In the previous blog, I mentioned that patients who have asymmetry of eyelid skin creases (doube eyelids) always find the eyes without the double eyelids appear smaller than the ones with double eyelids. In eye with double eyelid, the double eyelid forms a barrier and holds back the upper eyelid skin so that it does not fall over the eyelid margin. In eye without double eyelid, the upper eyelid skin droop over and occlude the upper eyelid margin. When viewed from the front, this skin hooding makes the eye appears smaller.
The right eye has no double eyelid so the skin falls over the
eyelid margin (blue arrows) making the eye appear smaller,
the left eye has a double eyelid which hold the skin away
(red arrows) from the eyelid margin.
The same principle applies to double eyelid surgery (Asian blepharoplasty). A successful double eyelid will create a skin crease that form a barrier so that the upper eyelid skin is held back from the lid margin. The picture below belongs to a patient whom I performed double eyelid surgery three months ago. The creation of the double eyelid (red arrows) make the eye appears bigger by holding back the skin from the eyelid margin (blue arrows).
The blue arrows indicate the position of he upper eyelid before
the double eyelid surgery. As the skin falls over the lid margin,
the eye appears small. Following creation of double eyellid,
the skin is held back by the skin crease (red arrows) so that
the whole eye is now exposed making it appear bigger.