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Julie Chen’s Double fold surgery not understood by the media.

Published onJanuary 7, 2014

This past month on The Talk, Julie Chen shared a personal secret that in the ‘90s while working at a TV station she was informed that she would never be on the anchor desk because she was Chinese. Ms. Chen actually presented a very subtle and nuanced discussion about why she ultimately went forward with double fold surgery. Her motivations were truly intermixed with both the racist attitudes of the day and the real reasons that many Asians seek double fold surgery.

Unfortunately the message is too subtle for mainstream American culture to understand. They prefer to understand the Julie Chen story as a young Asian who was forced to compromise her cultural identity and have her eyes “Westernized,” so she could climb the ladder to success. However, her story is much more layered than that. She had a physical issue: she lacked a double fold and had upper eyelid ptosis. These two physical issues are commonly seen in Asian eyelids. Ptosis means that the upper eyelid margin is too low on the eye. In addition to this she lacked an eyelid platform, which is a fixed area of skin above the upper eyelid lashes. This platform of skin is needed to hold eye makeup.

She was advised by a high level agent, who knew what he was talking about, that these two issues would affect her marketability on television. As she freely admits, her career took off after she had these physical issues addressed surgically. Her pictures also suggest that she had rhinoplasty but she has denied this. Make no mistake, she did not “Westernize” her eyelids. What she did was make it possible for others to see her eyes, which improved and enhanced her physical attractiveness. This small surgery made a huge difference in her career. Her surgery was a specialized Asian cosmetic eyelid surgery.

Double Eyelid Surgery

Asian blepharoplasty, also known as “double eyelid surgery” and “double fold surgery”, is cosmetic eyelid surgery that either creates an eyelid platform and an upper eyelid fold where none existed or improves an existing double fold. Scientific research has found that the eyes contribute significantly to the subjective assessment of beauty. While the perception of beauty is subjective, evolutionary neuropsychologists have found certain Universal standards of beauty including eyes that are larger, wider and more prominent. The upper eyelid crease serves to frame the eye and together with the aid of proper makeup, the appearance of the eye is esthetically enhanced. In contrast, the lack of a double fold with a well-defined upper eyelid platform, a droopy eyelid contribute to a slow, dull, or disinterested appearance. Double fold surgery is used to define an upper eyelid platform. It is limited superiorly by the crease and covered by the upper eyelid fold. The goal is preservation of the typical Asian eyelid with a limited but well define and even platform visible below the fold. It is essential that there be a fold that partially covers the upper eyelid platform. The platform skin and the muscle underlying the platform skin needs to be properly tensioned to the levator aponeurosis, the tendon that opens the upper eyelid. This transfers tension to the eyelashes. Done correctly, this helps support the eyelashes so they do not overly shade the eye. This contributes to a bright-eyed appearance.

The Procedure

It is far too easy to underestimate the challenges of double fold surgery. Double fold surgery is an exercise in extreme precision and finesse. No two eyelids are symmetric, yet our vision is capable discerning small difference between the eyes. This requires the surgeon to endeavor for a level of accuracy that is actually beyond what can reasonably be expected due to how the tissues heal. Dealing with this conundrum requires artfulness. The pre-operative assessment must be very detailed to design a surgery that encompasses the issues that must be addressed to realize the best possible outcome.

Beyond the lack of a fold, the true upper eyelid position must be assessed to determine if the eyelid is ptotic or droopy. Correcting this requires ptosis surgery, which is separate from what is normally thought of as double fold surgery-the creation of an upper eyelid crease and the removal of the correct amount of upper eyelid skin. During the assessment, the surgeon in consultation with the patient needs to decide how much platform is to show below the upper eyelid fold. The crease height then needs to be determined. Many textbooks describe how the upper eyelid crease should be placed at 10 mm for women. This is far too high for double fold. These eyelids need creases at 5.5 to 6.5 mm. The eyelid crease is the lower edge of the upper eyelid excision. The upper edge of this excision is determinied by how much skin is being removed. This is determined by the desired platform show. It is not unusual to only remove a few millimeters of upper eyelid skin with these surgeries. What is left is far more important than what is removed.

Generally almost no fat is removed from the upper eyelid in these surgeries. It is actually very important to preserve upper fold volume. Classical anchor blepharoplasty is then performed to precisely attach the upper cut edge of the eyelid platform to the levator aponeurosis. The levator aponeurosis is the tendon of the upper eyelid that raises the upper eyelid when the eye opens. When the platform is precisely defined, the skin and underlying platform of the upper eyelid heals with a snug appearance, which makes a suitable place for eye makeup.

Initially the swelling of the upper eyelid makes the upper eyelid crease look high. If this is not the case, it may be an early indication that too much skin was left in the eyelid. Generally within a couple of weeks of surgery, there is enough healing that strangers stop asking what happened. Generally it is a couple of months of healing before the crease begins to fall to a reasonable height. However, it is still many more months before all of the swelling disappears and a final result can reasonably be declared.

Repairing Unsatisfactory Work

World famous Beverly Hills Eye Plastic Surgeon, Kenneth Steinsapir, M.D. does amazing double fold surgery. Perhaps more remarkable is the repair work that he is able to accomplish to correct improperly done double fold surgery. The methods he uses are complex and often designed for unique individual situations. Using his vast experience and his detailed understand of the Asian eyelid, he has been successful in repairing and improving eyelids that others have described as impossible and beyond hope.

The Impact

Undergoing a double fold surgery can make a tremendous difference in your appearance. It can correct puffiness in the upper eyelids that causes the eyes to appear tired. When needed, this work can be combined with ptosis surgery to create a much brighter looking eye. For many, it will help increase their level of confidence in themselves. The story of Julie Chen exemplifies the impact this type of surgery can make. It is not about Westernizing the eyelid. It is about your personal aesthetic to be your best.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.