In common usage, the eyelid crease is often meant to describe a natural inward creasing of skin seen in the upper eyelid, typically dividing it into a lower segment adjacent to the upper eyelashes, and an upper segment of skin that starts from the crease to the border of the eyebrow.
The crease is present in about 50% of the Asian population, and found to be more prevalent in all non-Asians. The presence of a crease in an Asian is what differentiates a double eyelid (with a crease unequally dividing the lid into two sections, hence “double”) from an Asian with single eyelid (or mono-lid).
Double eyelid crease surgery (procedures) is a form of surgery to add or supplement an eyelid crease for an individual who seeks it. Often it may be for an individual who does not have a crease, or find that their crease is insufficient, or unbalanced between the two sides.
The reasons for electing this type of cosmetic enhancement may be plenty, and no individual tend to have the same reasons. The commonly cited and reasonable indications will include a desire to have the eyelid opening (fissure) more apparent, since a single eyelid often has a small fold of skin overhanging the opening and makes it look covered over and smaller than it actually is, making it narrower in vertical as well as perceived horizontal dimensions.
Other reasons may be to enhance the ability to apply make-up without smudging, to save time, to correct asymmetry, to create consistency and constancy, or to fulfill their correct impression that having a crease that simulates a natural crease makes the eye more attractive. The important phrase here is natural. It meant that the single-lidded individual almost always want the crease to mimic the dimensions of an Asian double eyelid.
The Crease is Delicate, Why?
The eyelid crease is a very delicate structure in that the correct position and function of it are interrelated to its form and attractiveness.
Let us elaborate on this: The eyelid crease as seen by us is both a landmark to which our eyelid opening muscle ( the elevating levator) attaches to and ends at, its location gives the eye opening its proportion and aesthetics. It just happens that this is also the location where eye surgeons would enter and exit the eyelid---it is in essence a portal or entry-exit point. As a cosmetic blepharoplasty surgeon I obsess over how precisely one should control the details of this in a person without a crease (for Asian Blepharoplasty by Chen or double eyelid surgery) as well as anyone who has a crease already and coming for age-related tune-ups (cosmetic blepharoplasty) or mechanical corrections, like droopy upper eyelids, inward-curling lashes.
The benchmark I set for myself is extremely high: I like to aim for creation of a crease that completely simulates a natural crease, in the width, height, shape, permanent consistency and aesthetics, yet without any temporary gimmicks, without any long term impairment (no matter how slight) in the strength and distance of which the eyelid can open, and without any noticeable reminders of the eyelid having had surgery (like buried sutures or noticeable scars other than the crease line thus created). Is that reachable? I believe it is. The eyelid crease and the levator muscle are interrelated; a natural crease should not cause functional problem, and a properly functioning levator should not affect its aesthetics. It would be a disservice if one finds that after eyelid surgery of any kind, whether cosmetic or for functional reconstructive indications (like ptosis repair, trichiasis, lid retraction, ectropion/entropion repair), the function of the levator muscle became impaired.
The key here of course is in the details: How can one perform the correct amount of surgery, measure everything in a correct way, allocate proper attention to each of the layers within the upper eyelid, and layer everything in a three dimensional way such that the function as well as the aesthetic of it working as a whole unit stands up to scrutiny of the human eyes, leaving the subject’s eyes feeling good and looking good to others. (And without use of any permanent buried sutures of course!)
Why bother with details?
The Asian eyelid procedure is intricate in that the exact sentiment expressed by consumers--"the only thing they care about is the final product, and not the process"--gets everyone, including patients as well as doctors into serious trouble. The reason being there are many short-cuts used in the community like using buried stitch methods, which gives good but temporary results (1-3 years), but leaves devastating long term burden (complications) because they seemed so easy and benign, because not enough thoughts are involved in choosing the right process. And my ebook spends a lot of time explaining the biodynamics (physics) needed of the ideal process(with ninja foot prints) and math analytics.(my Second Edition book in 2006 contained a lot of photos about the final products/ results, and is the first stage of me intellectually analyzing the process.)
In this new iBook on the Eyelid Crease, I admitted that I can identify myself with the sushi chef depicted in a 2012 documentary film “Jiro Dreams of Sushi”. Like a shokunin, I admit I dream of the eyelid crease!
Dr. William P. Chen, M.D.,F.A.C.S., Founder and Medical Director of the Asian Eyelid Surgery Center, graduated from U.C. Berkeley with Distinction in the Honors Program, majoring in Biochemistry and Zoology. He holds a medical degree from the St. Louis University School of Medicine and was inducted into the Alpha Omega Alpha Medical Honor Society. He completed his Medical internship at USC and his residency training in Comprehensive Ophthalmology at UCLA, Jules Stein Eye Institute, and followed up with a Fellowship training in Eye Plastic and Reconstructive Surgery at Emory University, a prestigious program in this subspecialty.
Dr. Chen has practiced in Los Angeles and Orange Counties since 1981. In high demand as a speaker on his specialty in this country and abroad, Dr. Chen taught "Asian Blepharoplasty", his unique method for creating a natural double eyelid crease, to other surgeons at various workshops in Cosmetic Eyelid Surgery. He has been teaching this topic at the American Academy of Ophthalmology's Annual National Meeting since 1988. Dr. Chen has published numerous scientific articles and chapters in textbooks, as well as being the original author of "Asian Blepharoplasty and the Eyelid Crease with DVD 2nd edition," "Asian Blepharoplasty: A Surgical Atlas" and two other recent textbooks related to Oculoplastic and Oculofacial Plastic Surgery.