Single eyelid

It is often said that the eyes are the windows to the soul. What would an unaesthetic periorbital appearance imply? It is no wonder that aesthetic improvement of the periorbital region is one of the commonest aesthetic requests. Oriental eyelids may sometimes have features that are regarded as unaesthetic. These include the lack an upper eyelid creases, the presence of epicanthal folds on the inner eyelids, and upper eyelid droopiness.

Many individuals seek correction of these features to attain current culturally accepted norms of upper eyelid appearance. A youthful and aesthetically pleasing upper eyelid region consists of well-positioned eyebrows, appropriate eyebrow-to-upper eyelid crease distances, well-formed upper eyelid creases, an appropriate degree of eye opening, and taut skin without wrinkles or pigmentary blemishes. These findings impart the image of an individual who is bright, attentive and confident.

How Does It Manifest?

Individuals with single eyelids are often described as inattentive or tired. The lack of a double crease increases the apparent length between the eyebrow and the eyelid margin and makes it look droopy and small.

How does it arise?

The normal upper eyelid has a crease located between 6 to 9 mm above the eyelash margin, and there is usually skin fold that drapes in front of and covers it. This crease is formed by the presence of fibrous attachments of the eyelid elevator muscle (levator palpabrae superioris muscle) to the skin.

Up to 40% of people of Oriental origin may be born without these attachments, resulting in a crease-less eyelid (“single eyelid”). Less commonly, individuals born with double eyelids may lose the eyelid crease from accidents (trauma) or infections.

Double Eyelid Surgery in Singapore: Upper Blepharoplasty for Single Eyelids

How are men and women different?

Females generally have thinner upper eyelid skin and a crease height measuring 5 to 6 mm from the eyelid margin. They tend to favor higher folds, revealing about 1 to 2 mm of upper eyelid skin above the eyelashes that permit the application of makeup.

 In contrast, males tend to have thicker upper eyelid skin and often prefer deeper-looking creases. Their crease height may range from 5 to 7 mm from the eyelid margin, and they often favor a fold that completely covers the upper eyelid skin without revealing the skin above the eyelashes. This is also known as a “buried” fold.

The Picasso Advantage

Upper eyelid aesthetic surgery is one of Dr Matthew Yeo’s key clinical interests. He is experienced in this area and delivers lectures in the Asia Pacific region on this topic. He applies proprietary techniques to deliver elegant results while minimizing the recovery period. Picasso Plastic Surgery has an en suite operating facility that assures you maximal privacy and convenience, and keeps facility and equipment costs contained.

treatment

Effective double crease creation requires surgically attaching the levator muscle to the upper eyelid skin at the appropriate level. The use of various energy devices (e.g. radiofrequency, electric etc) does not create reliable results. 

Surgery is required and there are two possible options: minimal-incision suture upper blepharoplasty and incisional upper blepharoplastyBoth techniques are able to create custom-designed creases that parallel with the eyelid margin, or tapered creases that are slightly narrower medially (inner side) and slightly wider fold laterally (outer side). 

Successful double eyelid crease creation significantly improves the overall aesthetic and improves body image and self-esteem.

The “Stitch Technique” | Minimal-Incision Suture Upper Blepharoplasty

The minimal-incision suture upper blepharoplasty creates natural-looking and well-defined double creases through small incisions with minimal recovery time. It is one of the most popular aesthetic procedures in Asia and is performed as an ambulatory surgery under local anaesthesia.

Individuals who are young and with no upper eyelid skin laxity are the best candidates to consider this procedure. Those with some degree of skin laxity may consider an incisional upper blepharoplasty as it will excise excess skin and produce a better result.

This procedure creates well-defined double eyelid creases between 5 to 7 mm above the eyelash margin, while revealing 0.5 to 2 mm of the “inner” eyelid skin above the eyelash margin in females and 0 – 1.0 mm in males. The incisions are small and well-concealed within the double eyelid crease line. The fold height and shape may be customized to suit the individual’s wishes.

Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.

The proposed crease line is marked out preoperatively. Local anesthesia infused into the wound for optimal intra- and post- operative analgesia. Four to five small incisions, 1 – 2 mm in length each, are made within the double eyelid crease. Stitches are passed between the muscle, the inner tissue, and back into the muscle to surgically create attachments between the muscle and skin. The incisions are each closed with a single stitch. Minimal-incision double eyelid crease creation is a fine art that requires preoperative planning and precise technical execution.

Mild swelling is expected after the surgery. Many individuals are able to return to work between the 5th and 7th postoperative day. The eyelid stitches are removed on the 5th postoperative day and most of the swelling will resolve by the end of the first week. their usual activities immediately following the procedure.

Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. An optional electromagnetic field device may be used for the first 5 days to accelerate wound healing and reduce swelling. Strenuous activity should be avoided for the first two weeks to minimize bruising.

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Incisional Upper Blepharoplasty

Incisional upper blepharoplasty is a minor surgical procedure that delivers effective and natural-looking double-crease creation that is long-lasting. It is one of the most popularly requested procedures in Asia. This may be performed as an ambulatory procedure under local anaesthesia, with optional intravenous sedation if requested.

The following are candidates for incisional upper blepharoplasty:

  • Individuals with absent crease and thick, heavy eyelid skin
  • Individuals with puffy upper eyelids (due to retroorbicularis oculi fat (ROOF) or muscle)
  • Individuals who have had previous minimal incision double eyelid crease surgery seeking a more defined crease

Incisional upper blepharoplasty creates well-defined double eyelid creases that reveal between 0 – 2.0 mm of the “inner” upper eyelid skin just above the eyelashes.

The upper eyelid skin will appear taut and have a smooth contour. Correction of the elevator muscle laxity, if present, creates larger vertical eye opening. The result is an individual who looks more attentive and energetic following the surgery.

Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.

The proposed crease is marked out preoperatively, and local anesthesia infiltrated into the upper eyelid for optimal intra- and post- operative analgesia. An incision is made along the planned crease. Removal of the ROOF fat is occasionally required, especially in males, to make the upper eyelid appear less puffy. The upper eyelid elevator muscle may be exposed and shortened in some cases to increase the eyelid opening, and the crease formation performed using sutures. The wound is then closed meticulously to deliver the best possible postoperative scar and aesthetic outcome. Incision upper blepharoplasty is a fine art that requires preoperative planning and precise technical execution.

Mild swelling is expected after the surgery, and most of it will resolve by the 10th postoperative day. The eyelid stitches are removed on the 5th postoperative day and most individuals are able to return to work after the first week.

Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. An optional electromagnetic field device may be used for the first 5 days to accelerate wound healing and reduce swelling. Strenuous activity should be avoided for the first two weeks to minimize bruising.