Monday, August 25, 2008

Asian eyelid crease procedure--Asian Blepharoplasty

I’ve been asked why I chose the term "Asian Blepharoplasty" rather than "Oriental double lid procedure" when I lecture on this topic. As a person who has been influenced by both the Eastern and Western cultures, I believe that the term "Oriental" is restrictive and conjures up images of Asians we commonly associate with in the entertainment industry. Rather, I believe the term "Asian" is geographically more representative of the diverse ethnic groups one thinks of when discussing the Japanese, Chinese, Koreans and Southeast Asians. I am using the term "Asian" to represent those people with Han ancestry, with the exception of Indians, Pakistanis, and Russians (although even in the former Soviet Union a great deal of their minorities have Han features.)

Along similar reasoning, I believe that the surgical steps necessary to create an aesthetically pleasing upper eyelid crease does require reconstructive steps involving the soft tissue layers and the fat pad of the upper lid. "Blepharoplasty" is therefore an accurate term and preferred by me over other terms such as "double eyelid procedure" or "lid crease procedure", which are adjectives describing the end goal rather than the actual steps it takes to get there. With the evolution of surgical knowledge and gradual diminution of stereotyping, Asian Blepharoplasty is a preferred term for describing the distinctive steps it takes to perform aesthetic upper lid surgery for the Asian population.

There is an interesting difference and contradiction that I have observed from interacting with my Asian patients from around the world. Asians who have immigrated away from Asia, or are born and raised oversea tends to have a relatively ethno-centric view of themselves as a group and strive to retain some of their cultures and roots, to remain connected to their ancestry in much of their values and judgement (as Irish-Americans or Italian-Americans do), including the sense of body, health and beauty. Native Asians often will have a much more modern and westernized view of themselves when it comes to their sense of fashion trends and beauty and may therefore be more liberal when compared to Asian-Americans or European-Asians. We often think that native Asians are more conservative than overseas Asians when it comes to cosmetic surgery but this may not be supported by data. By sheer numbers, there are far more Asian eyelid surgeries performed in Asia than there are here in the western hemisphere, averaging out population census.

There is also a far greater dichotomy of views in regards to the merits of cosmetic surgery here, perhaps due to the fact that the United States is principally a free society. There are Asians who view cosmetic surgery as an integral and elective part of personal health and then there are others who view any form of cosmetic surgery or correction as a form of ethnic alteration. Once long ago, I was invited as a “Physician-Professor expert” to explain what Asian eyelid surgery is at an Asian Studies department at a major university in Los Angeles---soon I found myself receiving comments that this is a form of cultural dilution or “ethnic destruction”, and that this is akin to body-multilation still practiced on women in some parts of the African continent. I am not a philosopher and I did not express any opinion then, though I find it odd that everything we do may be considered “Western”. As we arise in the morning (in Western or modern Asian countries), one may take a shower or bath with Western soap, brush with toothpaste, drink coffee, have a muffin, cereal or sandwich; put on a tie, shirt, belt and suit (and if a woman—apply makeup, hair styling, Western styled dresses and handbags), get into our automobiles, buses, shuttles or subways---all Western implements, and then go to work. We are then again surrounded by all kinds of Western machineries like computers, cellular phones, facsimiles and great inventions like Internet and e-mails. If one does not perform any of the above mentioned chores, one certainly can remain a purist and live in a remote environment; and if so, then there is absolutely no need to do anything. (e.g. refusing to go to a Western-trained dentist to have your tooth cavities fixed)

I see Asian eyelid surgery in its pure form, as a procedure to add a individually-desirable eyelid crease to the Asian face,that is all. Since half of the Asians are born with a natural crease anyway, the patients who do not have a crease and yet believe they can look better with an Asian crease should certainly be able to make that choice.

