This refers to a vertical skin fold at the inner corner of the eye, classified as mild, moderate, or severe. It primarily affects the formation of double eyelids at the inner canthus. The solution is an epicanthoplasty (inner canthus surgery). However, the satisfaction rate for this procedure is low, and visible scarring may occur in the short term. Not everyone is suitable for this surgery. It is only recommended for individuals with severe epicanthal folds and a wide distance between the inner corners of the eyes.Some individuals have a low nasal bridge, making the distance between their eyes appear excessively wide. In such cases, rhinoplasty alone may suffice, eliminating the need for canthoplasty. 2. Puffy Eyes Individuals with puffy eyes often exhibit thick fat pads, thick muscles, and thick skin. Creating double eyelids in such eyes is challenging and requires a highly experienced surgeon. Simple fat pad thickness yields the best results and is easiest to address—excess fat can be removed.If both muscle and skin are thick, the surgeon must employ specialized techniques during planning and execution.
3. Ptosis
Partial or complete loss of function in the levator muscle causes difficulty opening the eyes, resulting in ptosis. This is classified as mild, moderate, or severe based on the extent of pupil coverage.Individuals with severe ptosis cannot undergo double eyelid surgery; correction requires procedures like forehead muscle flap suspension or levator muscle shortening. Note: Some cases involve excessively loose eyelid skin covering the pupil—not ptosis. Avoid ptosis correction surgery in such instances; a simple double eyelid procedure with skin removal suffices.4. Upper Eyelid Skin Laxity Sagging upper eyelid skin can distort double eyelid shape. Severe laxity may impair vision and create a tired appearance, particularly noticeable in the outer third of the upper eyelid.The solution is to remove excess skin, yielding excellent results. Since skin inevitably sags to varying degrees with age, double eyelid surgery should not be overly conservative, especially in the outer third.
5. Brow-to-Eye Distance
From an aesthetic standpoint, this involves considering overall harmony, balancing eyebrow shape, eye shape, and facial proportions.When the distance between eyebrows and eyes is narrow, double eyelids should not be made too wide. Conversely, with a wider distance, choosing moderately wide, elegant double eyelids will not appear unnatural. In some middle-aged and elderly individuals, significant eyebrow drooping due to facial skin laxity, coupled with excessive upper eyelid skin slackness, can distort the double eyelid shape, creating what is commonly called "triangular eyes."Correcting this with skin-removal double eyelid surgery would only worsen brow drooping, further narrowing the distance between eyebrows and eyes. It would also disrupt the natural upward thickening gradient of the upper eyelid skin, making the upper layer of the double eyelid appear puffier.Therefore, for individuals with drooping eyebrows, the primary approach should be to correct the drooping through a brow lift or forehead wrinkle reduction surgery. This restores the normal distance between the eyebrows and eyes, thereby improving the double eyelid issue.
6. Orbital Fat or Lacrimal Gland Prolapse
The orbital fat in the upper eyelid primarily consists of three masses: medial, middle, and lateral. Excess fat causes puffy, tired-looking eyelids. In severe cases, the lateral fat mass may prolapse below the orbital septum, worsening eyelid laxity.When lateral eyelid laxity and puffiness occur, it's crucial to distinguish between fat and lacrimal gland issues. During surgery, appropriate removal or repositioning can be performed.
7. Short palpebral fissure Generally, individuals with a short palpebral fissure are not suitable candidates for double eyelid surgery. For those with relatively short fissures, the double eyelid crease should not be made excessively wide.Many consider inner/outer canthoplasty for short palpebral fissures. However, canthoplasty carries risks of retraction and potential eye distortion, making it unsuitable for all. Since no excess skin remains after canthoplasty, most cases cannot be revised—making it a irreversible procedure. Serious consideration is advised before surgery.
8. Tarsal Plate Width
The upper eyelid tarsal plate is relatively tough, with a normal width of approximately 10mm. In some individuals, it may be less than 7-8mm. Tarsal plate width is a critical factor for surgeons to consider before surgery, as it determines the maximum possible width of the double eyelid. The designed double eyelid width should generally not exceed the upper edge of the tarsal plate.Many cases of postoperative difficulty opening the eyes result from a double eyelid line extending beyond the tarsal plate's upper edge or from adhesion of the levator muscle.
In summary, double eyelid surgery is a procedure with distinct layers. Every detail handled during the operation affects the final outcome. Minimal surgical trauma and proper technique shorten recovery time—truly a case where "details determine success or failure."