Everyone is seeking the best shape of themselves. With the new standards of beauty, every part of the body can be adjusted and changed, especially the face. 

You have probably heard many facial surgical terms lately. I mean you must have heard about nose jobs, facelifts, face liposuction, and eyelid surgeries.

Our video today is specifically about eyelid surgeries. Eyelid surgery is one of the most common cosmetic surgeries, especially in South Korea. 

South Korea is known to have the highest rate of surgeries per capita globally, and eyelid surgery is a very popular procedure there. 

But why is eyelid surgery very popular in South Korea?

It is usually done for cosmetic reasons. For example, blepharoplasty is an effective way to improve sight in old people with sagging eyelids that get in the way of their vision. 

Other procedures usually help people to achieve bigger and more lively looking eyes or even correct asymmetry to have better-looking eyes. 

I just mentioned blepharoplasty. So, what is Blepharoplasty? 

It is a type of surgery that repairs droopy eyelids and removes excess skin, muscle, and fat. 

As we age, our skin ages with us. It gradually loses its elasticity, and therefore the eyelids stretch and the muscles supporting them weaken.

In addition, excess fat, especially that fat that cushions the eyeball from the skull, may gather above and below your eyelids giving you saggy eyebrows, droopy upper lids and bags under your eyes. The thin membrane that holds that fat in place weakens as we age, and consequently, it lets that fat come forward into the eyelids like a hernia.

The lack of elasticity and the constant pull from gravity causes excess skin to collect on both the upper and lower eyelids. 

Besides the old person appearance caused by these changes, if the eyelids are severely sagging, it will definitely affect your vision and field of vision, especially the upper and outer parts of your vision field.  

Blepharoplasty can eliminate these vision problems and give you a younger look. 

But have you heard about epicanthoplasty? It is also eyelid surgery. However, it is a different type of eyelid surgery. 

So, what is epicanthoplasty? And how is it different from blepharoplasty? 

Before we explain epicanthoplasty, you have to know about the Mongolian fold first. The Mongolian fold is one of the most prominent features in Asian countries. 

It is the skin of the upper eyelid that is covering the inner corner of the eye. It runs from the nose to the inner side of the eyebrow.

It sometimes looks like a web that covers the medial canthus of the eye. People usually seek epicanthoplasty because these folds make the eyes look smaller laterally and more tired looking. 

So, again, what is Epicanthoplasty? 

It is a type of eye surgery that aims to lengthen the inner part of the eyes so that they look wider and bigger. The procedure is also known medically as medial or lateral epicanthoplasty based on which fold is removed. It is sought by men and women who would like to have bigger, brighter eyes and a more alert look.

The procedure does not only give a bigger appearance, but it can also actually make the eyes physiologically bigger.

The procedure is often requested by people who have abnormally large epicanthal folds that impact the shape of their eyes.

You must have figured out the difference between epicanthoplasty and blepharoplasty by now. But as a quick recap, blepharoplasty is about removing excess skin and fat to have a younger look of the eyes, while epicanthoplasty is about removing the Mongolian fold to have a bigger more alert eye look. 

So, who is a good candidate for each of the two surgeries? 

For epicanthoplasty, it can be pursued by anyone who wishes to make their eyes wider as far as it is possible for them.

Although most of the people who seek epicanthoplasty are of Asian descent, it can be done to anyone who wants to improve their appearance with larger eyes. 

So, epicanthoplasty can be done to people who wish to improve their overall look and: 

• They are in relatively good health.
• Have eyes that are abnormally far from each other in terms of distance which leads to disproportionate appearance.
• Have well-developed epicanthal folds.

As for blepharoplasty, people who are struggling with droopy or sagging eyelids that keep their eyes from opening completely or pull down their lower eyelids. 

So, in conclusion, blepharoplasty is the best option for people who have:

• Baggy or droopy upper eyelids.
• Bags under their eyes.
• Excess skin on their upper eyelid that interferes with their peripheral field of vision.
• Excess skin on the lower eyelid. 

Although it might seem simple, each procedure has its own risks. Anyone who considers one of these procedures should be aware of the risks and complications.

Common risks of eyelid surgeries in general include: 

• Infection. 
• Bleeding. 
• Anesthetic complications and adverse effects. 
• Difficulty closing the eye. 
• Scarring. 
• Injury to eye muscles. 
• The need for follow up surgery. 
• Skin discoloration. 
• Temporary blurring of vision. 
• Rarely losing sight. 
• Blood clots. 

