Thoroughly updated, state-of-the-art coverage spans the latest procedures Step-by-step descriptions of every procedure, lavishly illustrated with full-color photographs and completely redrawn line drawings, provide helpful guidance to help you achieve superior, consistent surgical results. Product details Format Mixed media product pages Dimensions Table of contents 1. Historical Considerations 2. Comparative Anatomy of the Eyelids 3. Upper Lid Crease-Terminology and Configurations 4.
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However, the principal trade off is a significantly more protracted recovery period associated with the longer incision. Interestingly, scarring is less obvious in my opinion with the full-incision method compared with the partial-incision technique because the abrupt ends of the partial incision terminate in the middle of the eyelid and can be relatively more conspicuous.
This article details the full-incision method that has served me well over the past decade in practice so that the reader grasps the requisite preoperative, intraoperative, and postoperative considerations for the Asian patient desiring an upper-eyelid crease. Management of the aging Asian eyelid is a more complicated subject, and I have written about my strategy elsewhere in the literature. First, it is worth reviewing some fundamental and relevant anatomy that pertains to the Asian eyelid.
In the Occidental eyelid and in some Asians , the levator aponeurosis inserts into the dermis to create the natural supratarsal crease Fig. In the Asian there is a partial adhesion or an entire absence of the adhesion leading to variable degrees of crease presence. In addition, what leads to the narrower palpebral fissure eye opening and fuller, puffy eyelid appearance is the presence of orbital fat that descends lower toward the ciliary margin because the levator muscle does not prohibit its descent.
Accordingly, in many cases I do not remove much fat unless the fat is excessive and prohibits a strong levator-to-skin adhesion. Also, I have a proclivity to preserve fat because I am a proponent of fat grafting to restore lost volume related to aging, so I would not want to accelerate perceived aging through overzealous fat removal.
Culturally, it is worth discussing the evolution of an aesthetic over the past 30 plus years. This technique led to extremely artificial-looking results that did not appear white or Asian but simply alien in nature. Today, the watchword is cultural and ethnic preservation, which can subtly but dramatically enhance the appearance of an individual.
Creases are low and eyelids have a much fuller configuration; those are the only types of creases that I make, because it is outside of my desire to produce results that do not live up to a high aesthetic standard of naturalness and beauty. Besides aesthetic enhancement, other motivating factors for Asian patients may include better assimilation into a Western society, ease with applying makeup because there is now a fold into which the eye shadow can reside , improved vision afforded by a wider palpebral aperture, and more rarely a superstition of improved good fortune based on ancient Asian folkloric beliefs.
The surgeon should obviously be well informed, sensitive, and exploratory during the preoperative counseling phase to ensure a mutually satisfactory outcome for patient and surgeon alike. During the consultation, the surgeon should discuss the desired aesthetic shape and height of the supratarasal crease discussed in the next section along with the protracted nature of the recovery period and what can be done to ameliorate the convalescent experience discussed in the subsequent, relevant section.
Asymmetry is perhaps one of the most commonly encountered attributes in the preoperative eyelid, and this condition most often stems from one side having a greater degree of partial fixation than the other side.