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It’s all in the lids
Eyelid Surgery (Double Eyelid)

William Shakespeare wrote that the eyes are the window to the soul. He was right – alluring eyes can have a positive effect on an individual as well as on those who look upon him or her, so it is no surprise that upper eyelid surgery is one of the most sought after cosmetic surgery procedures in Singapore.

Younger patients desire “double eyelids” to make their eyes look larger, less droopy or less puffy.

With puffy eyelids, they may have difficulties applying eyeliner due to the excess fat on their eyelids. There are various “home-fix” techniques such as double eyelid tape, thick eyeliner or even rubbing of the eyes to create double eyelids. Such methods are, however, time-consuming and temporary. With eyelid surgery, patients are looking for a permanent solution to their desire for larger and “more attractive” eyes.

Mature patients often want correction of ageing eyelids with excess skin, fat and lax eyelid muscles. This may be complicated by drooping (ptosis) of the upper eyelids. This causes the eyes to appear smaller and misshapen, and in severe cases, vision may also be obstructed by the excess.

For “double eyelid” creation, the techniques include either suture blepharoplasty or incision upper blepharoplasty. Suture blepharoplasty (scarless double eyelid creation) is suitable for younger patients with minimal skin or fat excess. Usually three well-aimed sutures are placed in each eyelid, with technique and surgical precision being of utmost importance. The downtime is around 3-5 days as no cutting is involved.

Incision upper blepharoplasty is indicated for patients who have a moderate amount of excess fat. This technique involves judicious removal of upper eyelid skin and excess fat. Thereafter, the upper eyelid crease is created by stitching the skin down to the deeper tarsal tissue. This technique minimises the chance of losing the fold. As skin excision is involved, the downtime is typically 1-2 weeks. This is also performed to correct ageing upper eyelids where the excess skin, muscle and fat are excised.

For patients with concomitant brow descent needing correction, a new technique of browlift using the Endotine Transbleph device can be performed. This allows rejuvenation of both the sagging eyebrow and the upper eyelid with one surgery performed under local anesthesia.

Sometimes, droopy eyelids are caused by overstretching of the thin tendon-like structure that helps the levator muscle elevate the upper eyelids. Here, a slightly more complex procedure known as levator advancement must be performed. As the dissection is more extensive, patients should expect a two-week downtime.

For patients who desire “longer eyes”, medial or lateral epicanthoplasty procedures can be performed. It is important to know that good eyelid surgery should be customised to suit the patient’s facial aesthetics as well as his or her ethnicity. The Caucasian “double eyelid” usually is higher, deeply set and has a crease parallel to the lash line. The ideal Asian “double eyelids” are more subtle with slight flaring at the lateral edge. Previously, “westernisation” of Asian eyes was very common but resulted in unnaturally high folds with excessive fat and skin excision leading to a hollowed out and aged look post-surgery.

It is therefore vital that patients consult with qualified plastic surgeons with intimate knowledge of eyelid anatomy. Only an experienced eyelid surgeon can make an accurate diagnosis of the problem and recommend the appropriate surgical treatment.