In performing Asian eyelid surgery, one of the anatomic components that need to be evaluated is the thickness of the skin. Within the Asian eyelid skin, there are thin skin region, a medium thickness skin region, and a thick skin region. When a double eyelid fold is made in an Asian eyelid, the fold needs to be made at the junction of the thin and the medium thickness region. Mechanically, this junction within the Asian eyelid is an ideal break or a line of indentation can form a clean crisp double eyelid fold.
Asian eyelid skins are different compared to other ethnicities.
By properly identifying the thickness difference in Asian eyelid skin, an ideal Asian eyelid fold or Asian eyelid crease can be created.
Asian eyelid skin tends to be thicker while the eyelid elevating muscle is shorter or smaller. Therefore, if the Asian eyelid fold or double eyelid fold is made at the upper region of the eyelid skin, then the attachment to the eyelid elevating muscle or the levator aponeurosis is often made high as well. By attaching the Asian eyelid skin to the upper area of the levator aponeurosis, then the Asian eyelid fold becomes overly high. If the Asian eyelid skin crease is attached to the lower aspect of the levator aponeurosis, then a puffy Asian eyelid fold is made.
The junction between the thin Asian eyelid and the medium eyelid skin is at the junction where the levator aponeurosis and the tarsal plate (a thick cartilaginous component of the eyelid) meets. By fixating the Asian eyelid skin to the levator and the upper component of the tarsal plate, the Asian eyelid fold remains perfectly even, crisp, and thin. The eyelashes are also perfectly everted.
Dr. Kenneth Kim, a board certified plastic surgeon in Los Angeles, California will show the patient the various eyelid skin thickness in Asians.