La Jolla, Calif. Since the 19th century, Asians have turned to blepharoplasty to modify the shape and character of their eyes and eyelids.
But it is a practice that has always been at the center of a debate about whether the surgery is used to enhance the face — or to diminish an ethnic appearance. The historic perception, among both patients and physicians, was that patients who chose blepharoplasty did so to mimic the shape and character of Western, or Caucasian, eyes — primarily through the creation of an eyelid crease.
Over half of Asians lack an upper-eyelid crease, a variation known as a "single eyelid." In contrast, Western eyes commonly contain an eyelid crease, also called a "double eyelid." In upper-lid blepharoplasty, or "double-eyelid surgery," the lid crease is created surgically.New techniques have made the double eyelid procedure faster, easier and less expensive than ever before. Upper-lid blepharoplasty has become the most common cosmetic procedure in Asia, where it is sought by patients of both sexes and all ages. The procedure is also on the rise in the United States, one expert tells Cosmetic Surgery Times , where the Asian population — with the highest education level and median income of any other demographic group — has now reached 14 million.
"It came into vogue as Western culture was celebrated," explains Scott Miller, M.D., F.A.C.S.
"It was a sign of success and modernization, I think, to have the double eyelid. The implication is not there as much now."
Dr. Miller is familiar with how the expectations of blepharoplasty have changed over the years. He is a clinical assistant professor at the University of Southern California San Diego School of Medicine and lead training instructor at Surgical Specialties Corporation. In his private practice, he sees many minority patients, including Asians and Asian-Americans.
MODERN EXPECTATIONS Rather than craft a stylized Western appearance, the goal of modern double-eyelid surgery is to create a more carefully contoured crease that is in proportion to the Asian facial structure. As a result, the eyes appear larger and more open in a way that does not diminish the ethnicity of the patient. Young women, especially, seek the procedure for basic cosmetic reasons rather than to diminish the ethnic character.
"Young Asians are coming in for cosmetic surgery, but you don't see 20 or 25 year olds who want to change their appearance to something more Western. We just don't see that desire," Dr. Miller remarks. "They feel accepted, not ostracized. They feel as though avenues are open to them."
On the other hand, older Asian Americans, like other aging populations, are turning to blepharoplasty to maintain a more vibrant and youthful appearance. Common procedures include removing redundant skin and treating lower-lid puffiness by contouring the fat accumulation. As with the upper blepharoplasty, the emphasis with these procedures for the older population is also placed on addressing the areas of concern while preserving the patient's ethnic appearance.
"When it comes to eye surgery, patients distinctly say that they do not want 'that,' meaning, a more Western appearance. They have great pride in their appearance and their culture. It is important to them to maintain their ethnic features."
"What we tend to see is educated people celebrating their differences," he says.
MEDIA AND MULTICULTURE Dr. Miller believes that this change of attitude probably reflects the growing multiculturalism in American society, as well as an increased presence of Asian actors and role models in the media and in popular culture.
"Part of assimilation is celebrating differences. I think, overall, people want to look like themselves with fine-tuning," he says. "We're moving out of the area of extreme make-over. We're into precision modification with people wanting to look like the best 'them' they can be instead of looking like someone they don't recognize."
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