Double eyelidplasty is the most frequent cosmetic procedure for Asians, and different anatomy including the epicanthus was a conundrum which limit cosmetic result of double eyelidplasty. Among the various anatomical difference, the epicanthus was most significant problem which was not identified clearly at all. Double eyelidplasty without epicanthoplasty tend to be unattractive or unnatural. Aesthetically, the epicanthal fold is worsened when performing double eyelidplasty without epicanthoplasty, because double eyelid formation aggravates vertical tension on epicanthal skin. It has been a long-standing dilemma for plastic surgeons which procedure to choose, i.e. infold type double eyelidplasty with a less satisfactory result or outfold type double eyelidplasty with concomitant epicanthoplasty, taking risk of hypertrophic scar in Asian eyelid.

When the epicanthal fold is severe, the surgical incision of skin flap also become longer, and a scar could be easily visible in conventional method, which based on the concept of local skin flap. Although it has been reasoned that combined epicanthoplasty is helpful in Asian double eyelidplasty, there has not been clear understanding about epicanthal fold, resulting in controversies for solution. There have been so many epicanthoplasty methods developed in its early days, which are mostly based on skin flap concept. Currently using methods are combined technics including skin excision, z-plasty, myotomy or myectomy of preseptal orbicularis muscle, skin redraping, plication of medial canthal ligament and so on.

The development of incomplete methods were unavoidable without understanding about true nature of the epicanthus. As the clinical significance of the epicanthus is mainly related with Asian double eyelidplasty, essential epicanthoplasty should be a key to plastic surgeons for choice of all the type of double eyelid including high outfold type(parallel type). But, there has not yet been a potent epicanthoplasty method which deserves universal solution for Asian double eyelidplasty before development of devolutional epicanthoplasty (Kwon’s method, so called magic epicanthoplasty). Dr. Kwon researched basically the formative causes of the differences of Asian eyelid, and also epicanthal deformity and absence of double eyelid. Dr. Kwon finally solved this conundrum, and suggested Kwon’s Theory about the evolution of eyelid to explain anatomical differences of Asian eyelid and Kwon’s Method for Asian blepharoplasty based on devolutional concept.

Surface inspection is is important not only in the evaluation of general conditions such as existence of crease, epicanthus, epiblepharon, blepharoptosis, but in planning the most appropriate surgical plan in Asian double eyelid surgery. The eyelashes are the true boundaries of the palpebral fissure. The eyelashes of a Caucasian is exposed completely and the eyes look clear. Also, the eye looks bigger with the parallel supratarsal crease of eyelid. In contrast, most Asian people have the epicanthi of varying degree with absence or incomplete presence of supratarsal crease. The eye of Asian without supratarsal crease is veiled by various amount of skin drooping and the eyeline where the lashes grow is hidden beneath the soft tissues called epiblepharon. The more the eyelid tissues droops down, the smaller and the puffier the eyes look.

The canthus of Caucasian is exposed completely, whereas the inner part of medial canthus of Asian eye is veiled by the epicanthus. The shapes of the canthal angle are quite various, but generally Asian canthal angles are rounder and shorter than those of the Caucasians. There are various distortions of canthal shape in Asian medial canthus which have been affected in the eyelid evolution. The epicanthus and single eyelid exists as a normal characteristic in Asian ethnicity, and it is peculiar to East Asians. Asian blepharoplasty can be best performed with special reference to the anatomical blueprint and implemented with respect to the devolutional concept of normal eyelid structure with supratarsal crease.

Previously, Sayoc’s theory has been accepted to explain absence of supratarsal crease in Asian since 1956. Sayoc suggested that in Caucasian, parts of the levator muscle of the upper eyelid are attached to the skin, While in Asians, it is absent or sparse. So, the natural double eyelid is congenitally absent or incomplete in Asian. It had been main medical theory for double eyelid up to early 2000



However, the electron microscopic studies confirmed that levator aponeurotic fibers penetrate the orbicularis muscle in both single and double eyelids of Asian, of course Caucasian. This finding suggested that Sayoc’s theory of the “levator expansion” had been incorrect.

