In this article Dr. Kenneth Kim will discuss the various other reasons why Asians choose to undergo double eyelid surgery other than for aesthetic reasons. The prior article discussed how double eyelid surgery improves one’s eye shape and overall face–comestic reasons to why people undergoing eyelid surgery. However, there are other reasons why Asians elect to have double eyelid surgery. One of those other reasons may be due to an eyelid condition called ptosis. Eyelid ptosis is a medical condition where there is a weakness of the eye elevating muscle. Dr. Kenneth Kim will provide a general overview here and provide in depth detail about eyelid ptosis in other articles.
Simply put, when an individual has ptosis or weak eyelid muscle, they feel as though they have to force their eyes to open for them to stay open. Normally, when people open their eyes they do so with ease and without any strain. However, patients with ptosis feel a need to strain their eye muscles. If they do not forcefully open their eyes, they may appear tired and others may even comment on their tiredness. This is because patients with ptosis have eyelid position that is lower than normal (e.g., more closed). A normal eyelid position is when the iris (the color aspect of the eye) is shown 90% on females and 80% on males. When this level drops below, then one may appear tired or eyes half open. Aside from appearing tired, due to the lower eyelid position toward the pupil the visual field is obstructed and therefore a ptosis sufferer instinctually raise their eyelids to see. This is an automatic response from the brain and many times individuals with ptosis do not realize they they are straining their eyes to open them open. However, they will eventually experience tension on their eyes and head from this continued straining. One of the muscles used in this process is the frontalis muscle. This is a muscle on the forehead that when flexed causes the skin to wrinkle thus responsible for creating forehead creases. Therefore, patients with ptosis tend exhibit forehead creases even at a young age from the over use of the forehead muscles.
Frequently, Asian patients with eyelid ptosis will come for double eyelid surgery. Their main objective is to look brighter and more alert. They request that their eyes become larger and that they don’t look sleepy or tired. These patients mistakenly believe that their ptosis condition will simply be corrected with double eyelid surgery. For these patients, not only must they undergo double eyelids surgery but the ptosis must be corrected with ptosis correction surgery as well. Double eyelid surgery alone in patients with ptosis experience a much higher incidence of complications and unfavorable aesthetic outcome. Asian patients who undergo ptosis repair most often require double eyelid surgery and vice versa. For optimal surgical outcome, it is extremely important to diagnose a patient for ptosis prior to double eyelid surgery and the reasons for this will be further discussed in a future article.
Another reason why Asians patients choose to undergo double eyelid surgery other than for cosmetic reasons is due to irritation from downward pointing eyelashes. Specifically, eyelashes can irritate the cornea and create a sharp pain or a sense of irritation in some individuals with monolids. Asians without double eyelid fold or crease have eyelids that force the upper eyelashes to aim downward (inversion) into the actual eye. When the eyelid skin hangs over and pushes the eyelash into the eye, it can start irritating the cornea. You might be asking, how does undergoing double eyelid surgery correct this? During double eyelid surgery, if excess skin is present, the excess skin will be removed. But more importantly, a fold is made to the muscle that elevates the eye. The connection to the eye elevating mechanism in double eyelid surgery everts the eyelashes, causing them to point forward rather than downward. Thereby, the eyelashes are positioned in a way they are clear from irritating the cornea.