East Asian blepharoplasty

East Asian blepharoplasty, also known as "double eyelid surgery", is a type of cosmetic surgery where the skin around the eye is reshaped (blepharoplasty). The purpose of the procedure is to create an upper eyelid with a crease (i.e. "double eyelid") from an eyelid that is naturally without a crease (also known as a "single eyelid" or "monolid").[1]

Anatomically, there are a number of subtle differences in the upper eyelids of East Asians, compared with the eyelids of Europeans and Sub-Saharan Africans.[2] While some East Asians have a double eyelid and some do not, there is also a large variation in the crease position (double eyelid size) of the East Asian upper eyelid. The upper lid fold can range from 1 mm (0.039 in) above the eyelash line to about 10 mm (0.39 in). Several methods can be used to create the double eyelid — including the full-incisional, partial incision and no incision methods (e.g. the DST method). Each has its advantages depending on the patient's anatomy and desires.

East Asian blepharoplasty have been reported to be the most common aesthetic procedure in Taiwan,[3] South Korea and other parts of East Asia and is also frequently performed in Northeast Indian states such as Assam.[4] The procedure has been reported to have some risk of complications, but is generally quite safe if done by an expert plastic surgeon.[5] Practitioners of East Asian blepharoplasty include plastic surgeons (facial plastic and reconstructive surgeons), otolaryngologists, oral and maxillofacial surgeons, and ophthalmologists (oculoplastic surgeons). A procedure to remove the epicanthal fold (i.e. an epicanthoplasty) is often performed in conjunction with an East Asian blepharoplasty.[6]

The procedure to alter the natural East Asian "single eyelid" appearance has been a subject of controversy. For example, opponents of the procedure described it as being "indoctrinated by white standards of beauty", although New York-based cosmetic surgeon Dr. Edward Kwan states that many patients who get the procedure done are "not trying to look white", but look like the many East Asians who naturally have an eyelid fold. There is also a belief that double eyelids provide a more energetic appearance, and the procedure is popular among high school graduates in China with the view that it will improve their job prospects.[7]

East Asian blepharoplasty
East Asian blepharoplasty before after
A South Korean woman, before (left) and after (right) undergoing East Asian blepharoplasty
ICD-9-CM08

References

  1. ^ Chen WP (January 1996). "Concept of triangular, trapezoidal, and rectangular debulking of eyelid tissues: application in Asian blepharoplasty". Plastic and Reconstructive Surgery. 97 (1): 212–8. doi:10.1097/00006534-199601000-00035. PMID 8532781.
  2. ^ Jeong S, Lemke BN, Dortzbach RK, Park YG, Kang HK (July 1999). "The Asian upper eyelid: an anatomical study with comparison to the Caucasian eyelid". Archives of Ophthalmology. 117 (7): 907–12. doi:10.1001/archopht.117.7.907. PMID 10408455.
  3. ^ Liao WC, Tung TC, Tsai TR, Wang CY, Lin CH (2005). "Celebrity arcade suture blepharoplasty for double eyelid". Aesthetic Plastic Surgery. 29 (6): 540–5. doi:10.1007/s00266-005-0012-5. PMID 16237581.
  4. ^ http://www.theestheticclinic.com/reconstructive/eyelid-disease/blepharoplasty.html
  5. ^ Chen SH, Mardini S, Chen HC, et al. (October 2004). "Strategies for a successful corrective Asian blepharoplasty after previously failed revisions". Plastic and Reconstructive Surgery. 114 (5): 1270–7, discussion 1278–9. doi:10.1097/01.prs.0000135951.55118.59. PMID 15457048.
  6. ^ Yen MT, Jordan DR, Anderson RL (January 2002). "No-scar Asian epicanthoplasty: a subcutaneous approach". Ophthalmic Plastic and Reconstructive Surgery. 18 (1): 40–4. doi:10.1097/00002341-200201000-00006. PMID 11910323.
  7. ^ Waldmeir, Patti (23 July 2013). "When one pair of eyelids isn't enough". Financial Times. Retrieved 23 July 2013.
Capsulorhexis

Capsulorhexis or capsulorrhexis, also known as continuous curvilinear capsulorhexis (CCC), is a technique pioneered by Howard Gimbel used to remove the capsule of the lens from the eye during cataract surgery by shear and stretch forces. It generally refers to removal of a part of the anterior lens capsule, but in situations like a developmental cataract a part of the posterior capsule is also removed by a similar technique.