Three parts of the eyelid which are affected in evolutional process. In eyes with a double eyelid, parts of levator muscle are attached to the back of the skin. On the other hand, an eye without a double eyelid has a structure called a epiblepharon which result from orbicularis oculi muscle displacement . Also, the preaponeurotic fat tissue is drooped down like pseudoherniation.

If so, why does the supratarsal crease not exist although aponeurotic fibers do penetrate the orbicularis muscle in Asian single eyelid? Dr. Kwon reconsidered basically without stereotype for previous theory about Asian double eyelid and the epicanthus from 2005, because Sayoc’s theory could not explain absence of Asian double eyelid and presence of epicanthus clearly. Dr. Kwon’s research tried to address the formative causes of epicanthal deformity and loss of double eyelid at the same time in evolutional aspect. Dr. Kwon’s research concluded that the answer for Asian double eyelid is not “not previously existed” but “lost” during evolution. Environmental adaptation is the basic cause for loss of supratarsal crease and formation of the epicanthus. Genetically, all modern humans are included into the subspeciesHomo sapiens sapiens,i.e. the subspecies of Homo sapiens. It has been reasoned that the racial differences of modern humans are just phenotypic variations. The stereotype of Sayoc’s theory may mislead plastic surgeons to misunderstand Asian double eyelid and epicanthus incorrectly. So, the evolutionary approach to Asian epicanthus or absence of supratarsal crease has not been researched and not suggested ever. Dr. Kwon suggested Kwon'stheory for the evolution of Asian eyelid.

The stage of the eyelid evolution according to the main action of orbicularis oculi muscle in Kwon’s theory.

Loss of medial crease, formation of the epicanthus, loss of mid-lateral crease, formation of the epiblepharon occur in sequence.

I. Stage of hypertrophy: The hypertrophy of orbicularis oculi muscle and depressor supercilli muscle develop by repeated frowning. The hypertrophy of orbicularis oculi muscle cause attenuation of the aponeurotic expansion which penetrate through orbicularis muscle. The aponeurotic penetrations
loosen and become sparse.

II. Stage of sheer stress: Complete detachment of aponeurotic expansions with loss of supratarsal crease takes place on point S by sheer stress. The detachment of aponeurotic fibers can occur beneath the orbicularis muscle or on the orbicularis muscle. Orbicularis oculi muscle contraction acts as sheer tensional stress with depressor supercilli muscle. The depressor supercilli muscle plays an ancillary role.

III. Stage of tensional stress: The successive loss of medial crease below point S results from displacement of preseptal orbicularis oculi muscle toward eyelash and the vicious cycle between malpositioned muscle hypertrophy and crease loss. The orbicularis oculi muscle contraction mainly act as tensional stress on remaining aponeurotic fibers and medial crease.

IV. Stage of compressional stress: Excessive contraction of orbicularis oculi muscle acts as compressional stress on overlying skin of upper medial eyelid with resultant vertical skin shortage and tension. The tight tension band develops due to vertical skin shortening of upper medial eyelid.

V. Stage of traction and tensional stress: Contraction of orbicularis oculi muscle acts as tensional stress on remaining supratarsal crease resulting in successive loss of supratarsal crease on the upper eyelid superiorly and/or act as traction force causing skin tent toward point P on the lower eyelid inferiorly. During and after formation of a tight tension band by vertical skin shortage, the orbicularis oculi muscle contraction causes a prominent skin fold on the lower eyelid by pulling-up the muscle point of origin like setting up a tent pole during contraction. The preseptal orbicularis muscle pulled up its origin superolaterally with skin tent on lower eyelid during contraction.

