Modern Asian eyelid surgery is focused on achieving natural Asian appearance (about half of the population inherently have visible upper lid crease), as opposed to Caucasian imitation. The goal is to deliver results that look ethnically consistent and so the eye shape and even the entire face must always be taken into consideration.
The height of the eyelid crease is one of the key elements that will dictate how natural or “done” the results appear. All efforts are made to prevent too much height (i.e., more than 7 mm from the upper eyelash) because of the westernizing, incongruous effects. The consensus is to create just 2-5 mm height to achieve ethnically consistent results.
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While the underlying anatomies must always be respected to achieve natural results and reduce risk of complications particularly relating to asymmetry and eyelid ptosis (drooping), it remains important to establish the patient’s cosmetic goals to achieve satisfying outcome. For this reason, the right candidate for Asian eyelid surgery should be able to describe her aesthetic expectations in details.
For instance, some patients want the medially tapered crease, i.e., the fold begins very close to the inner eye and gradually curves; the “tail end” of the crease is ideally positioned marginally higher than the “beginning point” of the fold.
Others desire for a more parallel eye crease, i.e., the medial crease starts parallel to the eye.
Another critical issue is the shape of the eye crease. It is important to note that Asian eyelid surgery was first performed on a patient with only one natural eyelid; hence, the Japanese surgeon made sure that he created a new eye crease whose shape and height was almost the same as the other side.
The consensus is to avoid a semilunar eyelid (when viewed from the front) because of the westernizing effects, which of course look ethnically inconsistent. But as with any rule, it may not apply to everyone seeking Asian eyelid surgery. For instance, patients of mixed race or Southeast Asians may tolerate this deep inverted U look without the risk of looking “done.”
Another critical guideline to create natural- Asian eyelid surgery results is to avoid high fold, which generally favors patients with large eyes and strong levator muscle (which elevates the eyelid). Too much height is known to increase the risk of ptosis or eyelid drooping in Asian patients, particularly those with weak eye muscles, according to the California Surgical Institute website.
Eyelid surgery after care may differ from surgeon to surgeon, thus a prudent patient will only stick to her doctor’s specific advice. The main idea of postop care is to keep swelling and bruising to a minimum, ultimately resulting in shorter social downtime.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley explains his eyelid surgery after care tips.
* Pain Control. Most patients will only experience minimal discomfort that can be easily managed through acetaminophen such as Tylenol for a few days. Others do not even require medications.
* Head elevation for a few days. The goal is to keep swelling to a minimum and thus promote shorter social recovery, which typically occurs after 1-2 weeks.
* Cold therapy. In the first 48 hours cold therapy can control the amount of swelling; however, it should not be applied for more than 15-20 minutes at a time to avoid cold burns and blisters.
* Avoid or at least limit the consumption of alcohol and salty foods during the initial healing stage (2-3 weeks). They can cause fluid retention and thus aggravate the amount of swelling.
* Never rush one’s recovery. A good rule of thumb is to avoid rigorous activities that can result in increased heart rate and blood pressure for a minimum of three weeks. Nonetheless, bed rest is not good because it can lead to lethargy and may even aggravate swelling.
* Avoid activities that can dry the eyes. In the first week postop, activities that may dry up the eyes—e.g., using computer, watching TV, reading, and wearing contacts—must be avoided.
* Wear large dark sunglasses. The idea is to protect the sensitive eyes from harsh elements such as the wind, sun, and small particles.
* Expect 1-2 weeks of social downtime. Some patients may return work a week after their surgery, although they will most likely need a camouflage make-up to hide the outward signs of their surgery. At 2-3 weeks of their recovery, meanwhile, they can go outside without wearing eye make-up.
* Avoid drugs and supplements with blood thinning properties. These are best avoided 2-3 weeks before surgery and about a week afterward to prevent bleeding and persistent swelling and bruising.
A lower eyelid fat transfer is a powerful tool in facial rejuvenation procedure that can provide natural-looking results in the hands of a skilled surgeon, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
While dermal fillers can also correct the hollowed lower lid or deep tear trough, which is the transition between the thin-skinned eyelid and the thick-skinned cheek, fat transfer is perceived to be superior particularly if the goal is to achieve near permanent results.
The fat graft that persists about a year postop is expected to last a lifetime (or at least 10 years). Most surgeons aim to achieve a survival rate of 50-70 percent; it is important to note that some of the grafts will “perish” in the first few months of injection and so it might be necessary to slightly over-correct.
Dermal fillers, meanwhile, typically require 2-3 touch-ups every year because they are made of biodegradable material that the surrounding tissue gradually absorbs.
Dr. Smiley has recently performed lower eyelid fat transfer in a female patient with deep tear trough caused by soft tissue atrophy or “shrinkage” caused by the aging process. The procedure entails proper handling and injection of fat to achieve smooth, near permanent results.
The patient described has been considered as a good candidate for lower eyelid fat transfer “as a stand-alone” procedure (without simultaneous skin excision) because she only had very mild tissue laxity.
However, some patients can benefit more if their fat transfer is combined with the “standard” eyelid surgery (blepharoplasty) particularly if there is noticeable loose skin; this is achieved by placing the incisions at the natural upper lid crease or very close to the lower lash margin so the resulting scars are inconspicuous.
The celebrity plastic surgeon says one of the challenges or caveats of lower eyelid fat transfer is the risk of lumpiness because it deals with an area whose skin is markedly thin. To achieve smooth result, he highlights the importance of meticulous injection in which very small amounts of grafts (less than 0.1 cc) are introduced, as opposed to dumping them all at once.
The aforementioned technique, which is called structural fat grafting, also ensures spaces between each graft and thus allows blood vessels ingrowth needed for its long-term survival. Without this vascularization process, the body will eventually absorb the fat.
