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Since moving to Toronto, I have noticed a significant increase in the number of patients seeking upper lid Asian blepharoplasty (or double fold blepharoplasty) in my practice. This is not altogether surprising since Toronto has a large Asian population. Today, it is one of the most common procedures I perform. Most non-Asian patients probably don’t even know what Asian Blepharoplasty is, or what it does.

Asian Blepharoplasty in Brief

Many patients of Asian descent are born with a characteristic upper lid appearance that does not have a lid crease (called the supratarsal fold). For many, this appearance is deemed not as attractive when compared to those who naturally have the crease. For patients interested in remedying this situation, there are surgical procedures that can re-create the crease; this procedure is known by various names, including the Double Fold Procedure, Asian Double Eyelid Surgery, and Asian Blepharoplasty.

Performing the surgery requires a good knowledge of the Asian upper lid anatomy. A natural Asian crease typically sits much lower than a Caucasian lid crease, and excess fat in the upper lid sometimes needs to be removed in order to attain proper folding of the crease. When performing the surgery, the crease can be placed at any level desired, but most patients that I see want a more natural look. This means that the visible crease sits 2-4 mm above the lid margin. The result of creating the crease gives the eyes a larger, more expressive, and generally more attractive appearance.

My Personal Technique of Asian Blepharoplasty

There are many methods by which the crease can be created. They can be roughly categorized into:

After performing the various methods available, I currently favour using a short incision technique that uses an incision approximately 1.0 to 1.5 cm in length. This technique provides a permanent and natural looking crease while minimizing post-operative healing time and scar length. The crease is dynamic which means that when a patient closes their eyes, the crease disappears, and forms only when the eyes are open. The procedure take about 30-45 minutes and is done under local anesthetic with some light sedation. Patient are usually back to school or work within 4-7 days.

Keys to Success

The most important factor to achieving a successful outcome is good communication between the patient and surgeon. I make a great effort to ascertain what crease height a patient desires, and have them show me by using a small wire to simulate their results while looking in the mirror. Patients who are skilled at using ‘double fold tape’ or glue can also easily demonstrate the crease height they are seeking. Patient education is also very important. Patients need to understand that post-operatively, the lid height will be elevated, and may look unnatural. After a period of time, the swelling subsides and the skin relaxes providing a natural appearing fold.

Lawrence Tong, M.D., F.A.C.S., F.R.C.S.C.