VI. Stage of degeneration: The atrophy of orbicularis oculi muscle and accompanying degenerative fibrosis develop, leaving the epicanthus with incomplete crease or epicanthus without crease.
The hypertrophied orbicularis oculi muscle becomes atrophied and replaced by fibrosis, but there remains vertical skin shortage and tension left on upper eyelid and skin fold and wrinkles on lower eyelid. Also there has been left centripetal fibrosis toward point p under the skin of lower eyelid.

The formation of  epicanthus and loss of supratarsal crease are  remnant manifestations of eyelid evolution which resulted from hypertrophy of upper orbicularis muscle and related aponeurotic attenuation.
Increased blood supply induced by hypertrophied orbicularis muscle and climate factors would cause hypertrophy and pseudoherniation of preaponeurotic fat. Displacement of orbicularis muscle and fat pad would affect the levator muscle and Muller’s muscle. A relatively longer medial canthal ligament and underdeveloped nasal bone would be additional evolutional manifestation​s by hypertrophy of the orbicularis oculi and excessive tension.

The presence of epicanthus or absence of supratarsal crease are one of differences of phenotype by relevant environments. What we should do for Asian blepharoplasty is to understand the evolution of eyelid and reverse evoutionary processes for stability of surgical crease with minimally invasive technique.If patient understand evolutionary eyelid change, and relationship between the epicanthus and the supratarsal crease, epicanthoplasty should be considered the core surgery for Asian double eyelidplasty.

Combined epicanthoplasty and double eyelidplastymustdeserve one complete "structural eyelidplasty" for Asians. Considering the relationship of the epicanthus and double eyelid, these combined surgeries can acomplish a perfect plan and create best results.

There are three general methods, the complete incision method (incision), partly cutting (partial incision), and cutting for only the needle to enter(buried suture, non-incisional method). From any among them, we must connect a part of the levator muscle to the eyelid skin. There are merits and demerits respectively and it should be determined by enough consultation considering the length and size of the eyes, thickness of the skin, power to open eyes, quantity of fat, epicanthal folds and so on. There are many differences in devolutional eyelidplasty from conventional eyelidplasty without devolutional concept. The structural Asian eyelid surgery based on devolutional concept(magic epicanthoplasty combined with double eyelid surgery) dramatically improves the epicanthus and stably connects the eyelid skin with the levator muscle. In devolutiona lAsian eyelidplasty, destructive procedures on surgical crease for stronger adhesion is less necessary. The tensional stress on crease by vertical skin tension is main cause of crease loss after double eyelidplasty in Asians. Contraction of malpositioned orbicularis oculi muscle in vertical direction is also a potential cause of tensional stress on surgical crease. Because we have resolved the possible causes of crease loss with devolutional epicanthoplasty, aggressive adhesion which performed in conventional double eyelidplasty is less necessary.

In more cases, we can apply non-incisional(or partial incisional) method for crease formation in devolutional eyelidplasty except excessively thick skin condition with true epiblepharon. There are more incidence of mild blepharoptosis in Asian eyelids. We think mild blepharoptosis in Asian eyelid is related with the eyelid evolution. After the evolutional process, the loading conditions of levator muscle had been worsened. The fibrous tissues within the epicanthus and the epiblepharon, vertical skin tension on upper eyelid, hypertrophied orbicularis oculi muscle and hypertrophied preaponeurotic fat pad add levator and muller muscle more loadings, and act as causal factors of blepharoptosis. When we evaluate blepharoptosis, we should consider the epicanthus related factors. When we perform blepharoptosis surgery with devolutional epicanthoplasty simultaneously, correction of blepharoptosis become complete and is expected to get better result. Through more than five thousands cases of people who already underwent devoutional eyelidplasty by Dr. Kwon, Kwon’s theory and method has been proved to be a very effective and universal technique for Asian eyelid. The surgical outcomes are very natural and satixfactory.




