1. Definition

    Plastic surgery of the eyelids.

    This has been taken from dictionary.com, or to be more precise,
    The American Heritage Dictionary of the English Language, Fourth Edition

    This is, unfortunately, a very crappy definition. Blepharoplasty is a specific type of surgery to the eyelids, both upper and lower. It consists of modification or removal of excessive or baggy skin, or the layer underneath, including but not restricted to: the fat, the muscle, and the blood vessels.

    This has been my definition. Internet sites were terrible at giving me a good defintion.
    If anyone has access to a medical dictionary definition, let me know.

  2. Introduction

    This write-up will mostly be about the cosmetic procedure among Asians, though it does pertain partly to the other reasons this operation may be used.

    Common names: double-eyelid surgery, Asian blepharoplasty.

    Blepharoplasty is so much more than just the removal of skin. It is an operation, a damning cultural oddity, a racially charged issue... There are two types of surgery that fall in this category: the removal of skin/fat from the upper eyelids, and the removal of skin/fat from the lower eyelids. The former is typically either a cosmetic or medical procedure, while the latter is almost entirely a cosmetic procedure and also not as popular. Most, when hearing about this procedure, will only assume you did your upper eyelids.

    This particular surgury is wildly popular in Asia, as it creates a fold in the eyelid that many Asians lack due to genes. Why is this fold so important?

    1. The eyes are a feature that many people value aesthetically. Your eyes are the window to the soul, and many will pay money to make sure that people know that their soul is pure and beautiful. Or something like that. The fold apparently makes your face more appealing. Or Caucasian, depending on who is damning this procedure.

    2. Another reason many Asians do this to themselves is because it makes putting on eyeshadow and eyeliner that much easier.

      Blepharoplasty may seem like an extreme tactic for such a hypothetically useless reason, but this is usually done after the woman has become tired of paying for the other standard methods for creating the fold:

      1. Eyelid glue. This is a fairly expensive (if you look at Asian magazines, they can run you $60 US for a teeny weeny bottle). It does exactly what it says: it glues your eyelids temporarily together to create that fold. You apply this to your eyes and then you pinch the lids together with your fingers (or a fork prong thing that is sometimes supplied) while the glue dries. I understand applying makeup to this is not all that difficult, but for the life of me I cannot see how it can't be. I mean, there's glue in your way...

      2. Tape. This is the cheaper alternative to the glue above. You can sometimes find these in an Asian supermarket in the United States if you are in a heavily populated Asian neighborhood (particularly Korean or Japanese). These are crescent-shape double-sided stickers that you press onto your eyelid. These don't last as long as the above-mentioned glue, and can get pretty obvious once the sticking power stops.

    Of course, there is the standard, more "reasonable" reason people do this: sometimes eyelids droop so much they affect vision, and thus need to be corrected. This is the reason for upper eyelid surgery; the only medical reason I can think of for lower eyelid surgery is when the bags underneath your eyes are so puffed up as to obscure vision. Surgery on the lower eyelids are usually to reduce the "tired", "old" appeance one gets due to age.

  3. The Vict... ah, Patients

    The standard patient for this sort of thing is a teenage Asian girl, or an Asian woman in her early twenties. If a woman in her twenties are doing it, it is usually of her own accord; in the case of the teenager, this is usually because their mother is bringing them in so that they can look prettier.

    (Cultural note: The vanity may seem to be a fairly surprising cultural aspect, but physical beauty is heavily emphasized/prized in South Korea and possibly Japan. Less so among the Chinese, but still prevalent. If a mother is the reason for the procedure, your best bet is to assume she's Korean; it is said that over 40% of the women in South Korea has had this procedure. Just watch any Korean drama, and you'll notice that just about every single female movie star has had it done, to varying degrees of "naturalness", and not a few men.)

    Men who have this procedure are generally older, usually in their 30s or 40s. The cosmetic need for this is more to reduce appearance of age, as the fold makes eyes appear larger. This particular surgery is gaining popularity with men, though the majority of patients who undergo this are women.

  4. The Surgery Itself

    1. Cost

      In the United States, upper eyelids only will typically run around $4000, and up to $8000 if it includes lower eyelids. In places like South Korea, the procedure will cost you approximately $800, sometimes less. In Asian communities in the United States, there will always be a doctor who will do it for $1500 or so.

    2. Surgery Time/Recovery Time

      The surgery for upper eyelids takes approximately an hour. Two or more hours if this includes lower eyelids. You can opt for general or local anaesthesia, though general will cost you a small fortune and is also very inconvenient for the surgeon, as he will want you to periodically open and close your eyes to make sure that the eyelids fold evenly.

      Recovery time will take ~2 weeks. You will walk out of the hospital slightly groggy and looking like Frankenstein. The stitches stay in for about two weeks, and you will take lots of painkillers to reduce the inflammation and pain; smear cream on the stitches to reduce the chance of infection; and generally avoid keeping your eyes open. A followup with the surgeon happens two weeks later to remove the stitches, and then a visit six months later to make sure everything went okay. This scenario is only when everything goes well.

