Asian Eyelid FAQs

DOES DOUBLE EYELID SURGERY MAKE MONOLID EYES LARGER?

Double eyelid surgery can make eyes larger in two ways.

Double Fold Surgery

One way is by excising upper eyelid skin and creating a fold. During the process of changing a monolid to a double eyelid, any excess skin which covers the eyes is eliminated. Therefore, the surface area of the eyes is more exposed and visible after surgery.

Double-lidded eyes can also be created without excising skin by way of the non-incision surgery, also known as the suture technique. However, the effect of eye enlargement is more profound when skin is excised.

Ptosis Surgery

Another method to enlarge the eyes is by simultaneously performing eyelid ptosis repair. This procedure is used to correct a weak eyelid muscle – called the levator muscle, which is responsible for holding the eyelid open. This surgery is often performed at the time of double eyelid surgery to make the eyes open easily. But the main effect is that the eyes will be larger vertically. Eyelid ptosis surgery is considered a reconstructive procedure, but it still provides cosmetic benefits by creating a more open appearance to the eyes.

By combining procedures, patients will be able to open their eyes to the fullest in a vertical direction. The result: a more dynamic expression that influences how the face is perceived. More open eyes tend to be associated with youth and energy.

WHAT CAUSES MULTIPLE FOLDS AND TRIPLE FOLDS IN ASIAN EYELIDS?

Many of our patients have multiple folds in their upper eyelids – on top of their natural double eyelid, a crease has occurred. One of the reasons for this is that their eyelids lack fat. Therefore, rather than being an actual fold, it is a depression of the skin or a crease. There are two ways to solve this triple-fold. A simple way is to perform a double fold eyelid surgery.

A patient may wonder, “why recreate a double lid in an already existing double eyelid?” The reason is that a surgically created fold is stronger than a natural fold. The technique is the same as if the patient has a monolid and wants to have double eyelids. The fold is created between the lower eyelid fold and the higher eyelid crease.

It is important that the double lid not be set at the height of the eyelid crease. The height of the crease is too high to create a natural-appearing fold.

Another way to correct a triple-fold in Asian eyes is to excise the skin between the eyelid fold and the eyelid crease. This is followed by setting the double lid at the original natural site. By removing this depression of the eyelid skin, the triple-fold is completely eliminated. This method can only be done if the distance between the double eyelid fold and the crease is close enough to be excised. There are cases where the triple-fold is very high and the excision of the upper eyelid skin cannot be made. In this case, a fat graft can be placed in the upper eyelid to add more volume to prevent the eyelid depression from creating a double eyelid crease.

Dr. Kenneth Kim corrects multiple upper eyelid folds or creases in his practice. He is a board-certified plastic surgeon who has performed thousands of Korean eyelid surgeries. Dr. Kim also has a partnership in Seoul, South Korea where he works with his partners to offer the latest and most advanced procedures to patients throughout the world. During the consultation, Dr. Kenneth Kim will show how the eyes will look after the corrective and revision double eyelid surgery.

WHAT ARE THE CAUSES OF EYELID HOODING?

There are two main reasons why eyelids hood. One cause is eyelid skin laxity. The other reason is eyelid ptosis or blepharoptosis. If the cause is due to eyelid skin hooding, then a double fold eyelid surgery can be performed where a monolid is surgically converted to a double eyelid.

When eyelid skin hoods, it can cover the pupil and obstruct the upper visual field.

Eyelid hooding is more common in Asians with monolids. By having a double lid, there is an increase in surface area for the upper eyelid skin to travel or hood before it covers the visual field. Therefore, excess skin can be removed during the double eyelid surgery. Double-lidded eyes can also be created using a suture technique or non-incision eyelid surgery.

Another reason for eyelid hooding is eyelid ptosis or blepharoptosis.

Eyelid ptosis is a condition where the eyelid elevating muscle known as the levator muscle is weak or stretched. Therefore, in these cases of eyelid ptosis, the levator muscle has to be strengthened or corrected. This correction can be done simultaneously during double eyelid surgery. Eyelid ptosis correction can also be performed by itself as a reconstructive procedure if the patient already has natural double-lidded eyes.

In these particular cases, the eyelid is flipped and the levator muscle correction is performed without making an incision on the eyelid.

The most recent advance in eyelid ptosis correction is a 3-dimensional suture technique. In this surgery, eyelid ptosis is corrected and a fold is created without making an incision on the eyelid.

Dr. Kenneth Kim is a chairman of the upper visual field impairment correction guidelines committee. He has been working with other leading surgeons to set guidelines on blepharoplasty and eyelid ptosis repair to improve outcomes and patient satisfaction. Dr. Kenneth Kim has published numerous peer-reviewed articles on double eyelid surgery and eyelid ptosis correction. He is also the creator of the 3-dimensional suture technique.

WHY DO ASIANS HAVE MONOLIDS?

The Asian race is the only one with monolids. Even among Asians, it is the Eastern Asians who tend to have monolids.  Eastern Asians are Koreans, Chinese, Japanese, and Mongolians.

Other races have double eyelids or double-lidded eyes. The medical term for this is “supratarsal fold.”

Southeast Asians tend to have double lids more often than East Asians. Among the East Asians, Koreans and Mongolians have the highest prevalence of monolids. Therefore, more Koreans undergo double-fold eyelid surgery than any other Asian race. That is one of the reasons why Korean plastic surgeons excel in Asian eyelid surgery, also known as Korean eyelid surgery.

One reason why so many Koreans and Mongolians have monolids is that they share the common Mongolian heritage.

In Mongolia, the climate is cold and windy. Therefore, it was an advantage to have monolids to cover the eye as much as possible so as to protect them. The double lid would have been a disadvantage in a cold and windy environment.

This monolid gene has been passed on to the Koreans, Chinese, and Japenese people.  For that reason, East Asians often undergo blepharoplasty, a procedure in which a monolid is changed to a double lid. This procedure can help open the eyes and expose more of the inside of the eye. Dr. Kenneth Kim regularly performs variations of the procedure for patients of various Asian backgrounds including Koreans, Chinese, Japanese, and Mongolians, as well as Southeast Asians.

Choosing the Right Surgeon

Dr. Kenneth Kim is a board-certified plastic surgeon who has performed thousands of eyelid surgeries and double fold eyelid surgeries. Dr. Kim has been in practice for 13 years and has trained in both the United States and in South Korea. Dr. Kenneth Kim specializes in minimal scarring double fold eyelid surgery and making the monolid into a double lid that looks as natural as possible. Dr. Kim performs monolid surgery with cutting-edge techniques. His patients are kept comfortable and safe during the entire procedure. If you are interested in learning more, give our office a call or schedule a consultation on the website.