many eyelid crease formation theories have been postulated, but none is scientifically proven because multiple factors are possibly involved. Thorough understanding of Asian eyelid anatomy is imperative. The eyelid is the key distinctive feature of the Asian eye. Improving patient appearance while maintaining ethnic characteristics is the goal of Asian eyelid surgery.