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Which technique/procedure would you use to create a higher crease? A woman wants a double eyelid with a higher eyelid crease. She is confused between incisional and non-incisional approaches for Asian double eyelid surgery. Dr. Amiya Prasad is an oculofacial plastic surgeon who specializes in eyelid surgery, and has been doing Asian eyelid surgery for over 20 years. His personal philosophy about Asian eyelid surgery is that he wants patients to look as if they were born with that eyelid crease. Anyone who sees them should not think they had eyelid surgery. For Asian eyelid surgery, a high crease which is beyond a few millimeters, or 6-8 millimeters above the eyelashes tends to look unnatural. It’s natural to have a certain fold over the skin so that it looks like the patient was born with the crease. However, to create a higher crease, fat should be reduced and taken out very aggressively. Unfortunately, when fat is taken out, a hollow space is created which will make someone look older. As people of Asian origin get older, there’s a loss of fat in the upper eye area. On a younger Asian person, a volume of fat gives them a lot of fullness. As they get older, the area of the orbit or the upper part around the eye starts to look very hollow. The debate between incisional versus non-incisional approach depends a lot on skin tone, quality, and tension. Dr. Prasad had patients who preferred the incisional approach because they were under the impression that incisional is better. Certainly there’s a lot of value with that approach because of more direct visualization and control. However, in his experience, in the right patient, the non-incisional procedure is a great procedure and can look very good. Dr. Prasad suggests that this woman meet with actual surgeons who perform a lot of Asian eyelid surgeries and learn about these options. He explains that there are more than a few options, but she must have a certain vision as to how high she wants her crease. She should make sure that her doctor share her vision and be able to attain that result. For more information about Asian eyelid surgery, please visit our website: http://prasadcosmeticsurgery.com/pras...