Words Hannah May-Lee Wong

Having large, round eyes with well-defined double eyelids has been a long-standing trait of conventional beauty. Genetically, however, many Asians are born with a mono-lid (single eyelid) or have upper eyelid folds that are covered with excess skin, making them less obvious. While beauty is in the eye of the beholder and double eyelids are certainly not a necessity to look and feel beautiful, men and women can opt for a blepharoplasty if they desire to add the double eyelid to their looks. Dr Somasundaram explains the procedure and the risks involved.

Blepharo-what?

A blepharoplasty refers to surgery on the eyelid and is also known as the double eyelid surgery. It is one of the most common cosmetic procedures that plastic surgeons perform in Malaysia. The procedure involves the removal of excess skin from the upper eyelid and reconstruction of the eyelid to create a fold when you open your eyes. Actually, most people already have a fold in their upper eyelid, but in most Asian people, the fold is covered by excess skin, so you can’t see it.

If a person has puffy eyes, the surgeon will also remove some fat during the blepharoplasty, but not too much. If the surgeon removes too much fat from the eyelid, the person may have hollow-looking eyes, and those tend to look a little sickly (not a good thing aesthetically).

The age range of people getting blepharoplasties is quite wide. People can get it done anytime from their teens to their 80s. Older folks may have more excess fat and skin which could droop over the eye and block their vision. When these are removed during the blepharoplasty, their vision would be improved.

A double eyelid surgery is different from an eye lift. An eye lift is done via an eyebrow lift, whereby the surgeon increases the distance between the eyelash and eyebrow. People do it because they may think that the distance between eyebrow and eyelash is very short, which may not look very pretty – the preferable distance is at least 1.5cm. To create that ideal distance, surgeons make a cut and raise the eyebrow. They can also do this with botulinum toxin, a method not involving surgery.

What happens during a blepharoplasty?

It’s a very straightforward procedure. A patient will come for a preoperative consultation. We go through their medical history, allergy tests and make sure they are not on any blood thinning products, vitamin E or gingko biloba that can cause bleeding.

Before we tell the patients what they can do to their face to make them happier and prettier, we assess their face anatomically. We take note of their condition before surgery: whether they have extra skin or extra fat around the eyelids and whether their eyebrows are drooping. Then, we can recommend the type of procedure they should go for based on the results they want. It could involve raising their eyebrows, removing excess skin to create a double eyelid or both. The choice of procedure also depends on how much time the patient has to recover as they will need to take time off work. Of course, we must take the cost into consideration as well.

Once that’s all done, we show the patients before and after pictures, especially of past patients who have similar facial features. If they are happy with the expected results, we explain the complications of surgery before making a booking. A blepharoplasty is usually done under local anaesthesia, with pre-operative markings on the eyelids indicating how much skin is needed to be excised. The surgery will take around half an hour to 45 minutes; it’s a fairly quick day procedure and patients can go back home on the same day. In five days to a week after the surgery, the patient comes back to the hospital to get the stitches removed. Thereafter, there may be swelling for two to three weeks before it subsides completely and the patient gets the results that he or she was hoping for.

What are the risks?

When you put a knife to the skin, there are always risks. The possible complications could include bleeding, allergies to medications or infections (which are rare). In eyelid surgery, asymmetry may happen, where the right and left eyelid turn out to be uneven. In fact, 1-2mm asymmetry is quite common, and may be present even before surgery. If the patient already has asymmetry before the blepharoplasty, it is the surgeon’s duty to point it out as the surgeon may not be able to equalize the eyelids perfectly. There is also a small risk of blindness, but that is extremely rare. As far as I know, blindness caused by a double eyelid procedure has never happened in Malaysia, but there have been reports of it happening overseas.

How does a person prepare for a blepharoplasty?

If a patient has existing medical conditions such as diabetes, heart disease or is on medications, we run a blood test to make sure they are fit for surgery.

Patients have to take at least a week off work and they’ll need to get someone to drive them home after the surgery (because their eyes are going to be bandaged). Although they are still able to see clearly, their eyes are going to feel heavy after the surgery and injections. Post operation, the patient manages with antibiotics, painkillers and ice packs.

Will the result of blepharoplasty stand the test of time?

Aging is a constant process. It is genetically induced and you age according to your genetic make-up; it is also affected by the stressors you put your body through. A poor diet, lack of sleep and exercise and binging on alcohol or cigarettes can make a person age a lot faster than someone who leads a healthy lifestyle. But whatever procedure you do, it will deteriorate over time. Generally, a blepharoplasty lasts a long time, up to 15 to 20 years. But if excess skin redevelops, it will have to be removed again.

Can a patient have other aesthetic procedures done at the same time?

Yes, the combination of eyelid surgery, face lift and neck lift is quite popular. It takes about four-and-a-half hours.

In recent years, there has been a trend of going to Korea to get cosmetic procedures done. Do plastic surgeons in Malaysia provide the same services as they do in Korea?

Yes, Malaysian surgeons offer the same aesthetic procedures that are available in Korea, it’s just that the Korean marketing may be a lot better. Unfortunately, we have been seeing a lot of complications. Sometimes, patients return from Korea with problems such as bleeding, unevenness or infections and local doctors have to manage those complications.

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