The Asian Eyelid: Relevant Anatomy

Abstract

The eyelid of Asians has its own unique characteristics. If the surgeon does not acknowledge this, aesthetically pleasing results will seldom be achieved. Here the authors review and summarize important up-to-date anatomical and relevant clinical studies of the Asian upper eyelid, aiming to help surgeons thoroughly understand its unique features, including Asian eyelid morphology, anatomical details, and the mechanisms of upper eyelid crease formation. Hopefully, an in-depth understanding of the Asian eyelid will aid surgeons to accomplish their work and lead to novel new techniques in this field.

Keywords: Asian blepharoplasty; Asian double crease; Asian eyelid; Asian eyelid anatomy; Asian eyelid morphology; eyelid anatomy.

Fig. 1

Asian eyelid morphologies are categorized into six types. (A) Single eyelid (no visible lid crease). (B) Low eyelid crease (low-seated, nasally tapered, including hidden fold). (C) Double eyelid crease, infold type: the height of the upper lid crease is lower than the epicanthal fold. (D) Double eyelid crease, on fold type: the height of the crease is right on the epicanthal fold. (E) Double eyelid crease, outfold type: the height of the crease is higher than the epicanthal fold (asterisk). (F) Double eyelid crease, outfold type without an epicanthal fold.

Fig. 2

Unnatural result caused by a traditional upper blepharoplasty in the elderly with supratarsal skin removal. The upper lid fold is formed by thick skin.

Fig. 3

An Asian woman with a brow tattoo. (A) Preoperative photo. (B) Intraoperative photo after infrabrow skin was excised. (C) Postoperative photo 1 month after surgery.

Fig. 4

An Asian lady without a brow tattoo. (A) Preoperative photo. (B) Two-year results after sub-brow lift in a patient without brow tattoo. The scars are not visible and the upper lid creases look natural.

Fig. 5

Intraoperative photo (surgeon's view) demonstrates the levator palpebrae superioris, levator aponeurosis, and adjacent structures. OOM, orbicularis oculi muscle.

Fig. 6

A diagram of sagittal cross section across the center of the pupil of an Asian upper eyelid.

Fig. 7

The right eye of a patient with a low crease. (A) The upper eyelid skin is stretched by pulling the eyebrow upward. The dense skin–orbicularis oculi muscle– (OOM–) tarsus complex (asterisk) is visible from eyelashes to the upper lid crease. (B) When the brow is pushed downward, the skin over the dense complex does not move, but the skin above the crease moves downward and folds over the dense complex creating upper eyelid crease and fold.

Fig. 8

The four types of epicanthal fold according to Johnson's classification. (A) Epicanthus tarsalis. (B) Epicanthus supraciliaris. (C) Epicanthus palpebralis. (D) Epicanthus inversus.