Dr. Kenneth Kim, a board certified plastic surgeon who specializes in Korean aesthetic surgery, will discuss why tape or glue on the eyelids creates a double eyelid fold or crease on some Asians and not on other Asians.
In our prior article, Dr. Kenneth Kim discussed some of the negative consequences of applying tape or glue when attempting to create a double eyelid fold or crease. If you have tried to create a double eyelid fold or double eyelid crease through these non-surgical methods, you may have realized a few interesting things about Asian eyelids.
Let’s say we take ten young patients in the age range of 16-20. Of the ten patients, you may realize that tape or glue will work in creating a double eyelid fold or double eyelid crease in some people, while not on others. So what is the cause of this discrepancy? First and foremost, if a person has excess upper eyelid skin, then the fold will not form properly. One may wonder why such young patients will have excess skin.  But Asians without a double eyelid fold or a double eyelid crease (termed monolid) often develop excess skin which will need removal at the time of his/her double eyelid surgery. In the near future, Dr. Kenneth Kim will also discuss why a person with double eyelid fold has less skin hooding. Excess upper eyelid skin impedes the double eyelid folds or double eyelid creases from occurring, thus leading to early or immediate loss of a fold. In order for a double eyelid fold or a double eyelid crease to occur, an unobstructed invaginating pathway is needed, especially if weak and superficial applications such as tape and glue are used to create a double eyelid fold or double eyelid crease.
The second most significant reason why a double eyelid fold or a double eyelid crease will not occur is that a person has eyelid ptosis, also known as weakness of the eye elevating muscle. When a person has ptosis, superficial methods such as tape or glue cannot transfer enough force for the weak muscle to create a fold. In these patients, if they receive double eyelid surgery without ptosis correction, two things can happen depending on the method used in their double eyelid surgery. If a suture technique is used in a patient with eyelid ptosis, then fold loss will occur, as the weak muscle cannot pull hard enough to create a double eyelid fold or a double eyelid crease. If an open technique is used to create a double eyelid fold or a double eyelid crease, then a larger than anticipated fold can occur. In addition, the skin between the fold and the eyelashes will be full. More on the exact mechanism of how these processes occur will be discussed in future articles.
Furthermore, some of these patients who apply eyelid tape or glue will have an asymmetric fold or their eyes will appear asymmetric. This can be attributed to the asymmetry in their eye elevating muscle power. Specifically, they have asymmetric eyelid ptosis. These people would need their eyelid elevating muscle adjusted in order for their double eyelid fold or double eyelid crease to be in conjunction with the opening of their eyes.
In addition, some patients will experience a fold at the inner corner of the eye that may not extend all the way to the outer corner. Their eyes may also look widely apart. These patients have an epicanthal fold which prevents a double eyelid fold or double eyelid crease to extend all the way to the inner corner naturally. In addition, the excess skin at the inner corner (epicanthal fold) makes their eyes look not only widely apart, but short as well. In addition, it makes their bridge of the nose flat and wide. These patients are ideal for epicanthoplasty as it will allow the double eyelid fold or double eyelid crease to extend naturally to the inner corner and make their eyes and face more proportioned.
Thus, you can see that if you take 10 young Asian patients without double eyelids and have them apply eyelid tape or glue, various outcomes will occur. Unless patients are thoroughly examined by a plastic surgeon who specializes in double eyelid surgery, these important factors can be overlooked. In addition, once correctly diagnosed, each variable needs to be taken into account and corrected to create both a natural looking double eyelid fold and beautiful eyes.
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