In order to remove a cataract with modern techniques, the capsule of the lens must be opened. In older style surgery (intracapsular cataract extraction), the whole lens and capsule was removed. This was done to prevent the inflammatory response to leftover lens material. Since it was all removed en-bloc, there was no residual. With modern techniques, however, the removal of practically all the material can be achieved while leaving the intact capsule. This is important since it provides a barrier between the front and back of the eye, and prevents the vitreous from moving forwards. In addition, this allows the artificial intraocular lens an ideal place to be located in the eye, away from contact with other structures yet solidly held in place.

Prior to the advent of the CCC, a "can opener" approach was used, with a small bent needle making small incisions around the anterior surface of the lens, forming a somewhat continuous hole that the lens could be removed through. However, any of these ragged edges could promote a tear that could proceed outwards. A CCC when done correctly, does not have any edges, and any forces applied to the capsule during surgery are distributed and do not result in a tear.

The usual method is to use the same bent needle to begin a tear in the capsule, and then either guide the edge with the same needle around the anterior surface, or use a special forceps to do the same. There are advantages and disadvantages of both approaches, and most surgeons will use both instruments as the situation requires.

As noted in children, often an anterior and posterior capsulorhexis is made, since the posterior capsule becomes cloudy even more commonly in children than adults. Since a simple office procedure using a Nd:YAG laser commonly performed on adults is difficult with a child (since they cannot sit still at the machine), it is better to deal with the posterior capsule at the time of surgery. Since the vitreous in children is much more formed, the loss of vitreous is less common (since as a solid it stays put), though often an anterior vitrectomy is still performed.capsulorhexis is done with a special instrument - Utratas forceps

Cataract surgery

Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye (also called "crystalline lens") that has developed an opacification, which is referred to as a cataract, and its replacement with an intraocular lens. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract, causing impairment or loss of vision. Some infants are born with congenital cataracts, and certain environmental factors may also lead to cataract formation. Early symptoms may include strong glare from lights and small light sources at night, and reduced acuity at low light levels.

During cataract surgery, a patient's cloudy natural cataract lens is removed, either by emulsification in place or by cutting it out. An artificial intraocular lens (IOL) implant is inserted (eye surgeons say that the lens is "implanted") in its place. Cataract surgery is generally performed by an ophthalmologist in an ambulatory setting at a surgical center or hospital rather than an inpatient setting. Either topical, peribulbar, or retrobulbar local anesthesia is used, usually causing little or no discomfort to the patient.

Well over 90% of operations are successful in restoring useful vision, with a low complication rate. Day care, high volume, minimally invasive, small incision phacoemulsification with quick post-op recovery has become the standard of care in cataract surgery all over the world.

Eye surgery

Eye surgery, also known as ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist. The eye is a very fragile organ, and requires extreme care before, during, and after a surgical procedure to minimise or prevent further damage. An expert eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. Today it continues to be a widely practiced type of surgery, having developed various techniques for treating eye problems.

Eyelid

An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eyelid features a row of eyelashes along the eyelid margin, which serve to heighten the protection of the eye from dust and foreign debris, as well as from perspiration. "Palpebral" (and "blepharal") means relating to the eyelids. Its key function is to regularly spread the tears and other secretions on the eye surface to keep it moist, since the cornea must be continuously moist. They keep the eyes from drying out when asleep. Moreover, the blink reflex protects the eye from foreign bodies.

