PLASTIC SURGERY: ASIAN EYELID LECTURE IN HILTON HEAD
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Dr. Lam lectures on the Asian eyelid and focuses on technique as well as a new classification for the aging Asian eyelid which he devised.
Dr. Lam has classified the aging Asian eyelid into three types: the aging Asian eyelid with a natural crease, the aging Asian eyelid without a natural crease, and the aging Asian eyelid that has a previously surgically made crease. Each scenario requires a different approach to attain the best results.
The aging Asian eyelid with a natural crease may be thought of as very similar to a standard Occidental eyelid. However, there is one major distinction. If the extra skin is simply removed from the upper eyelid for the aging Asian eyelid, the crease will oftentimes be made too high, which will appear unnatural. As mentioned, Dr. Lam believes that this higher crease also looks bad on the Caucasian patient but looks exceptionally unnatural in the Asian patient. Accordingly, if Dr. Lam needs to remove some extra skin for the individual with a natural crease, he will almost always perform fat grafting simultaneously to create the natural convexity of a youthful eyelid shape but also to maintain the eyelid crease height. Phrased another way, fat grafting permits maintenance of the eyelid crease height by pushing the eyelid crease back down to a natural height after skin removal alone raises the crease unnaturally.
The aging Asian eyelid that has had a previous surgically created crease can also pose a unique problem. If the crease created in the past was natural, i.e., very little fat removed and a low crease configuration fashioned, then the eyelid can practically be treated the same as an eyelid with a natural pre-existing crease. However, oftentimes, the Asian patient had an aggressive "Westernization" procedure performed many years ago that appeared very unnatural at the time but somehow over time has become increasingly more natural in appearance. The reason for this change is that the loss of fat in the upper eyelid, increase in skin laxity, and brow descent have camouflaged the previously very high crease that was present years ago.
In order to determine whether this is the case, you can simply lift up the eyelid to see where the crease was placed. If the crease appears very deep and high when lifting the eyelid up, most likely the previously made crease is very unnatural. Also, even though the crease has fallen over time, it can still look a bit unnatural because the thickened brow skin that descends downward still does not resemble the thin eyelid skin of a natural, lower crease.
Here is the problem: if the surgeon simply removes upper-eyelid skin without paying attention to the patient's prior surgery, the result can unmask the previously very high eyelid crease and return the patient to an unnatural result. A browlift can also create the same problem since the elevated brow can expose the former unnatural crease height. A combination of a browlift and upper-eyelid skin removal can be a disaster. Accordingly, there are very few options for such a patient. Fat grafting alone can provide limited but safe rejuvenation of the upper eyelid without causing the problem mentioned above.