      As for the brand-new fold in your eyes, it will look abnormally large for the first few months (and give you a slightly buggy goldfish look). A good surgeon will make the fold slightly larger than normal, because over time, the fold settles and lowers as you heal. There is approximately a six month recovery time on this, though if nothing goes wrong, you'll look slightly odd for the first month (but nobody will pinpoint the reason why), and then completely normal starting the second month.

    3. The Actual Process

      (This is only the procedure for upper eyelids; if anyone's got a first hand account for the lower eyelids, please feel free to share. This is not a personal account, however; this is partly a) a witness account and b) the slightly embellished words of a friend who went through this surgery.)

      The cosmetic surgeon will give you a once over to make sure you don't have any medical problems and then mark up the potential cutting spots with a permanent marker on your eyelids. He'll also inject a temporary sedative to knock you out momentarily (read: just enough so that you can't cry out with pain) so that he can inject local anaesthesia into your temples. A paper mask will be drawn over your face with only your eyes showing, just to reduce the mess you'll have all over your face. This is really all the prep they'll give you.

      You'll be awake for all this, so pay attention. Most of the time, your eyes will be closed because the thought of something slicing into you will be a little too much, among other things. When the knife goes for your eyeball, you'll experience a hazy sort of fear, but not a whole lot because that's what the anaesthesia is for.

      You'll feel tugging as they cut you open like a ripe fruit. You'll feel blood running down the side of your face. You can, intellectually, understand that the warm blood is running down the side of your face, but you won't feel pain, fear, or anything at all, really...

      When you close your eyes, red, green, and blue flowers of color will bloom across your vision; it's the kind of display you see only when you close your eyes and lightly press down on your eyeballs. It's a beautiful sight. Though they seem very pretty, a small thought runs through your head:

      I may not feel a thing, but somewhere, somehow, a little tiny part of my brain is screaming.


      The cutting is not the worst part. It's when they fire up the torch to burn the fat. In order to achieve a perfect "fold", one must burn the excess fat stored in the eyelid (the excess fat being the reason why you do not have a fold in your eye in the first place) so that the skin folds over properly when you open your eyes. The hissing sound is one thing, but it's the smell of burning fat that really takes the cake.

      You'll be reminded irresistably of frying bacon.

      Asian blepharoplasty differs slightly from the normal procedure done to non-Asians; aside from the shape of the eyelid, the shape of the epicanthal fold among Asians is also different. The epicanthal fold is a small patch of skin by the nasal area that causes an interestingly shaped crease in the eye that must be accounted for when doing this surgery. This is largely the reason why Asian people will generally go to Asian doctors when going for blepharoplasty; not accounting for the epicanthal fold makes for some very oddly done eyes.

      When everything is done, they'll take a needle and thread and stitch you up. They'll also give you some sort of painkiller as the local anaesthesia wears off. They'll smear some sort of ointment over your lids (Bactrin or something similar), give you some painkillers and more bactrin, and cheerfully wave you goodbye to you as they count out the money (read: cash only) you've just handed to them.

  5. The Outrage

    This is one of those cultural oddity quirks, rather like the way butt surgery is popular among Brazilian women, breast implants in the US, or nose surgery among Jewish girls. Unfortunately, the double eyelid thing is considered by many to be some sort of homage to Westernization, which may or may not be true...

    What one must understand, though, is that it's not a desire to appear Caucasian. It's to enhance beauty as perceived by whoever you want to appeal. Like all cosmetic surgery, really, in the end. Making the fold too high, which will make you look completely non-Asian, is considered to be a badly done surgery; you'll look too non-Asian. That's just not cool; you'll be perceived as ugly by both Asian women and men.

    That said, you can't really escape the fact that it's a procedure with very little point to it, considering that not having a fold is very common among Asian people.

  6. The Outcome

    So you're out a couple of grand and you look like the Bride of Frankenstein. How much worse can it get?

    It can get much worse.

    Sometimes the cosmetic surgeon does a shoddy job. Sometimes a mistake happens. Sometimes you heal oddly or your wounds get infected. In any case, when something goes wrong, things go very wrong, very fast. If any of the above happens, you stand a very good chance of having your folds come out uneven.

    I should think that you can picture how that would look on a normal person.

    Repairing whatever mistakes happen is an expensive, time-consuming, and frequently embarrassing process. Because you are in the process of healing, not many surgeons will reoperate on you until you heal properly, and this can take a while. The waiting game is what really costs you the most, in terms of social standing - everyone will know what happened, unless you happen to have this all done during summer vacation or something similar. The cost of redoing a blepharoplasty are frequently twice or even three times as much as the original procedure. You will scar heavily (this will show later, after you've healed fully).

    And people will always ask. Why you do this to yourself? Why are you are willing to risk it for something so pointless? You'll just smile and shrug.

    "No price is too high for beauty."

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