Systematic approach and selective tissue removal in blepharoplasty for young Asians.

Although the double eyelid operation was initially designed to create supratarsal folds in Asians, it has evolved into a cosmetic procedure to make Asian eyelids more aesthetically pleasing. Therefore, it is appropriate to call it "blepharoplasty for young Asians." All the candidates for this operation desired natural-looking attractive eyelids with double folds, which is far from puffiness and severe epicanthus. Two hundred forty-one patients underwent "blepharoplasty for young Asians" from 1991 to 1996 at Asan Medical Center, and they were performed by one surgeon (Yoon). A systemic approach has been adopted for the procedure: first, the size of the folds is determined; second, debulking of the upper eyelids and handling of the epicanthus is taken into consideration in relationship with future folds. In addition to creating folds, half Z-plasty is used to alleviate the epicanthus, and a selective tissue removal technique is applied to titrate the amount of puffiness in the upper lids.