LAM FACIAL PLASTICS

Hello Dr. Lam, I have a question regarding converting a tapered crease to a parallel crease. I'm an Asian male with existing tapered double eyelids, albeit with minimal double eyelid show. I want to raise the crease to increase eyelid show and make the crease parallel. However, I'm wary of epicanthoplasty as the change can be dramatic and have heard of people regretting the procedure (too much white/red show, looks too "fierce and aggressive", too western, etc). I've seen Asian eyelids where the parallel crease is on top of the epicanthic fold (read, without epicanthoplasty to remove the epicanthus) like how I've drawn in the attached pic of me. But how would I get this done and reconcile the tapered fold? Do they somehow stitch the inner eyelid with the epicanthic fold to make it "one inner piece"? And then would they join the newly created epicanthal incision with the outer eyelid? I hope I explained this coherently. If you look at my pic, I think you would understand. I've been wrapping my head around this for a while wondering how it would work in my case. Thanks in advance.


This is how my eyes look like now. I pulled up slightly on my brow to simulate more eyelid show.



I drew in lines to show how a parallel crease would look like without epicanthoplasty. This is what I meant by questioning how the doctor would reconcile the existing tapered fold (that goes underneath the epicanthal fold) with the new crease that would be formed on the epicanthus.



This is a good example of someone with a parallel crease while still having the epicanthal fold (no epicanthoplasty to remove the epicanthal fold). Would this parallel crease be possible in my case?



Another example of someone with a parallel crease w/o epicanthoplasty.



He has a parallel crease now (obviously), but if you look closely, does this look like he originally had a tapered crease that was surgically altered to be parallel (notice the faint tapered crease lines)?

you can make a parallel crease without adjusting the epicanthus in most cases. i do not know about that last case whether that has been operated on or not and whether the extra fold represented scarring or just a case of multiple folds. now, if you already have a very defined crease, which it seems you do, it is not easy to readjust the shape of it. it is much easier to do that in someone without a crease. can you send a photo of yourself without the brow holding up?
thanks,
sml

Sure no problem. In the first pic, I had really relaxed my eyelids. In the second, I tried opening them up. I would probably look like somewhere in between in most realistic situations.






You said it would not be easy, but does the tapered-to-parallel conversion fall into the impossible category? Thanks Doc.

And btw doc, I had double eyelid surgery done in 2005. You think my eyes look bad right now, my super thick single eyelids looked horrendous hehe. I want a revision since I still look chronically angry and tired (which is why I got them in the first place). It's better, but my eyelids still have lots of room for improvement.

And also, the first doc did some kind of inner epicanthal carving, but I guess it was a very very conservative approach? I still have my epicanthal fold. In a way, I guess I should be thankful he did not totally remove them as I'm not sure I want epicanthoplasty done.

a revision procedure always is significantly harder than a virgin case. if you add the complexity of what you are desiring, i would say it is not going to be easy and it carries risk. i would not be comfortable personally trying to achieve what you desire.
best,
sml

Thanks for your frank and candid feedback, Dr Lam. Taking into account what you said, if I still want to achieve a parallel crease, then I guess the only way to accomplish this seems to be with an epicanthoplasty, where minimizing or removing the epicanthus virtually converts the tapered crease into a parallel one, all by itself. Now, I've seen a couple of epicanthoplasty results which looked great but have also heard of regrets. Do you think an epicanthoplasty in my case, to widen the eyes a tad, be done tastefully?

Also, is epicanthoplasty by definition, complete removal of the epicanthal fold? Or can it mean partial removal?

i do not perform an aggressive epicanthoplasty so yes there are shades of epicanthal modulation. that being said, i do not even think an aggressive epicanthoplasty will change the crease shape much to a parallel. that is my opinion. sorry.
best,
sml

I thought that by removing the fold, the resulting "show" of the inner part of the crease is what then makes it parallel. Maybe I'm just not understanding it right hehe. Anyway as always, thanks for your input Doc.

you are not that far off but it is not such a simple 1:1 change. it may not become parallel.