In an eye with double eyelid, the levator muscle holds the skin and the skin is pulled as people open their eyes and forms a double eyelid. While in Asian eye without double eyelid, most have no attachment between the levator muscle and the skin. There are thick fibrous tissue and malpositioned orbicularis muscle which block pulling the skin. The fibrous tissues and malpositioned orbicularis muscle within epicanthus and epiblepharon prevent even transmission of levator muscle power toward the eyelid skin because the aponeurotic fibers have been detached and do not extend to the epicanthal skin area any more.

The preexisting vertical skin tension on medial eyelid acts as tensional stress on newly formed surgical crease. The epicanthal skin tension is considered as a major factor which inhibits the sustainability of surgical crease in Asian double eyelidplasty. Also, the malpositioned orbicularis muscle can be reactivated as a vertically acting inhibitor which causes active tensional stress on mid-lateral surgical crease, especially when we have performed the outfold type double eyelidplasty without epicanthoplasty. Therefore, Asian double eyelid surgery should reform not only this attachment, but also should resloves the epicanthus and epiblepharon. Then, we can finally creates anatomically stable crease and natural-looking beautiful eyes.



Blepharofissure(The width of the eyes) is long and the tails of the eyes are not so pointed upwards.
The distance between the eye and eyebrow is not short.
The skin of the eyelid is not droopy.
The eyelid skin is thin
Proper amount of fat exists but not too much.
There is no severe epicanthus and epiblepharon.
The function of the muscle to open the eyes is normal and the exposure of pupil/iris is enough for bright looking eye.
Both eyes are symmetric
The position of the eyebrow is not hung down and is symmetric.

In cases that a lot of these conditions are satisfied, the Asian blepharoplasty can express very good results without much difficulty. But actually, most of cases are not like that. If patient don’t meet any or only a few of these conditions, there may be a high chance that less satisfactory results may be shown.The unfavorable conditions are much related with epicanthus and eyelid evolution. In unfavorable cases, devolutional concept of Asian blepharoplasty is more important. We can get better result through structural eyelidplasty based on devolutional concept. Through cases who already underwent devolutional Asian blepharoplasty, this method has been proved to be a very satisfactory and beneficial method for Asian eyelid. We could lessen the rate of sausage phenomenon, loss of surgical crease and hypertrophic scar obviously in unfavorable cases. The surgical outcomes are very natural and much better than conventional double eyelidplasty.


The eye of Asian without supratarsal crease is veiled by various amount of skin drooping and the eyeline where the lashes grow is hidden beneath the soft tissues called epiblepharon. The more the eyelid tissues droops down, the smaller and the puffier the eyes look. A single eyelid of Asians is likely to cover the iris and pupil partially. When skin drooping is severe, eyelashes can prickle the cornea and it can cause problem of visual acuity . In this case, a double eyelid surgery removing parts of the drooping eyelid , forming a double eyelid and extending exposure of pupil, will brighten the patients’ vision. Therefore, a double eyelid surgery has a positive effect to get a better vision for the basic function of the eyes. After double eyelid surgery, the eyes look more clear and bright.

There would not be a ideal crease type and height which is best for all cases. As is the case for all aesthetic facial surgery, the surgical aim should be determined under individual anatomical conditions and patient’s request. We should consider anatomical differences of Asian eyelid to accomplish naural-looking surgical results. The fusional part of the orbital septum and levator aponeurosis in Caucasian eyelid is typically in the skin crease(8-12 mm from eyelid margin). Its location lies above the superior tarsal border, which limit the downward prolapse of the orbital fat pads and enable aponeurotic expansions to insert toward the subdermal surface of the pretarsal eyelid skin. Whereas the fusional part lies at the lower point(6-8 mm from eyelid margin) in Asian eyelid and its location lies usually at the superior tarsal border. The height of tarsal plate is relatively less than Caucasian’s( more than 8 mm in Caucasian). It is anatomically desirable to form surgical crease at the level of superior tarsal border in Asian blepharoplasty. If the longitudinal length of tarsal plate long, it is beneficial when forming bigger parallel surgical crease.

