Primary goal: Formation of a crease in the upper eyelid
Secondary goal: Creation of a more expressive and bigger-appearing eye
Anesthesia: Sedation is kept minimal so the surgeon can evaluate the position of the developing crease during surgery.
Surgical technique: The preferred approach is incisional. Skin, fat, orbital septum, and muscle are thinned, although removal is more conservative. A "deep fixation" suture closure is used.
Variation: "Non-incisional" techniques that involve a few small incisions (thus, not really non-incisional) rely instead on the placement sutures within the eyelid. The sutures create inflammation that holds the crease in place. No substantial anatomical change is created.
Advantages: Incisional double eyelid surgery creates a very long-lasting, if not permanent, result. While simple suturing techniques are still practiced primarily in the Orient, the crease often disappears within a matter of years.
Limitations: Asian double eyelid surgery should ideally enhance the appearance of the eyelids in a manner that is consistent with the rest of the facial characteristics. "Westernizing" the eyelids is ill-advised.
Recovery: Asian skin has been said to be more reactive than Occidental skin, which may result is some slight delay in healing and softening of the scar. Crease shape and height will vary during the months after surgery and not reach its final configuration for six months or more.
Risks: In addition to blepharoplasty risks discussed elsewhere, crease complications comprise the major source of dissatisfaction. An overly high or arched crease may appear unnatural on an Asian face. Attempts to modify the epicanthal fold (epicanthoplasty) may lead to noticeable scarring and such surgery should be undertaken with caution.