I am grateful to see that some of the terminology I have used in the Asian Blepharoplasty textbook (1995 and Second Edition 2006) has filtered into general and acceptable use in the aesthetic and plastic surgical field, in publications, the media as well as other surgeons’ websites. An accurate description of surgical findings and techniques will improve on the knowledge base for the whole field and ultimately benefits patient care.

(Portion of above excerpted from “Asian Blepharoplasty and the Eyelid Crease” by William P.D. Chen M.D. (2006 Butterworth Heinemann/Elsevier Science).)

Resources for Asian Eyelid

William Pai-Dei Chen M.D.;F.A.C.S.
Ophthalmic Plastic and Reconstructive Surgery,
--2865 Atlantic Avenue,#220,Long Beach,CA (562)426-0603
--302 West La Veta,#101,Orange,CA 92666 (714)633-7951
--1401 Avocado,#501,Newport Beach,CA 92625 (949)640-2212
New Location:
18 Endeavor #305, Irvine, CA 92618 (949)640-2212

Internet e-mail:

Publications by Dr.Chen on this topic alone:
1.Chen,WPD: Asian Blepharoplasty(A Surgical text).Butterworth-Heinemann(1995).

2.Chen,WPD: Asian Blepharoplasty. Ophthal. Plast. Reconstr. Surg. 3(3): 135-140,1987.

3.Chen WPD: Insights from a Series of Asian Blepharoplasty. Presented at the Annual Scientific Symposium of the American Society of Ophthalmic Plastic and Reconstructive Surgery. Atlanta,Georgia,1990.

4.Chen,WPD: A Comparison of Caucasian and Asian Blepharoplasty. Ophthalmic Practice 9(5):216-222, 1991.

5.Chen,WPD: Concept of Triangular, Trapezoidal and Rectangular Debulking of Eyelid Tissues:Application in Asian Blepharoplasty. Plast. Reconstr. Surgery; Vol.97, No.1:212-218;Jan.1996.

6.Chen,WPD: Upper Blepharoplasty in the Asian Patient. Chapter 11,pages 101-111, Cosmetic Oculoplastic Surgery (A.M.Putterman). Third Edition(1998).

7.Chen,WPD: Concept of Triangular, Trapezoidal and Rectangular Debulking of Eyelid Tissues:Application in Asian Blepharoplasty. Reviewed in Yearbook of Plastic, Reconstructive, and Aesthetic Surgery,1997; pages 166-167.

8.Chen,WPD: Expert Commentary on "Blepharoplasty and Blepharoptosis Surgery in Asians",pages 68-71; in Unfavorable Results of Eyelid and Lacrimal Surgery, by JA Mauriello,Jr; Butterworth-Heinemann,2000.

9.Chen,WPD: Aesthetic Eyelid Surgery on Asians:an East-West view.HongKong Journal of Ophthalmology,Vol.3:1(27-31),2000.

10.Chen, WPD: Asian Blepharoplasty--Finesse and Pitfalls; Chapter 15 in "Oculoplastic Surgery--The Essentials"(Chen WPD), Thieme Medical Publishers,2001. ISBN: 15889-00274

11.Chen,WPD:in “Color Atlas of Cosmetic Oculofacial Surgery”(Chen, Khan,McCord)-Chapter 7(Primary Asian Blepharoplasty)and Chapter 15 (Revisional Asian Blepharoplasty). Butterworth-Heinemann/Elsevier Science, Ltd. (2004) ISBN: 07506-74229

12.Chen,WPD: “Asian Blepharoplasty and the Eyelid Crease,with DVD.”
(A color atlas).Butterworth-Heinemann/Elsevier Science,Ltd.(2006)ISBN: 07506-7574

13.Chen WPD:The Concept of a Glide Zone as It Relates to Upper Lid Crease, Lid Fold, and Application in Upper Blepharoplasty.Plastic & Reconstructive Surgery. 119(1):379-386, January 2007.

14.Chen WPD:Beveled Approach for Revisional Surgery in Asian Blepharoplasty.Plastic & Reconstructive Surgery. 120(2):545-552, August 2007.