If the eyelid crease in the inner corner of the eyes is not clearly visible due to the epicanthus , it is an infold. The infold crease is usually very low. Although low Asian crease is generally infold, it looks natural. In cases of Asian descent who have a crease congenitally, the crease is usually low infold or inout crease. If the epicanthus is mild, the congenital crease is usually medium height inout crease. For natural image of surgical result, the relationship of the epicanthus and double eyelid should be taken into account.

If it is located on the epicanthus apart from medial canthus , it is an outfold. The height of outfold is usually more than medium. To form an high outfold like those of the Westerners, patient should undergo the epicanthoplasty and resolve epicanthus . For ease Asian decent, people don’t have depressed eyeball socket characteristics and high nose, so the high outfoldmay turn out unnatural in structural aspects. But an inout-fold or medium outfold can turn out to be relatively natural with structural eyelidplasty (combined epicanthoplasty and double eyelid plasty)and is usually recommended.

Previously many patients concerned about whether to take the epicanthoplasty or not. Now it is definite that the epicanthus determines the type of double eyelid crease and natural images after Asian blepharoplasty . So, devolution epicanthoplasty must be accompanied for higher parallel crease and a natural-looking, stable inout crease in Asians.The higher outfoldcrease patient prefer, the epicanthoplasty is more instrumental in Asian blepharoplasty.

It is not true that only large double eyelids make big and beautiful eyes. Because skin thickness, fat, muscle, surround bony structure of eye are different in each person, proper height is also different in each case. The most important key for natural looking beautiful eyes depends on the designed height of the double eyelid which is appropriate for each anatomical condition. An inadequate height can make eyes look unnatural and disturb functioning of the eyes (opening and closing the eyes) and will swell for a long time, and even look as if people have drowsy looking eyes.Patient should understand that there is medical limitation in crease height and crease type to preserve natural image of the eyelid after Asian blepharoplasty.

Generally, all surgical double eyelids can become attenuated or fade away as time passes. The fading risk is less when the epicanthal tension is weak and there’s small amount of fat in the eyelid, and when the eyelid skin is thin. The tensional stress on medial crease by vertical skin tension is the main cause of crease loss after double eyelidplasty in Asians.

(Left) After conventional double eyelidplasty, 1 year post-operatively. A clue of past evolutional process, notice aggravation of vertical tension on the epicanthus and attenuated medial crease. This eyelid is similar with the stage of compressional stress before loss of mid-lateral supratrsal crease in the eyelid evolution. (Right) A natural Asian eyelid with an epicanthus and incomplete presence of attenuated supratarsal crease. Notice loss of medial crease, epicanthal bulging, appearance of lesser crease along the malpositioned preseptal muscle, and skin fold of lower eyelid. This eyelid shows the vestiges of eyelid evolution obviously.

Contraction of malpositioned orbicularis oculi muscle in a vertical direction is a potential cause of tensional stress on mid and lateral surgical crease. When the crease is designed high, the tension and fading risk increase proportionally. To maintain the stable double eyelids, it is recommended to make the inout-fold or the outfold with resolving the epicanthus by proper epicanthoplasty.

Consultation for an Asian blepharoplasty (double eyelid surgery) during the preoperative visit is probably as important as the surgery itself, since it is during the preoperative visit that the important decisions about the design of the eyelid crease are made such as where to set the height and shape of the eyelid crease. The ultimate aim of an Asian blepharoplasty is to create a skin crease to enhance the appearance of the eye, yet at the same time, preserve the features of Asian ethnicity for the individual patient. It is therefore very important that when seeing a patient for the first time for their eyelid surgery, that time and meticulous attention is spent to ensure that both patient and surgeon are clear about the desired eyelid configuration.