However, you should discuss these risks with your surgeon and decide if the surgery is the best option for you after thinking about the benefits and risks. 

But all in all, if the surgery is performed by a licensed well-experienced surgeon, it will be a safe procedure with very high success and satisfaction rates. 

One of the risks of eyelid surgeries we just mentioned is the need for follow-up surgery. So, what is this? 

This is called revision eyelid surgery, have you ever heard that term? 

When we say revision blepharoplasty or revision epicanthoplasty, we usually refer to a secondary procedure that is done to correct any problems that have arisen from the initial eyelid surgery or to improve the results of the initial surgeries. 

When the patient is not happy with the results of the surgery due to disfigurement or a resulting defect that is distressing them, then, a revision procedure will be recommended. 

Revision eyelid surgery is one of the most popular eyelid surgeries. When performed professionally and correctly, revision eyelid surgeries can dramatically refresh and rejuvenate one’s facial appearance. 

Although it only focuses on a patient's dissatisfaction, revision surgeries are more complex than the primary procedure and can be done in several ways. That’s why you need to look past the usual advertisements and base your surgeon selection on irrefutable qualifications. 

Let’s take revision blepharoplasty as an example. 

Why would a patient undergo a revision of Blepharoplasty? 

Because, as we mentioned earlier, people may be unhappy with the primary surgery results. Maybe it is due to noticeable scarring around the incision. Maybe the original surgery was an under corrected surgery.  Or maybe the surgeon removed too much skin and fat. 

Because blepharoplasty deals with a very delicate area in the face, many problems can arise. However, the complexity of the problems varies significantly from person to person. 

But here are the most common causes of undergoing revision blepharoplasty: 

• Scarring. Normally, eyelid skin heals very well. But sometimes the scar can be too vigorous that it can lead to noticeable bumps around the eye. The patient may have not anticipated such a visible scar. It is usually dealt with effectively by a scar revision procedure. 
• Under corrected eye surgery. Imagine undergoing surgery and then the problem is not completely fixed. In blepharoplasty, under correction means not enough skin was removed and the muscles are not tightened enough. When this happens, the face appears older and heavier. The patient then feels that the surgery was pointless. In this case, revision surgery is highly recommended because the problem can affect the patient’s visual field. 
• Over removal of skin or fat. This can lead to severe problems for the patient, especially when the changes are on the lower eyelid which leads to retraction and wider exposure of the eye. Lower lid retraction complications are severe. They cause dryness and soreness of the eye as well as unsatisfactory aesthetic results for the patient. Another problem that can arise from too much skin and fat removal is poor positioning of the eyelids. An asymmetrical and unnatural appearance can result. In this case, revision blepharoplasty is done just to restore the previous symmetry and realign everything in its normal place. Retraction usually results from too much skin removal, but what happens if the surgeon removed too much fat? This can lead to a hollow sunken look under the eyes. But this can be simply fixed by injecting fillers or transferring fat to this area. 

Complications are an inherent risk of any surgery. However, the better and more professional your surgeon is, the better the results are. 

Our role today is to answer most of your questions regarding Eyelid Surgeries. Today we have Doctor Kim, who is the leading doctor at BK Plastic Surgery in Seoul, Korea. He is going to discuss with us about Eyelid Surgeries from an experienced medical point of view.

Interview

My first question about eyelid surgery – are there any changes between the revisional and primary eyelid surgery?

Yes, when it comes to eyelid surgery, before most were first time patients but now there are many more revisional procedures done. The biggest difference between the initial and revisional surgery are that the first surgery is done in a clean blank slate without any scars. Also, revisional surgeries typically address issues such as crookedness, unbalanced eyelids, or any other issues that are visible. Thus, the surgery tends to be more complex and the recovery time longer.

How do you find the perfect eyelid shape for your clients?

There is no perfect or ideal shape, in reality. We go with what the patients want most is the perfect shape. However, in Asia, many have small eyes with a possible aggressive look, so many tend to prefer to change to a set of bigger eyes, wide open sideways and vertically.

What kind of person is not suitable for epicanthoplasty?

Epicanthoplasty extends the eye openings and gives a sense of openness. This procedure is good for those with strong Mongol eye folds and those who have eyes separated too far apart. If the eyes are set close together, this procedure is not recommended.

