A 15-year-old lady wants to have double eyelid surgery. After using tape, her eyelid skin was sagging and her creases are not forming well. She wants to know the difference between full incision and partial incision procedures.
Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon working in Manhattan and Long Island for over 20 years, has a particular area of specialty in Asian eyelid surgery. He does all the different methods and techniques and he customizes these to the individual. He explains that there’s no one best method, but there is a particular method that’s right for her individual situation.
To understand the anatomy as well as the genetics, Dr. Prasad explains that the patient must know the details of the eyelid structure. It’s understood that 50% of patients of Asian origin have an eyelid crease while 50% do not. Some may have a partial crease or multiple creases and they want to have one defined crease. The anatomy of the Asian eyelid is affected by the levator muscle that lifts the eyelid. Its muscle fibers go into the skin and create a crease. Every Asian eyelid surgical procedure whether it’s incisional, non-incisional, or partially incisional has to do with creating that connection.
Dr. Prasad makes a decision on whether or not to do an incisional technique versus a non-incisional by doing a physical examination. Through that, he is able to determine if there’s fat that’s getting in the way of the eyelid crease or if there is extra skin that is obstructing or overlapping and preventing a crease from forming. He also asks if there is ptosis or drooping of the eyelid. Drooping of the eyelid is also related to the levator muscle and we need to recognize that before doing the eyelid surgery.
For someone who is young, who doesn’t have fat and extra skin, Dr. Prasad’s preferred technique is a non-incisional procedure. The term non-incisional procedure isn’t quite accurate because by design, he is making little openings into the eyelid skin. He strategically places openings along the natural crease and through those openings, he passes a suture. Those sutures are responsible for creating that connection between the eyelid skin and the underlying levator muscle. There are techniques where he can do either a single suture or several sutures. It’s about customization and looking at the behavior of the eyelid when he is doing the procedure. He even asks his patients to open their eyes during the procedure. They don’t feel anything and it helps to position of the eyelid as he is doing this.
Since she is starting at the age of 15, she still has many decades ahead of her. As she gets older, things do change but she’s not going to change in her 30s, 40s and beyond. One of the concerns about the non-incisional approach is how well those connections form and will they last a long time. There is some variability in the longevity of the surgery. In Dr. Prasad’s experience, his patients look good and hold up for many years and that connection seems to work very well. However, she has to think about different skin types in terms of thickness, as well as lifestyle, eye rubbing, allergies and other factors that contribute to whether or not the crease holds.
Since she is young, she has to go with her parents or guardian to meet with doctors. She must have an understanding of what’s involved, what the procedure is like, and whether she and her parents are comfortable. There are have been many patients who come to him with their parents who wanted to have this done in a relatively young age like her so that as they got a little bit older, it was always as if they’ve always had the crease. It’s just seems a particular value that is important to some people who have come with their families for this procedure.