Preparation before eyelid surgery guidelines, as explained by celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley.
* Review the patient’s medical history. Honest communications between the parties are critical to avoid or at least minimize risk of complications.
The surgeon must explain the possible risks (which come with any surgery) and the risk factors such as diabetes, blood disorder, allergies, glaucoma, dry eyes, and thyroid problems.
* Listen to the patient’s personal preference and cosmetic goals. Both parties should agree on the same aesthetic problems that can be realistically improved by eyelid surgery.
* Conduct physical and vision exam. It is important to get the tiniest anatomical details and eyelid dimension to achieve the desired result. Occasionally, a vision test is also needed to support insurance claims.
Should the hanging upper eyelid skin affects the patient’s peripheral vision, insurance may cover the cost of surgery, provided that there is medical documentation demonstrating that the procedure is medically necessary.
* Be honest and tell every thing to the surgeon, particularly pertaining to medical conditions, use of drugs (prescription, recreational drugs, and supplements), and cosmetic goals.
The patient must notify his doctor about her use of medications (including tobacco products and herbal supplements), previous surgeries, and past and current medical conditions.
* Discontinue blood-thinners that include but not limited to ibuprofen, aspirin, and naproxen. Some herbal supplements and homeopathic remedies are also known to increase bleeding. For this reason, a prudent patient will only take medications approved by her doctor.
* Arrange for at least a two-week off. Most of the swelling and bruising is gone after two weeks, although some patients may choose to return to work after 5-7 days. Meanwhile, it is best to avoid strenuous activities for at least three weeks to prevent healing problems.
* Quit smoking. A good rule of thumb is to avoid smoking for at least three weeks. It is important to note that tobacco products contain nicotine, which is a very strong vasoconstrictor—i.e., they cause the blood vessels to shrink in size. For this reason, smokers generally experience poor healing and higher risk of unfavorable scars, infection, and skin necrosis.
Blepharoplasty recovery tips primarily aim to control the amount of swelling and bruising, and ultimately promote shorter “social downtime,” as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Blepharoplasty, or more commonly referred to as eyelid surgery or eyelid lift, removes the crepe-like skin above and/or below the eye. If needed, the procedure also eliminates the herniated fat that causes the “puffiness” or “shadowing.”
While the bruising and swelling are generally mild, “prudent” patients must give themselves a month or so of healing. This is particularly critical if they are going to attend a social function—e.g., wedding, graduation, and reunion.
However, it is safe to surmise that a good number of patients would look presentable in public (very minimal or barely detectable swelling and bruising) after two weeks. At this time, “camouflage” eye makeup can be used to further conceal the residual bruises.
In the first 7-10 days, most patients can expect mild discomfort that can be easily alleviated by over-the-counter painkillers. During this time when there is an increased risk of bleeding and poor healing, any medication categorized as blood thinners, such as non-steroidal anti-inflammatory drugs, aspirin, and aspirin-like products, are best avoided.
Extreme pain is very rare after blepharoplasty, and should it occur it is almost always a sign of healing problems, infection, or some type of complication that must be addressed immediately.
Controlling the amount of postop swelling and bruising is the key to enjoy quick “social recovery.” Head elevation, even when sleeping, for a few days after surgery can help the symptoms resolve quicker; this can be achieved by using large pillows or inclined foam wedge.
Furthermore, cold compress in the first 48 hours could help control swelling, although using it longer at a time (20 minutes longer) may lead to frostbite. To prevent this, a thin cloth should be placed between the ice pack and the skin, and apply this only 10-15 minutes at a time.
Some surgeons, meanwhile, advocate the use homeopathic remedies such as bromelain and arnica montana, although there is little scientific data proving their “purported” benefits.
Because blepharoplasty recovery tips may differ from surgeon to surgeon, a prudent patient should only stick to her doctor’s specific recommendations.
The eyelid surgery with fat transfer approach provides a more natural and stable result compared to an excision-alone procedure (i.e., simply removing some excess skin and fat).
In the past, it was typical to remove all the excess fat and skin in the lower and upper eyelid surgery with little thought on soft tissue preservation. While this approach could eliminate the appearance of puffiness due to herniated fat and the crepe-like skin, patients were often left with some type of surgical stigmata such as lid retraction, unnatural eye contour, or abrupt transition between the lower lid and the upper cheek.
But over the past several years, eyelid surgery has undergone a paradigm shift in which the focus is on preserving the soft tissue. This has become possible with the advancements in fat transfer.
Facial fat transfer or fat grafting collects a few teaspoons of “unwanted” fat usually from the tummy-hip area, which is then purified and re-injected into the face.
Fat grafting is particularly ideal in lower eyelid surgery, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley who has demonstrated the said technique on his Snapchat account.
Eyelid surgery with fat transfer, he said, creates a smooth transition between the lower lid and the upper cheek, leading to a more natural, youthful result.
In the past, lower eyelid surgery typically removed the entire herniated fat; hence, there was an abrupt transition between the lower lid and the upper cheek. For this reason, Dr. Smiley said he avoids this approach due to the resulting hollowness.
Instead of removing the herniated fat entirely, most patients will require just a small amount of removal before the remaining fat is rearranged accordingly to achieve a smooth surface, and possibly followed by fat transfer to further refine the results.
Aside from creating a smoother lid-cheek junction, Dr. Smiley said that eyelid surgery with fat transfer is expected to last longer than an excision-alone approach because enhancing the soft tissue ultimately results in stronger “internal support.”
And because eyelid surgery with fat transfer makes it possible to rely less on internal support measures and excision techniques, the risk of deformity or distortion of the lower eyelid surgery is significantly reduced as well, he added.