At consultation, a patient should thoroughly explain what he/she wants to gain from the surgery. And the doctor must fully understand the expectations by the patient and explain the possible and impossible things that could be done to give the best results. If your eyebrows look like they are hanging down too much, the doctor may consider lifting it up(brow lift surgery) along with your eyelid surgery. Surgical methods are determined among an incision, partial incision method, or the buried suture method.

An eyelid has a weak and thin skin and a double eyelid surgery without significant problems can be taken even to a keloid constitution. Usually a keloid scar is different from an hypertrophic scar. A hypertrophic scar is similar with a keloid in that irregular scar is seen when an eyelid are healed. It is different from keloid in that a hypertrophic scar can happen to anyone not relating constitution. Also the hypertrophic scar will spontaneously fade away within 6months. On the other hand, the keloid extends more and more. And after incision, it can be more severe. Generally, a hypertrophic scar may last longer for people who have dark and thick skin, but it is not something to worry much about because they usually last up to only around 3-6 months.

In devolutional Asian eyelidplasty, destructive procedures on surgical crease for stronger adhesion is less necessary. The tensional stress on crease by vertical skin tension is main cause of crease loss after double eyelidplasty in Asians. Contraction of malpositioned orbicularis oculi muscle in vertical direction is also a potential cause of tensional stress on surgical crease. Because we have resolved the possible causes of crease loss with devolutional epicanthoplasty, aggressive adhesion which performed in conventional method is less necessary. In more cases, we can apply non-incisional method for crease formation except excessively thick skin condition with true epiblepharon.

When we should remove excessive and malpositioned soft tissues in cases of droopy eyelids with epiblepharon, conservative resection for resolving the displaced soft tissues of the anterior lamella and partial removal of preaponeurotic fat in the posterior lamella is enough without unnecessary tissue injury. The overactive resection and resultant unnecessary tissue injury only cause prolonged swelling and depression scar. Therefore there would be less chance of hypertrophic or depression scar in structural Asian blepharoplasty based on devoutional concept.

The buried suture method, natural adhesive method (non-incisional double eyelid surgery)

For the buried suture method, we must consider the amount of ptosis, size of eyes, thickness of tissues of the eyelids, the degree of the hanging down of the eyelids, your skin, and your muscles. The buried suture method needs to make small halls with the needle in several units for binding skin and levator muscle through these holes. If you feel that you cannot see much of a difference after the surgery, or if your new image is hard to accept, it can be returned to your original natural state by the removal of the suturing thread. This surgery is operated by very a very small incision (usually 1-2mm.). Usually after the surgery, a scar cannot be seen, even without make-up on.

In this method, there are various types. The first type is that we make a single loop. Another type is that we make a short loop in three to five parts. And the final type is to make many loops according to doctor’s demand. The main reason to avoid this method is that the double eyelid might fade away after a long time. However, Teuim plastic surgery minimizes that problem by experienced suture technique and devolutional epicanthoplasty. In devolutional eyelidplasty, destructive procedures on surgical crease for stronger adhesion is less necessary. The tensional stress on crease by vertical skin tension is main cause of crease loss after double eyelidplasty in Asians. Contraction of malpositioned orbicularis oculi muscle in vertical direction is also a potential cause of tensional stress on surgical crease. Because we have resolved the possible causes of crease loss with devolutional epicanthoplasty, aggressive adhesion which performed in conventional method is less necessary. Through devoutional Asian blepharoplasty, we can apply non-incisional method for crease formation in more cases, except excessively thick skin condition with true epiblepharon

In Kwon’s classification of Asian eyelid, type I, II, III are good candidates. The buried suture method is basically suitable for thin skinned eyelids.Surely, the buried suture method can be applied to any type of eyelid, but the best results can be expected in thin eyelids. Also, for people who easily make crease with Eyecharms, tape, or eye glue, this method is useful. In general it is desirable method for people who have good skin conditions.


