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M. Cho, I. P. Glavas; In vivo Measurements of Asian Upper Eyelids. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2306. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
More US trained facial plastic and oculoplastics surgeons are performing Asian eyelid surgeries. With such popularity of "double eyelid" surgery, it becomes prudent and crucial for surgeons to become familiar with Asian eyelid anatomy. We performed metric measurements of various Asian eyelid anatomies.
A cross-sectional descriptive study of 5 Korean-American and 9 Chinese-American subjects. Digital photography of each eye, both open and closed, were taken with a metric ruler placed next to the eye. The standardized photographs were uploaded to a computer and measurements were made using Photoshop. The 14 pairs of eyes were analyzed separately. Three types of eyelid anatomy were described: 1) single eyelid, no lid crease when eye open and closed, 2) low eyelid crease, no lid crease when eye open but measurable lid crease when closed, 3) double eyelid, lid crease when eye open and closed.
Subject’s age ranged from 27 to 31 (mean 28.8). Among the Chinese American eyes, mean palpebral fissure (PF) height was 10.8 + 1.6mm, mean PF width 30.5 + 3.4mm, and mean PF inclination 5.6 + 3.0°. 11% had single eyelid, 22% had low eyelid crease (mean crease height 1.5 + 1.1mm), and 67% had double eyelid (mean crease height with eye open: 3.8 + 1.3mm, at medial limbus 3.7+ 1.4mm, at lateral limbus 4.6 + 1.2mm, mean crease height with eye closed: 6.3 + 3.2mm). Three eyes had "triple" eyelid crease located medial to laterally when open. One eye had an incomplete form of double eyelid and 2 subjects had asymmetric eyelids. Among the Korean American eyes, mean PF height was 9.5 + 1.6mm, mean PF width 29.1 + 1.8mm, and mean PF inclination 6.7 + 2.5°. 10% had single eyelid, 60% had low eyelid crease (mean crease height 1.4 + 0.6mm), and 30% had double eyelid, all incomplete (mean crease height with eye open: 2.0 + 1.3mm, mean crease height with eye closed: 1.3 + 0.3mm). All 3 double eyelid eyes had "triple" eyelid crease medial to centrally when the eyes were closed (range 3-4mm) corresponding to the incomplete form of double eyelid. Two subjects had asymmetric eyelids.
Eyelid anatomies vary among different Asian Americans. What appears as a single eyelid while the eye is open may in reality have a low-lying crease apparent when the eye is closed. For complete double eyelids, the crease height when the eye is open was approximately half the crease height when the eye is closed. The crease height when the eye is open tended to be greater laterally than medially although this was not statistically significant. Surgeons need to be mindful of these differences and may be able to use these measurements to plan the most natural-looking Asian eyelid surgery.
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