Many Asians have puffy upper eyelids & no visible upper lidfold, a feature nearly always present in Caucasians. Eyes without the fold are referred to as “single eyes or eyelids” those with the fold as “double eyes or eyelids”. In the caucasian upper eyelid the deeper layers of the eyelid converge 6 to 8mm above the eyelid margin/eyelashes & 3 to 5mm above the upper edge of the eyelid cartilage to create a fold. In the asian upper eyelid these layers do not converge so there is no fold. Additionally the fat descends into the eyelid giving the puffy look that is seen in asian eyelids. The surgical procedure to correct this involves removing some of this fat & suturing these layers as well as the skin of the eyelid to the upper edge of the eyelid cartilage in order to create a fold. The puffy look is thereby also diminished. The suture used is absorbed by the body but the healing process keeps the new point of convergence intact. The result is creation of a double lid.
The inner corners of the eye remain unchanged so that an Asian look still exists. To treat the fold at the inner corner of the eyes if it is present & if the patient wishes it addressed it is best to augment the nasal bridge. This takes up the excess skin & gets rid of the inner corner skin fold without leaving any visible scar. Some minor surgical procedures have been devised to treat the inner corner fold but these leave scars in the area & do not address the root problem which is insufficient nasal bridge in the Asian nose. The important part of the procedure is suturing the layers properly & removing tissue contributing to the puffy look not the skin incision itself.