What is the difference between double eyelid surgery and upper blepharoplasty?

Double eyelid surgery is a surgery mostly done by younger patients while upper blepharoplasty is usually done by older people with drooping eyelid bags in order to make them look younger.

What is a lateral canthoplasty? Is it a must to do with epicanthoplasty?

The surgery done to widen the sides of the eyes, media epicanthoplasty and lateral canthoplasty. Lateral canthoplasty deals with widening the sides of the eyes while media epicanthoplasty deals with the inner sides being widened. These two procedures help widen the eyes on both sides of the eyes. 

Which kind of canthoplasty do you do mainly in Korea?

The most common is epicanthoplasty. Since most Koreans have Mongol folds, many get this procedure to widen the eyes and give a softer, more open look. Next common procedure is lateral canthoplasty. 

How do you resolve the aesthetic difference between yours and the client’s

Patients always have their own standards and satisfaction. While I also personally have my own set of standards and knowledge based on textbooks, I tend to follow the choice of the patients.

What would doctors do to resolve unbalanced eyelids and or maybe pronounced scars after eye surgery?

Anyone can have some side effects such as scars, unbalanced eyelids, or even one side coming off. But these side effects can be easily remedied with revisions such as fixing unbalanced eyelids or removing scars. 

How often do patients come to you or come to Korea after their first unsuccessful eyelid surgery?

It is possible to have dissatisfaction arising from surgery. It can be fixed with revisions or an after-surgery consultation. For foreign patients we do video consultations as it can be difficult to travel. For Singapore and China, we sometimes go over there to answer any questions. In cases where revision surgery is needed, they must come back to BK Plastic Surgery in Seoul. In reality, revision surgery at BK is not too common as many have results within their expectations.

Is it difficult to redo the work from another doctors?

Revision surgery is always more difficult. It tends to be easier if the original surgery was done by myself and more difficult if done by someone else. In my case, I specialize in revisions for eyelids. Regardless of which doctors did the original surgery and regardless of the original issues, I can fix the problems with revision surgery.

Who do you usually recommend non-incisional double eyelid surgery?

In double eyelid surgery, we have incisional and non-incisional methods. A method that involves cutting skin and a method that does not. Non-incisional methods are appropriate for those with thin skin, low fat content, skin that is soft and supple, skin that does not droop too much, and young. The opposite is true, also – if the patient has lots of fat, has thick skin, drooping skin and is old, then we recommend incisional methods.

What if the patients want to do a Lasik surgery and also epicanthoplasty, which do you prefer the patient to get first?

Lasik surgery done at an ophthalmologist and epicanthoplasty done at a plastic surgery center are separate procedures and the order does not matter. As long as the two procedures are apart by about a week, it does not matter which one is done first. 

Is it possible to have epicanthoplasty on only one eye when the other eye already has a double eyelid?

If necessary, it is possible. But in most cases, doing both eyes at the same time results in a better look. So, it is not really done on one eye.

Conclusion

When it comes to eyelid surgery, long ago most were first time patients but now there are many more revisional procedures done. The biggest difference between the initial and revisional surgery are that the first surgery is done in a clean blank slate without any scars. Also, revisional surgeries typically address issues such as crookedness, unbalanced eyelids, or any other issues that are visible. Thus, the surgery tends to be more complex and require longer recovery time.

Epicanthoplasty extends the eye openings and gives a sense of openness. This procedure is good for those with strong Mongolian eye folds and those who have eyes separated too far apart. If the eyes are set close together, this procedure is not recommended.

Double eyelid surgery is a surgery mostly done by younger patients while upper blepharoplasty is usually done by older ones with drooping eyelid bags in order to make them look younger. In double eyelid surgery, we have incisional and non-incisional methods. A method that involves cutting skin and a method that does not. Non-incisional methods are appropriate for those with thin skin, low fat content, skin that is soft and supple, skin that does not droop too much, and young. The opposite is true, also – if the patient has lots of fat, has thick skin, drooping skin and is old, then we recommend an incisional method.

Lateral canthoplasty deals with widening the sides of the eyes while medial epicanthoplasty deals with the inner sides being widened. These two procedures help widen the eyes on both sides of the eyes.

Anyone can have some side effects such as scars, unbalanced eyelids, or even one side coming off. But these side effects can be easily remedied with revisions.