Double Eyelid Surgery, Upper Blepharoplasty

About 50% of Asians do not have a double fold. The presence of a double fold will give the perception of a bigger and more attractive eye. There are generally two ways to create a double fold namely the Stitch Blepharoplasty or Scarless Double Eyelid Surgery and the Open Upper Blepharoplasty

What is a Scarless Double Eyelid Surgery or Stitch Upper Blepharoplasty?

The Stitch Upper Blepharoplasty is done by applying 3 anchoring stitches and connecting sutures between the anchoring sutures to create a smooth double eyelid fold and make it permanent. The sutures are left permanently inside and the puncture holes healed without leaving any noticeable scar. 

 

Who is suitable for the Scarless Double Eyelid Surgery?

It is suitable for the young people who has thin upper eyelid without excess skin. For those with thick upper eyelid due to fat, the excess fat may be removed at the same time through an additional small incision.

 

How long is the surgical procedure? What is the Recovery time?

The procedure is done under local anaesthesia. The duration is about 45mins to 1 hour. After cold compress for 30 mins, the patient may do home to rest. There will be swelling for the first 2 days, and will subside thereafter. Patient can generally return to work after 1 week. The double fold will look natural when the swelling has fully subsided after a month.

 

Ageing Upper Eyelids or Droopy Upper Eyelids

With ageing the upper eyelid skin becomes excessive and droops over the double eyelid fold or eyelashes. The loose and excess skin causes the upper eyelid to appear tired or heavy and sometimes causing obstruction of the vision on the outer corners. This is more prominent on patient who has single eyelid fold. This phenomenon is also called Dermatochalasia of the upper eyelid.

Droopy upper eyelid are commonly caused by

  • Ageing with excess skin (Dermatochalasia)
  • Ageing with weakness of the upper eyelid attachments causing Ptosis

Ptosis of the upper eyelid could be due to weakness or stretching or thinning of the attachments (aponeurosis) to the upper eyelid, long term use of contact lenses resulting in overstretching of the eyelids or trauma to the upper eyelids or congenital ptosis due to weakness of muscle or nerve.

The technique for correction of Droopy Upper eyelid will depend on the cause. For Excess skin due to ageing, only an open upper blepharoplasty to remove the excess skin with or without repositioning the double fold is required. For droopy Upper Eyelid with Ptosis, an additional ptosis surgery to tighten the loose attachment is required.

What is Open Upper Blepharoplasty?

The open method involves making an incision along the intended fold, cutting away some skin, muscle and fat and anchoring the lower skin flap to the levator to create a double fold. 

 

Who is suitable for Open Upper Blepharoplasty?

  • Young patients with thick upper eyelids or fatty upper eyelid. An incision is made to remove excess skin and fat.
  • Older patients who have droopy upper eyelids due to excess skin or fat that is covering the double fold or eyelashes. The excess skin is removed to reveal the double fold and give a more youthful appearance. The original double fold is preserved. If there is asymmetry of the double fold, it may be corrected at the same time of the upper blepharoplasty surgery. 

 

How long is the procedure? What is the Recovery time?

The procedure is done under local anaesthesia and takes about 1 – 1.5 hours. After cold compress to reduce swelling, the patient may go home to rest. There will be swelling for the first 3 days and will subside thereafter. Patient can generally return to work after removal of stitches in 1 week. The double fold will look natural after the swelling has fully subsided in a month.

 

What is Ptosis Correction Surgery?

Ptosis of Upper eyelid is a phenomenon where the upper eyelid is unable to fully open and the vision may be impaired or blocked. The severity of the ptosis can be graded as mild, moderate or severe. Moderate and severe ptosis is medically indicated for surgical correction because it obstructs the visual field.

 

How is the procedure done?

The surgery may be done under local anaesthesia as day surgery. The upper eyelid muscle and its attachments to the tarsal plate is exposed through an upper eyelid incision. The upper eyelid muscle or levator aponeurosis is repositioned or reattached back to the tarsal plate with multiple sutures. At the same time the double fold is created or preserved.

What is Epicanthoplasty?

Some Asian eyes are almond shape, slit like or has a ‘Mongoloid’ appearance. It has a medial epicanthic fold or an extra skin fold drooping over the inner side of the eye, making the eye aperture appear smaller and shorter. Epicanthoplasty is a surgical procedure to open up the inside corner of the eye by eliminating or lifting the inner skin fold. It will make the eye look rounder or bigger. Epicanthoplasty is also called ‘Opening up the Inside Corner of the Eye’ in Singapore. This procedure is commonly done together with double eyelid surgery.

 

How is Epicanthoplasty done?

Epicanthoplasty is done by using a modified Z-plasty technique or to create 2 skin flaps and reorientate them to eliminate the skin fold. The procedure takes about 1 hour under local anaesthesia.

 

FAQs

What is the downtime?
– swelling for the first 1-2 days; advised to do cold compress
– warm compress after 2 days to help in resolution of bruise.
– recovery time about 1 week

What is the cost?
– Ranges from $2500 to $3500 per procedure.
– Medication: $100- $200
– 7% GST

What are the risks?
– Immediate risk: bleeding, haematoma and infection.
– Longer term risk: dry eye, change in the shape of the eye or ectropion, asymmetry and scarring, hollowness of eye, loss of double fold (<5% to minimal)

How long does it last?
– Effect of surgery is long lasting, usually more than 5 years.

Insurance?
– Usually a cosmetic surgery; not covered by insurance.
– Exception: Severe ptosis which obstructs the visual field.

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