Double Eyelids

Open Blepharoplasty – Cutting and removal of Skin / Muscle / Fats

Open blepharoplasty refers to cutting of the eyelid skin, exposing and removing portion of the underlying structures such as the muscle and fats. Repositioning of some of the lid elevating muscles is usually required.

This is a good site which shows the step by step operation of the cutting method for double eyelid surgery

Surgery by Dr. Frank Meronk

Such an operation is anatomically more appropriate as the structures are left in the natural compartment relative to each other. However, risk of complications is higher especially if any of the steps involved are not carried out judiciously. These include error in the amount and shape of skin removal, inadequate or excess removal of muscles and fats, wrongful repositioning of the lid elevating muscles. Unless the surgery is performed with a very experienced doctor, the potential for complication can be significant.

As the surgery involves cutting and removal of eyelid skin and its underlying structures, there is an element of uncertainty. With numerous anatomically variables, the doctor would not be so precise such that he can control crease height to the millimeters. Unlike the suturing / stitching technique, it would not be possible for the doctor to provide an exact physical simulation of how the double eyelid would look like after the procedure. As such, creating a vary ‘natural’ looking double eyelid will be more challenging using this technique.

The downtime in open blepharoplasty is significantly longer than its counterpart suturing methods, due to the innate nature of being an invasive surgery with cutting and removal of eyelid structures. There will be more swelling and inflammation that can persist for many months. Visit the Dr Meronk website for more information.  Dr Meronk is an internationally renown practitioner of double eyelid surgery.

Complications with open blepharoplasty are potentially more significant due to the fact that chances of error are higher in a surgery that involves more invasive steps and healing is more unpredictable.  Some common complications are demonstrated below:

Dolls’ Eye Deformity after blepharoplasty

Over-removal of fat, skin and muscle

Like most invasive operation, this procedure is Not Reversible – the doctor cannot return your eyelid to its original state should you change your mind after the surgery.

The main advantages of open blepharoplasty are that it can create double eyelids that are long lasting in retaining the crease and removing redundant skin. However using the cutting technique does not equate to assured longevity. In inexperienced hands, a double eyelid that is created using the cutting method can ‘disappear’ after 2 – 3 years.

Furthermore, with new suturing techniques that are able to produce double eyelids that are longer lasting, more patients prefer the popular stitching methods over surgeries that involves cutting of the skin and muscle. The trend is towards recommending open blepharoplasty in the event if there is significant excess skin due to laxity, aging and other eyelid pathologies such as ptosis

As mentioned in the previous section, the concept of Fat Preservation and the principle of ‘Less is More’ cannot be over emphasized. Over zealous removal of fats in the upper lid has lead to disastrous consequence in subsequent years after the procedure. Refer to the section on Fat Preservation for more information.

Always choose a clinic that can offer you both the suturing / stitching and cutting methods so that the doctors can give you an unbiased opinion on the various methods of operation.