"Precision is required in analysis of the patient's anatomy, in communicating with the patient about what can be achieved, in planning the procedure, and in execution," Jeffrey Schiller, M.D., tells Cosmetic Surgery Times.Dr. Schiller is a clinical assistant professor of ophthalmology at the University of Medicine and Dentistry of New Jersey. He has taught surgical techniques in China, Singapore, Thailand and the Philippines, and in his private practice he focuses on cosmetic and reconstructive surgery of the eyelids, lacrimal system, orbit and face.
Another major characteristic of the Asian eye is the epicanthic fold, or epicanthus. This vertical fold of skin on either side of the nose is prominent enough in some patients to cover the inner canthus and, in some cases, the epicanthus blends into an inner, or tapered, eyelid crease.
DISSECTING THE DIFFERENCES In recent years, magnetic resonance imaging (MRI), high-resolution ultrasound and scanning, and standard electron microscopy have been used to document anatomic differences between Asian and Western eyelids.
"The main anatomic difference is that the orbital septum inserts much lower on the levator aponeurosis in the Asian than in the Western eyelid," he explains. "In the Western eyelid there is a system of interconnected fibers which both attach the skin to the levator aponeurosis creating the lid crease, and hold the skin and orbicularis flat against the tarsus. In half of Asians, the lower insertion of the septum does not allow formation of these attachments. Hence the lack of a crease, and the absence of a flat platform of skin in front of the tarsus."
"Furthermore," Dr. Schiller continues, "the orbital preaponeurotic fat is both lower and more anterior in the eyelid, resulting in a fuller appearance."