The appearance of the human upper eyelid often varies between different populations. The prevalence of an epicanthic fold covering the inner corner of the eye may reach up to 90% in East Asian and Southeast Asian populations and is found in varying degrees in others. Separately, but also similarly varying between populations, the crease of the remainder of the eyelid may form either a "single eyelid", a "double eyelid", or an intermediate form.

Eyelids can be found in other animals, some of which may have a third eyelid, or nictitating membrane. A vestige of this in humans survives as the plica semilunaris.

Eyelid glue

Eyelid glue, commonly called eye putti (アイプチ, ai puchi), is a type of eye make-up used in East Asia designed to change the monolid (eyelid without a crease). Eyelid glue is a water-soluble adhesive that is easy to remove.

Hydrodissection

Hydrodissection is the process of injecting small amounts of a special fluid into the capsule of the lens in the eye in order to make dissection easier. It makes the surgeon more capable of performing maneuvers during extracapsular or phacoemulsification surgeries..

Hydrodissection in general surgery means injection of small amounts of fluid to release a trapped nerve or to reduce intraoperative blood losses

Kawaii

Kawaii (かわいい, pronounced [kaɰaiꜜi]; "lovable", "cute", or "adorable") is the culture of cuteness in Japan. It can refer to items, humans and nonhumans that are charming, vulnerable, shy, and childlike. Examples include cute handwriting, certain genres of manga, and characters like Hello Kitty and Pikachu.The cuteness culture, or kawaii aesthetic, has become a prominent aspect of Japanese popular culture, entertainment, clothing, food, toys, personal appearance, and mannerisms.

Korean beauty standards

Korean beauty standards have become a well known feature of Korean culture. In 2015, a global survey by the International Society of Aesthetic Plastic Surgeons found that South Korea was the only East Asian country in the top 10 countries with the highest rate of cosmetic surgeries. Korean beauty standards prioritize a slim figure, small face, v-shaped jaw, small lips, straight eyebrows, flawless skin, and larger eyes. Beauty standards for the eyes include aegyo-sal, which is a term used in Korea referring to the small fatty deposits underneath the eyes that are said to give a person a more youthful appearance. East Asian blepharoplasty is a surgery to create double eyelids (creates upper eyelid with a crease). Aegyo-sal and blepharoplasty make the eyes appear larger. Korean beauty standards have been influenced largely by those in the media, including actresses, TV personalities and K-pop stars. The physical appearance of K-pop idols have greatly impacted the beauty standards in Korea.

Physical attractiveness

Physical attractiveness is the degree to which a person's physical features are considered aesthetically pleasing or beautiful. The term often implies sexual attractiveness or desirability, but can also be distinct from either. There are many factors which influence one person's attraction to another, with physical aspects being one of them. Physical attraction itself includes universal perceptions common to all human cultures, as well as aspects that are culturally and socially dependent, along with individual subjective preferences.

In many cases, humans subconsciously attribute positive characteristics, such as intelligence and honesty, to physically attractive people. From research done in the United States and United Kingdom, it was found that the association between intelligence and physical attractiveness is stronger among men than among women. Evolutionary psychologists have tried to answer why individuals who are more physically attractive should also, on average, be more intelligent, and have put forward the notion that both general intelligence and physical attractiveness may be indicators of underlying genetic fitness. A person's physical characteristics can signal cues to fertility and health, with statistical modelling studies showing that the facial shape variables that reflect aspects of physiological health, including body fat and blood pressure, also influence observers' perceptions of health. Attending to these factors increases reproductive success, furthering the representation of one's genes in the population.Men, on average, tend to be attracted to women who have a youthful appearance and exhibit features such as a symmetrical face, full breasts, full lips, and a low waist-hip ratio. Women, on average, tend to be attracted to men who are taller than they are and who display a high degree of facial symmetry, masculine facial dimorphism, and who have broad shoulders, a relatively narrow waist, and a V-shaped torso.

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