Subdermal placement of sutures in double eyelid surgery.

Increasing numbers of Asian patients of varying ethnicity are expressing preferences and expectations for a specific aesthetic appearance following double eyelid surgery. Those of Northern Mongolian ethnicity (Northern Chinese, Japanese, or Korean heritage) generally prefer a narrow crease, whereas those of Southern Mongolian ethnicity (Indonesian, Filipino, or Malaysian) prefer a wider fold. Older techniques performed until the mid-1990s resulted in a deep fold, giving the patients a more "Western" appearance. In this article, the author describes a modified technique of placing the suture in the subdermal layer, which allows for variety in the width of the fold, enabling the surgeon to retain anatomical aspects that are typical of each patient's ethnicity. With this technique, an Asian patient may now choose the width of fold that he or she prefers, resulting in a more ethnically natural look.