There is a distinct difference in the anatomy of the eyelids between the Oriental and Caucasian races. Some of the differences relate to the particular arrangement of the muscle that lifts the upper eyelid, creating a fold in all Caucasians and only in some Orientals. Many Orientals do not have the upper eyelid fold. Fig. 17a. This can be achieved by a surgical alteration of the muscle attachment and sometimes combined with the removal of redundant skin. Fig. 17b. The results of this operation, which is performed under local freezing, are usually pleasing. There are transient side effects similar to those mentioned under the section "blepharoplasty".

    The main difficulty related to this operation lies in achieving absolutely symmetrical folds in both eyelids. In some instances, despite perfect symmetry on the operating table, the eyes may show a slight difference when the healing is complete. Such asymmetry frequently occurs in many people who have not undergone surgery; and therefore, is aesthetically acceptable. Nevertheless, a touch up operation may further improve the symmetry with minimal discomfort to the patient.

Figure 17a

Figure 17b

Figure 18a

Figure 18b

Figure 19a

Figure 19b

Figure 20a

Figure 20b

Figure 21a

Figure 21b