Favorable conditions for non-incisional method

1. Eyes with not much fat and with thin eyelids.
2. People with a double eyelid on only one side of the eye.
3. Eyelids that are not symmetric and are imbalanced.
4. Men who want to get small crease .
5. People who have eyes that are easy to make double eyelids with tapes or glue.
6. Eyes that sometimes form double eyelids but sometimes not.
7. Eyes that have an indistinct double eyelid crease.

Buried suture method shows rapid recovery with less swelling. It is natural and a scar is hardly seen. The eyes will look natural in only about 2-3 weeks. It creates a very natural double eyelid line. A scar won’t remain. The duration of the operation is about 20-30 minutes. The recovery period is also very short. But, the final result of incisional method is more likely to be permanent due to the creation of stronger attachments between the skin and underlying deeper eyelid structures. Despite the open incisional technique being a superior operation, the closed suture techniques remain the most popular surgery due to their simplicity and no scar.

It’s a fact that people have experienced their creases fading away in the past from the buried suture method. The main reason for this is that there was a chance the eyelid surgery was undertaken improperly. If the crease gets loose, it causes discomfort for both the patient and the doctor. It is wrong to think that the buried suture method would get loose and fade away even though a proper surgery is performed from a skillful surgeon. The tensional stress on crease by vertical skin tension is main cause of crease loss after double eyelidplasty in Asians. Contraction of malpositioned orbicularis oculi muscle in vertical direction is also a potential cause of tensional stress on surgical crease. Because we can resolve the possible causes of crease loss with devolutional epicanthoplasty, aggressive adhesion which performed in conventional incision method is less necessary. If we apply combined epicanthoplasty and non-incisional double eyelidplasty in proper cases, there’s no need to worry about crease loss.

When skin hangs down a lot, it is better to take an incisional double eyelid surgery including excision of excessive skin. For eyes that hang down, although the lines are made high, looks like small creases due to drooped skin.

It can be said that for 30% of Korean woman, an excision or incision is needed for beautiful eyes. Most these cases need combined surgery considering the epicanthus and the condition of the eyelids. But when skin the conditions are good, then the buried suture method or the partial incision method can be effective. When buried suture method is operated for eyes that really need an excision, the double eyelids are most likely to fade away in spite of combined epicanthoplasty. In most thick skin conditions, Asian eyelids tend to have severe epicanthal folds, so the epicanthoplasty is necessary for good results. So it is true that most hospitals apply incisional or non-incisional method properly. If a hospital operates only with the buried suture method, it cannot be accepted both surgically and aesthetically. This cannot create desirable results and it would be an act against the cosmetic principle either

In Kwon’s classification of Asian eyelid, type II, III, IV are candidates. This is suitable for a person who has slightly puffy eyes and who wants to obtain a natural medium double eyelid. It can be operated by a minimal incision and it can make a more certain adhesion than the buried suture method. In a months, the swelling will decrease.

Advantages
Patient will experience a rapid recovery. Also the fat of the eye will be minimized.
1. It is unnecessary to worry about a scar after surgery with minimized incision.
2. Fat is removed.
3. Recovery time is short.

Disadvantages
1. It cannot be applied to eyes that show true epiblepharon
2. The swelling eases faster than that of the full incision or excision method, but more than that of the buried suture method.

Puffy eyelids are common for Asian women. These eyes are formed when the fat in an eyeball socket is abundant or the orbicularis oculi muscle is thick(true epiblepharon), or when the orbital skeleton is protruded around the eyes. In these kinds of eyes, it is needed to make the eyelid thinner. Operational plans have to be made by determining what the reasons are for the eyes to look swollen. Then, the reason for puffy eyelid must be fixed. The fat may be removed, the skin and muscle may be cut out, and additional operations must be taken if necessary. In cases where the patient has a severe epicanthus, the magic epicanthoplasty must be done at the same time.

When eyes have a thin eyelid and a weak Mongolian fold, a natural eyelid can be made by only a simple operation such as the buried suture method. There will be no scar remained because the eyelid is not really cut, and a natural double eyelid can be made. In this case, patients are usually satisfied with their existing eyes and hesitate to take an operation, but the result is so good and their satisfaction is usually higher.

