What makes asian eyes different

The skin that covers the inner corner of the eye is called the epicanthal fold which can be of varying size and configuration. An epicanthoplasty is a procedure that is performed to release or partially release the epicanthal fold. The excess skin which creates a heavy epicanthal fold is therefore removed, but not all the fold is removed since it is what creates the characteristic almond shape of the Asian eye. The epicanthoplasty procedure can create softer, bigger, and more alert-looking eyes that also seem less widely spaced.

Performing an epicanthoplasty can also aid in creating double eyelid folds that are smoother at the inner corner of the eye by avoiding a sharp stop or a break in the fold. Anyone considering Asian Blepharoplasty or any other form of eyelid surgery should consult a leading board-certified Facial Plastic Surgeon, like Dr. Denton, who is highly experienced with the Asian facial anatomy and the surgical techniques required to perform it successfully.

It is important that your facial plastic surgeon takes the time to consult with you and establish a customized treatment plan. Computer imaging can also be used to reflect the anticipated changes.

To learn more about Asian Blepharoplasty or upper eyelid surgery and whether it is right for you, schedule your consultation here today. Denton can help you achieve the result that will make you feel more confident about your appearance. The Single Fold or Monolid The primary difference between the upper eyelids of Caucasians and Asians is the crease above the lower margin of the upper eyelid.

Epicanthoplasty The skin that covers the inner corner of the eye is called the epicanthal fold which can be of varying size and configuration. Considering Asian Blepharoplasty? There has been a lack of information concerning the terminology and the anatomical characteristics of the Asian eyelid. A clinically known anatomical racial difference in the upper eyelid between Asians and Caucasians is apparent in the upper eyelid crease.

Most Westerners regard the Asian upper eyelid as a single eyelid without visible lid crease. However, there are 3 morphologic types of Asian upper eyelids: single eyelid: no lid crease with puffiness; low eyelid crease: low-seated, nasally tapered, inside-fold type of crease; and double eyelid: lid crease parallel to the lid margin.

We have studied the Asian eyelid in the cadaver to demonstrate any anatomical differences between Asians and Caucasians. Noninvasive techniques for studying the eye structures were used to obtain additional anatomical information and dynamic images of structure. Recent advances in magnetic resonance imaging MRI techniques have made it possible for us to study noninvasively the Asian upper eyelid's dynamical anatomical images. Two groups of anatomical specimens were studied and compared.

Special attention was given to differences in the structure and its relation to the upper eyelid crease. One orbit of each cadaver was used for anatomical dissection while the contralateral orbit was sectioned for histological analysis.

Eyelid crease structure was bilaterally symmetric in all specimens. Dissection findings were recorded photographically. The upper eyelid specimens were cut into lateral and medial portions to study the central portion.

Four healthy young to year-old Asian men were studied by MRI following proper informed consent procedures. The subjects were scanned after 0. All MRI experiments were performed with a 1. Five series of sagittal images of the upper eyelid were obtained with a 7. Closed eyelid images of T 1 -weighted spin echo image were done by an echo time of 20 milliseconds and a repetition time of milliseconds.

Opened eyelid images were performed with an echo time of 14 milliseconds and a repetition time of milliseconds. Opened, half-opened, and closed eyelid spoiled gradient echo were done by 4. With dissection of the orbicularis muscle posterior surface from the eyelid margin to the orbital rim, firm connections were observed between the levator aponeurosis and the orbicularis muscle at the lid crease area in Caucasians. In contrast, a loose fibroadipose layer was interposed between the orbicularis muscle and the orbital septum with fat deposits on the anterior surface of the tarsal plate in the Asian single eyelid Figure 2.

After complete orbicularis oculi muscle extirpation in the Caucasian specimens, the orbital septum was noted to fuse above the supratarsal border with the levator aponeurosis. The orbital septum of the Asian single eyelid fuses with the levator aponeurosis below the supratarsal border, sometimes close to the eyelid margin Figure 1. The levator aponeurosis is noted to attach to the tarsal plate 3 to 4 mm above the upper eyelid margin in Caucasians and 2 to 4 mm above the upper eyelid margin in Asians.

In cases of Asian double eyelid specimens, the anatomical dissection findings were similar to Caucasian eyelid, except more subcutaneous and suborbicularis muscle fat was found. The fusion level of the orbital septum with the levator aponeurosis in the Asian double eyelid is higher than in the Asian single eyelid.

The fusion of the orbital septum with the levator aponeurosis above the supratarsal border in the Caucasian and the Asian double eyelid specimens prevents the preaponeurotic fat pad from extending toward the lid crease area; the levator aponeurosis is inserted into the subdermal eyelid tissue. In contrast, the preaponeurotic fat pad in the Asian single eyelid specimens extends closer to the eyelid margin, inferiorly limited by the low fusion between the orbital septum and the levator aponeurosis.

Additionally, subcutaneous and suborbicularis muscle fat layers with pretarsal fat are noted in Asian specimens that inhibit the levator insertion into the subdermal skin of the Asian single eyelid Figure 3 and Figure 4.

Comparison of Asian single, low, and double upper eyelid anatomical structural differences were evaluated by dynamic high-resolution MRI study. The Asian single eyelid showed a remarkable amount of subcutaneous fat. The fusion of the orbital septum to the levator aponeurosis below the superior tarsal border with interposed preaponeurotic fat was noted during eyelid closure: when open, the orbital septum folded and the preaponeurotic fat pad retracted posteriorly Figure 5.

