The Asian eyelid is a unique structure that differs from the Western eyelid in many ways, and a deep understanding of the anatomy and healing process is critical as there is no margin for error. Furthermore, the Asian ideal aesthetic is different from the Western ideal, and many patients desire the eyes to be more open, longer horizontally, and with a different shape. Operating on an Asian eyelid in the same manner as a Western eyelid can lead to adverse consequences such as scarring, unintended formation or destruction of the eyelid crease, or an undesirable cosmetic outcome.
The Asian eyelid may have a full crease, partial crease, or no crease. Up to 50% of Hispanic patients have an Asian-configuration eyelid with partial or no crease. Many Asians also have an epicanthal fold which gives a characteristic appearance. This variability is caused by additional layers of fat and differences in how the deeper eyelid tissues attach to the skin. This may also cause the eyelashes of the upper or lower eyelids to scratch the delicate surface of the eye, causing tearing and a gritty sensation in the eyes.