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Occidental V Asian eyelid a comparison
Approximately 50 percent of all Asians are born with the "Single eyelid", specifically there is NO upper eyelid crease, while the Others are born with an upper lid crease either in part or full length of the eyelid. When there is a well formed crease it is called the "Double eyelid" type.
The Asian upper eyelid appears puffier than the Occidental eyelid and several factors contribute to this:
- the orbital fat extends lower
- a weakness of the orbital septum that allows the orbital fat to bulge
- the eyebrow fat pad that is thicker and projects lower into the eyelid
- a much thicker subcutaneous fat layer positioned just below the skin that adds noticeable "padding" over the entire eyelid and may interfere with crease formation
There are 2 explanations for the lack of an eyelid crease and either explanation doesn't exclude the other and in reality the truth is a combination of the 2 factotrs.
Theory 1
The Asian orbital septum fuses with the levator aponeurosis at a lower level and the orbital extends further down into the eyelid and blocks substantial attachment of the lid elevating mechanism from acting on the skin.
Theory 2
A creased eyelid appears to have a strong natural fibrous connections between the front of the tarsal plate and the skin at or adjacent to the eyelid fold.
The (levator) muscle in the upper eyelid elevates the thin tarsal cartilage when the eye opens.
In an eyelid that has a double fold there is an extension of the levator muscle into the skin and or fatty tissue of the eyelid. Thus the pulling force of the levator is shared between opening the eye by lifting the lid and creating a skin recess and fold.
If, however, these natural connections are weak or absent, the lower skin and orbicularis muscle simply slip down along the rising tarsal plate to form a smooth curtain and the characteristic excessive skin fold.
The Incisional double eyelid procedure creates internal adhesions that prevents fat descent and addresses both theories.
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Photo pictorial of procedure
Choices of folds
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