The Asian low eyelid showed a lesser amount of subcutaneous fat than the single eyelid, with a similar low orbital septum fusion with the levator aponeurosis below the superior tarsal border Figure 6.

The Asian double eyelid demonstrated a moderate subcutaneous fat layer, orbital septum fusion to the levator aponeurosis above the superior tarsal border, and absent downward prolapse of the preaponeurotic fat pad Figure 6.

Until recently, for several reasons little has been written in the American literature regarding the Asian upper eyelid anatomical characteristics, especially with regard to lid crease and the aesthetic features.

First, most studies on the subject are written in Asian-language journals. Second, until the number of emigrated Asian people reached higher proportions in North America, there had been less interest here in Asian anatomical studies.

Third, religious and cultural inhibitions to cadaver donation in Asian countries considerably limit materials available for anatomical study. By the eighth century BC, Mongoloid tribes living in the forested areas of North Asia had moved to the Kamchatka peninsula along the eastern side of Asia.

Mongoloid groups, including Korean, Mongolian, Turk, Japanese, Chinese, and Indo-Chinese, have similiarities in their physical stature and language. For our purposes of comparison and discussion, Korean eyelid anatomical characteristics have been grouped with those of the Japanese and Chinese because of cultural, religious, and geographic similarity.

To our knowledge, this is the first report of Korean eyelid cadaver anatomy study in the English-language literature. Many Americans misunderstand the importance of upper eyelid crease variations in Asian people. Asian people who want to have an eyelid crease think of an upper eyelid crease not as a westernization but as a form of beauty.

Eyelid crease formation surgery was performed in Asia before the occurrence of notable western influence. Some Asian individuals with a single eyelid perceive their eyes as puffy, small, and drowsy, and then want blepharoplasty to create the appearance of a bigger eye.

Several previous studies have identified differences of anatomical characteristics between Caucasian and Asian people. They noted that the levator aponeurosis fuses with the orbital septum below the level of the superior tarsal border.

Preaponeurotic fat anterior to the tarsus prevents the insertion of the levator aponeurosis from extending to the subcutaneous tissue and thus prevents the normal eyelid crease formation. Asian authors have found the location of the orbital septum fusion site with levator aponeurosis to be a main factor in eyelid crease formation. We found more prominent subcutaneous, suborbicularis, and pretarsal fat tissue in the Asian upper eyelid specimens. This is in agreement with Uchida's 16 study, wherein he first described the presence of 4 areas of fat pads in Asian eyelids: the subcutaneous, the pretarsal, submuscular or preseptal, and the preaponeurotic fat pads.

He identified pretarsal fat as an entity different from a herniated preaponeurotic fat pad. In this study, we confirmed the presence of pretarsal fat in Asian single and low eyelid specimens. We consider the more prominent subcutaneous and preseptal fat tissue in Asians as spacers that act to prevent the levator aponeurosis from extending to the subdermal tissue.

Western authors may think the Japanese, Chinese, and Koreans have the same Asian characteristics of upper eyelid anatomy; however, the configuration of the crease in the upper eyelids of Asians varies greatly.

The crease may be absent or exhibit variable shape. We have not identified an Asian study comparing the Korean with other population groups. Chen 13 classified Asian people who have an inner or incomplete upper eyelid crease by their upper eyelid crease shape. One of us S. Most of them want to have an upper eyelid crease inferiorly that tapers medially with a gentle lateral flaring unpublished data, Hisatomi 7 studied the anatomy of the single eyelid in Japanese cadaver specimens.

He found the following typical differences from the Caucasian eyelid. First, white fibrous connective tissue containing fat is located under the orbicularis oculi muscle.

Second, distal insertion of the orbital septum is several millimeters above the upper eyelid margin. Third, orbital fat is prolapsed to the anterior surface of the tarsal plate. Liu and Hsu 12 described thicker upper eyelid skin in association with the presence of a thicker subcutaneous areolar layer in Asian eyelids. Wang and Bian 18 dissected Chinese eyelids and found that the fusion level of the orbital septum with the levator aponeurosis in single eyelids is lower than in double eyelids.

Our findings agree with these reports. Additionally, our Korean eyelid dissections and findings from histological studies have identified a pretarsal fat layer. This pretarsal fat layer is not inferior orbital fat prolapse, but a separate entity. Single eyelid anatomy and the inner upper eyelid crease anatomy have been characterized by a lower primary insertion of the levator aponeurosis just above the upper eyelid margin, 19 thicker fat and hypertrophic orbicularis oculi muscle and upper eyelid skin, 20 and a lower primary insertion of the levator aponeurosis through a relatively thin orbicularis oculi and skin at the level of the middle or lower upper tarsal plate.

In summary, it is evident that the location of the orbital septum fusion with the levator aponeurosis plays a major role in forming the upper eyelid crease. However, there are more considerations in the formation of the upper eyelid crease.

They are the amount of soft tissue subcutaneous fat, suborbicularis fat, pretarsal fat, and preaponeurotic fat and the characteristics of the skin and orbicularis oculi muscle of the upper eyelid, especially in the lid crease area.