Section: Risks and Revision
Risks and Complications
Special Considerations in the Asian Eyelid
Because the primary goal in Asian cosmetic eyelid surgery is the creation or alteration of the upper eyelid crease, shortcomings with final crease position take on added significance. While the list of problems below may seem long, the large majority of patients undergoing such surgery are pleased with the ultimate outcome.
• Asymmetric eyelid creases - Unmatched creases different in shape, depth, length, and/or height may present a problem. Some slight final asymmetry is not unusual and may occur even in the hands of a highly-experienced surgeon. External factors independent of surgical technique (such as preexisting facial, brow, or orbital bone differences) may also impact on final crease position.
• Overly high eyelid crease - If the skin incision is placed too high above the eyelashes and/or excessive skin is removed, the final eyelid crease may sit at a higher level than desired.
• Undesirably shaped eyelid crease - Variations in the shape of the eyelid crease are discussed elsewhere. If a patient desires, for instance, a nasally-tapered crease but ends up with a parallel crease, he or she may be disappointed.
• Hollowness - If too much fat is removed, a more rounded semilunar crease may result and the typical fullness of the Asian upper eyelid can be lost (although a few patients may be seeking this result).
• "Westernization" - If a patient without a pre-existing eyelid crease desires only thinning of a baggy eyelid but ends up with an obvious new crease, he or she may be disappointed by the unintended cosmetic change. Furthermore, aggressive surgery may create a crease that looks "unnatural" on the Asian face (obviously, a subjective judgment that varies observer to observer).
• Loss of the eyelid crease - Regardless of the procedure employed, the new eyelid crease may soften or sometimes be lost over time. This change, however, is not only common but almost to be expected with less invasive non-cutting suture techniques of crease formation.
• Multiple creases - Aggressive dissection in the muscle layer above the tarsal plate as well as other surgical maneuvers may result in the formation of more than one crease.
• "Triple eyelid" - The creation of two creases rather than one is usually related to excessive fat removal.
• Eyelid ptosis - If the levator aponeurosis is injured or excessively tethered, a droopy eyelid may result and require reoperation.
• Upper eyelid retraction - Excessive skin removal or inadvertent inclusion of the orbital septum in the sutures may interfere with full eyelid closure (lagophthalmos).
• Prolonged swelling - Aggressive orbicularis muscle dissection may lead to prolonged tissue edema (swelling), which eventually resolves.
• Hypertrophic scarring - An aggressive reaction (more redness and thickness) in the healing external eyelid scar is slightly more common in Asian skin. Time is usually curative.
• Scarring after epicanthal fold surgery - A number of procedures have been proposed for reduction of the epicanthal fold. Most require complex skin incisions and/or excess muscle, which may result is unacceptable permanent scarring or tissue depression in the operated area.
• Eyebrow ptosis - If aggressive surgery to obtain a high crease is undertaken on a patient with a pre-existing low brow position, the brow may be pulled lower.
• Unrealistic expectations - Perfection in any type of plastic surgery is almost never attained, and some asymmetry is the rule rather than the exception. If this fact is not comprehended before surgery, a patient may later be disappointed by an entirely acceptable result.
• Unhappiness with new look - Rarely, a patient who undergoes Asian eyelid surgery may be disappointed with his or her "new" look even though the surgical result is precisely as discussed ahead of time with the surgeon. It is important to understand that once an eyelid crease is created, it is not possible to revert back to the unoperated appearance. A conservative approach to Asian eyelid surgery is thus always preferable.
• Impatience - Healing after double eyelid surgery takes time. Unfortunately, some patients begin to question their results within a matter of a few weeks or even days (or even hours).
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