Thanks Dr Lam, I understand now.

More important than making the creases parallel, the reason I was looking into epicanthoplasty was to widen the eyes just an iota and to narrow the distance in between them. BUT, I totally forgot that I'm planning on possibly getting my bridge raised slightly next year. I assume that raising the bridge will in effect simulate epicanthoplasty in that it would pull the inner corners of the eyes inward toward the nose (when I pinch the skin above the bridge with my fingers and raise it, the corners of my eyes are pulled in). Having said that, I think I'll get the double eyelid revision right now (just to raise the crease higher), then do the nose, then after that, evaluate whether or not I need the epicanthoplasty. What do you think? I assume that doing the double eyelid surgery first right now is fine, since the crease goes underneath the epicanthal fold, any slight pulling of the skin won't affect the new crease.

Just to show you how much I'm looking to raise the bridge, here are pics I posted earlier in another thread. From the pics, the bridge height increase doesn't look that much. But what I think is little might be drastic by your standards. My frontal pics are at the top of this page. Thanks Dr Lam.

yes, you can move forward with the double eyelid and it will not affect the nose. i do not feel comfortable doing the eyelid procedure, as i do not believe i will be able to deliver what you are expecting. as far as the nose is concerned, your eyes will not be closer together after an augmentation rhinoplasty. that is a mistaken idea that almost everyone has when they pull their skin together because the skin will almost immediately relax and you will see no improvement in your eyes. if you are doing the rhinoplasty to make the nose look better (which it sounds like you are) then that is reason enough or should be. with thick Asian skin, i cannot guarantee the level of tip definement you are showing but i can move you toward that direction, especially the supratip break you are showing (the little indent above your nose tip you drew). that is very hard to deliver on in thick skinned Asians. and to be honest it is a feminizing trait and not a masculine feature. however, in general refining the tip, adding tip projection, and refining by elevating the nasal bridge is something that i am very skilled at doing. hopefully i could help you with that next year.
best,
sml

Thanks Dr. Lam.

Yea at this point I'm not so concerned about tapered/parallel as I am about just raising the crease and making it visible. As you can see in my "relaxed" pic from one of my previous posts in this thread, you can barely tell I have "double eyelids". I look terminally upset and tired.

So I guess what you're trying to say is that if I am to get epicanthoplasty right now, to get it because that is what I want NOW, without regard to how a future nosejob would affect my inner corners since the effects would be nearly negligible anyway.

Surely, you are on my list of rhinoplasty doctors to consider, as you seem very knowledgeable and experienced. The only negative being that you're a few thousand miles away hehe, but that may be a small price to pay for a great job. Regarding thick Asian skin, can you "de-fat" the tip a bit? I've heard of docs doing this but perhaps what I've heard has been overexaggerated. Without the use of rib or L-implants, do you think you might be able to reasonably approach what I have drawn? Or is something like that only really achievable with rib or L silicone?

hi,
1. yes, as i said the nose should not affect the eye position so do what you feel you want for the eyelids.
2. i truly think rib and l-struts look fake and feel fake in the nasal tip and may get you better definition at the price of something that can feel and look unnatural. that is too large a price in my opinion.
3. yes, i can defat the tip but not too much or you can experience chronic color changes to the skin. i defat the supratip region only typically. taping will help shrink the nose down to the new architecture over time.
best,
sml

Thanks for your help Dr Lam.

Yes, regarding your #2, those are the tradeoffs I've been fearing... looks vs feel. I wonder... if you have solid rib mounted on your nose and there is no give or play to absorb bumps and hits, I'm assuming it would be much easier to break and damage your nose.

possibly. i personally think rib is just too firm for most noses. it would work better for a major reconstruction of a collapsed nose. i do not like how high noses look with ribs too, at least in Asians.
best,
sml