Eyelid anatomy (medical terms for eyelids and related conditions)

Double Eyelid

Double eyelid surgery or Asian blepharoplasty is the most commonly performed cosmetic surgery among Asians population. Double eyelids improve the appearance of upper eyelids and make them very attractive. There are few techniques in creating double eyelids. The choice of double eyelids differs from individuals and the doctor would analyse and customize a suitable technique for each patient.

1. Suture technique
The suture technique utilizes sutures to create an upper eyelid crease. This procedure is more suitable for younger patients with thin skin and minimal puffiness. The advantages of this procedure are short operating time and quicker recovery. However, the skin crease may not last.

2. Small incision technique
A central small incision measuring about 1-1.5 cm is created in the upper eyelid. This technique is suitable for patients with minimal or no excess skin to remove puffiness. The wound is closed with few stitches. The recovery time is quicker than conventional full incisional technique.

3. Incisional technique
This is the conventional way of creating double eyelids. A full incision is created from inner to outer corner of the upper eyelids. Usually excess skin is removed along with fat tissues that cause puffiness. Skin is closed with sutures which is removed a week after. The recovery usually takes about a week.

Epicanthal fold

1. Medial epicanthoplasty

The epicanthal fold is a skin fold covering the inner corner of the eyes (medial canthus). This fold is more common among East Asians. Epicanthoplasty, sometimes called medial canthoplasty, is an operation designed to remove or minimize the epicanthal fold to create a much larger and attractive eye. This procedure is commonly performed together with double eyelid surgery. A fine stitch will be used to close the skin and removed after 5-7 days.

Excess upper eyelid skin

The eyelid is the thinnest skin in the whole body and it is the first area to show signs of aging on the face. The skin loses its elasticity with age and as a result the skin sags forming a fold over the upper eyelid which gives a hooded and aged appearance. In severe cases, it may even block your vision.

Blepharoplasty or upper eyelid lift surgery is an eyelid surgery whereby the excess skin and in some cases fat, are removed. This will give a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert.

1. Blepharoplasty
The amount of excess skin to be removed is determined and removed under local anaesthesia. In some instances, fatty tissues are also removed to reduce puffiness. Double eyelid can be created during this surgery.The wound is then sutured and stitches are removed 1 week later.

2. Infrabrow blepharoplasty
In some patients who have existing double eyelid or lid crease, infrabrow blepharoplasty can be done to retain the natural eyelid crease. In this technique the excess skin is removed right below the eyebrow and sutured. Stitches are also removed 1 week after. The eyebrow hair is tattooed 6 weeks later to camouflage the scar.

Droopy Eyebrow

Besides sagging of the upper eyelid, the eyebrow may also sag as age catches up. As you age, the brow fat pad shrink and the underlying bone undergo absorption, thus the eyebrow loses support and droop. This causes the upper eyelid skin to hangover the eyelid margin further. Therefore, removing the excess upper eyelid skin alone is sometimes not sufficient. Brow lift is essential to fix the brow back to its original to restore the youthful appearance. Brow lift surgery is usually performed together with upper eyelid lift surgery.

Brow lift can be achieved by 2 methods:

1. Direct brow lift
The excess skin above the brow is removed and the brow position is immediately lifted. The scar created above the eyebrow may then be tattooed to camouflage the line. This technique is quick and easy. In some instances, patient may have some tingling or numb sensation over the forehead which lasts for weeks.

2. Pretrichial brow lift
In this technique, the incision is hidden in the hairline so the scar is not visible. This technique is suitable for patients who mainly require a temporal brow lift.

Xanthelasma

Xanthelasma is a yellowish fatty deposit in the skin usually around the eyelid. These fatty deposits are not harmful or painful but may be disfiguring. While small lesion may be treated with laser, the incidence of recurrence. These lesions are best removed surgically with lower recurrence rate.

1. Xanthelasma excision
Depending on the site of the xanthelasma, the lesion is excised following the facial lines to reduce scarring. If the lesion is situated close to the eyelid crease, the scar may be hidden with the lid crease and it is not visible. Sutures are removed 1 week after and 2-3 weeks after for scar modification treatment if necessary.

Customized Surgery

1. Double eyelid with medial epicanthoplasty

2. Double eyelid with eyebag correction

3. Double eyelid with droopy eyelid correction

4. Upper and lower eyelid lift