The eyes look very tired if many lines exist on the eyelid. This line is very different from the ordinary, typical eyelid crease, and most of them form as wrinkles and the traces of wrinkle are remained even when closing the eyes. By forming one crease to the proper height, the remaining wrinkles disappear spontaneously.

Some women use glue or Eyecharm tapes to make temporary double eyelids, but using this can cause the skin to hang down and create weak elasticity of the eyelid skin. A healthy eyelid must have tension without wrinkles even when the eyes are closed. If glue or tape is used repetitively on the eyelid, the skin will hang down and thickening of the skin may also occur. Because of this, the eyelid skin of teenagers looks often as those of the 30s. The habit of gluing on eyelids to make temporary double eyelids is not an habit to fix easily. Accurate evaluation and selection of the proper surgical method(excisional, incisional, or buried suture method) must be done depending on the degree of drooping of the skin.

This is a case that occurs to people who have thin eyelids and a mild epicanthus .double eyelid is formed when the eyes get tired. To fix this problem, the taking the buried suture method with /without epicanthoplasty is the best way.

Many Asians’ skin of the eye hangs down and slightly covers the pupil due to true ptosis or epiblepharon. In epiblepharon case, an incisional double eyelid surgery and the magic epicanthoplasty can give clear and distinctive eyes by exposing the pupil properly. There are more incidence of mild blepharoptosis in Asian single eyelid which show epicanthus and epiblepharon. We think mild blepharoptosis in Asian eyelid is related with the eyelid evolution. Sometimes it can be confused with ptosis, but it is different with true ptosis, and correcting the ptosis is not always necessary and only the double eyelid operation can be enough.

The ideal distance between the two eyes is different depending on the size of the face, but it is usually about 33-35mm. The actual distance of typical Korean women is about 35-38mm. And when it is over 38mm, it gives an awkward impression. For these kinds of eyes, the epicanthoplasty is definitely needed. It will achieve better face image. The results are more effective when plastic surgery of the nose is done together

There are some people who have different size of double eyelids on each eye. Too much difference may give a mismatching image so it’s better to fix it. Although it is possible to operate one eye, it is recommended to take operation on both eyes for desirable results.

People who have an eyelid on only one side may think it is one of their unique characteristics, but may also feel insufficient about the imbalance of their eyes. So the eyelid surgery is taken to create balanced, even eyes. If the better symmetric crease is made, the eyes will look more beautiful.

Eyes with its tails pointed up do not give a good impression generally. In this case, the lateral canthoplasty can help the problem.

If the tails of the eyes point downwards like as shown in the picture below, they can seem to have a depressed or aged appearance. In old-age case, it would be better to take the surgery that lifts the eyebrows so that it can correct the parts that are hanging down.

These kinds of eyes can express a not so good impression because it gives a tired and drowsy look. This is mainly caused by less fat in the eyelids with deep eyeball sockets. These can be corrected to a more attractive look by the autologous microfat graft, injecting fat to aponeurotic fat pad.

There are casess when the eyeballs get poked by own eyelashes. If this occurs frequently, the eyes will get damaged a lot. By the epicanthoplasty and double eyelidplasty , the direction of your eyelashes can be corrected to point outwards.

When a person opens his/her eyes, only 1-2mm of the iris should be covered by the upper lid nrmally. When more is covered, the person will look sleepy. This is called “ptosis” medically. The cause of this is the weak power of the muscle which raises the eyelid. In this case, merely the double eyelid surgery cannot make good results and a ptosis correction is surely needed to make better eyes additionally.



Eyeball protrusion such as these are caused by the exophthalmos. The excision of skin method or the removal of fat is usually unnecessary. Partial incision or the buried suture method can be easily applied to make natural looking double eyelids with/without epicanthoplasty.