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.
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.