Concept of Double-eyelid Segments Ratio: Practical Application in Asian Blepharoplasty

Abstract

Background: There have been few articles on the vertical dimension of the Asian upper eyelid, the eyelid crease segment, and the upper palpebral segment. The eyelid crease height manifests differently depending on whether it is closed (on extreme downgaze), open, or on upward gaze. This study will investigate a ratio practical for use in Asian blepharoplasty (external incisional method). Methods: The central vertical dimensions of Asian upper eyelids were measured, together with the upper palpebral segment and eyelid crease height when present. These parameters were recorded preoperatively and following double-eyelid surgery, and remeasured at 1 week and 2 months postoperative with eyelids closed and with eyes open looking straight ahead. The ratios of anatomic upper/lower segments and apparent (eyes opened) upper/lower ratio were tabulated for each case. Results: The mean vertical height of upper eyelid skin among Asian women 30 years of age and younger was 23.4 mm, and between 31 and 50 years of age was 25.4 mm. The design of Asian upper eyelid crease and determination of skin tissues that can be safely removed include designing crease height to be 7 mm or slightly less and leaving an upper eyelid segment of at least a length 2 times or more of the crease height, to yield an aesthetically desirable double-eyelid segments ratio. Conclusions: The study confirms the practical application of the upper/lower segments ratio at surgery and at full recovery (2 mo) using such technique and shows its progression to a desirable range of double-eyelid segments ratio. It has proven effective and useful for patients seeking Asian blepharoplasty.