East Asian blepharoplasty

East Asian blepharoplasty, more commonly known as double eyelid surgery, is a cosmetic procedure that reshapes the skin around the eye to create a crease in an upper eyelid that naturally lacks one. This surgery is especially popular among individuals of East Asian descent, including those from Chinese, Japanese, and Korean backgrounds. The primary goal is to enhance the eyelid's appearance, making the eyes appear larger and, according to some cultural aesthetics, more attractive due to a 'wide eyed' and expressive appearance.

Historical context
The procedure was first performed in 1896 by Dr. Kotaro Mikamo in Japan, a period marked by significant Western influence following the Meiji Restoration. This era in Japanese history was characterized by rapid modernization and integration of Western cultural and technological innovations. Mikamo's introduction of the surgery coincided with these broader social changes, reflecting evolving beauty ideals and greater exposure to Western aesthetics.

Mikamo's introduction of the surgery has been interpreted in different ways. One perspective is that the procedure was intended to "westernize" the eyes of Japanese women, influenced by Western beauty standards that were becoming increasingly prevalent in Japan during the Meiji period. However, Mikamo estimated that the majority of Japanese women actually have the double eyelid appearance, considering it a physiologically normative feature among the population. He described the single-eyelid look as being "monotonous and expressionless," suggesting that his motivation for the surgery was rooted in enhancing natural beauty rather than solely conforming to Western ideals. According to this perspective, Mikamo was working within existing Japanese aesthetics and norms, aiming to accentuate a feature he believed was already prevalent and culturally appreciated in Japan.

Surgical techniques
Asian blepharoplasty is primarily performed using two techniques: non-incisional and incisional methods.

Non-incisional Technique (Suture Ligation)
The non-incisional method, or suture ligation, involves the strategic placement of sutures through all layers of the upper eyelid at the level of the upper tarsal margin. This technique facilitates adhesion between the subdermal tissues and the underlying levator aponeurosis, effectively creating the eyelid crease. It is less complex and has a shorter operation time, leading to a quicker recovery and fewer complications compared to more invasive methods. However, it tends to produce a static eyelid crease that does not vary with facial expressions and may diminish over time. Additionally, the underlying sutures can sometimes lead to corneal irritation.

Incisional Technique (Surgical Resection)
The incisional method, known as surgical resection, entails making an incision across the upper eyelid to remove excessive tissue, including skin, subcutaneous fat, orbicularis oculi muscle, and other anatomical components. This approach not only allows for the creation of a more dynamic and permanent eyelid crease but also can address other aesthetic concerns by removing excess skin and fat. The results are more aligned with the natural anatomy of the eye, making the crease appear more natural and dynamic. However, this method is more complex, requiring a longer operation and recovery time. One significant risk is lagophthalmos, where excessive removal of lid tissue can prevent the eyelid from fully closing.

Each of these techniques offers distinct advantages and poses specific challenges, making the choice between them dependent on individual anatomical and aesthetic considerations.

Modern trends
East Asian blepharoplasty have been reported to be the most common aesthetic procedure in Taiwan, South Korea and other parts of East Asia and is also frequently performed in Northeast Indian states such as Assam. The procedure has been reported to have some risk of complications, but is generally quite safe if done by an expert plastic surgeon. Practitioners of East Asian blepharoplasty include plastic surgeons (facial plastic and reconstructive surgeons), otolaryngologists, oral and maxillofacial surgeons, and ophthalmologists (oculoplastic surgeons). A procedure to remove the epicanthal fold (i.e., an epicanthoplasty) is often performed in conjunction with an East Asian blepharoplasty.