Dr. Edward S. Kwak is a New York City board certified surgeon specializing in facial plastic surgery. His focus is cosmetic surgical procedures strictly limited to the face and neck region.

Dr. Kwak graduated cum laude from Tufts University. His medical education began at Indiana University School of Medicine where he garnered several academic awards including induction to the Alpha Omega Alpha medical honor society and the Eli Lilly/K.K. Chen Pharmacology Award. After medical school, Dr. Kwak moved to New York City for his post graduate medical training. He studied one-year of general surgery at Saint Vincent's Hospital in Manhattan. After this year he went on to one of the country's most prestigious residencies in Otolaryngology-Head and Neck Surgery at The New York Eye and Ear Infirmary. As a resident, he earned the J. Swift Hanley award for his research in Head and Neck Surgery. Upon completion of residency, Dr. Kwak was chosen to one of the elite fellowships in facial plastic surgery at the University of Texas-Texas Medical Center in Houston, Texas, under the preceptorship of Dr. Russell Kridel and sponsorship of the American Academy of Facial Plastic and Reconstructive Surgery. Upon completion of his fellowship, Dr. Kwak traveled to Seoul, Korea where he served as a visiting surgeon to some of the country's most famous plastic surgery clinics.

Dr. Kwak has written several scientific articles and book chapters on numerous topics in facial plastic surgery. He continues to give national lectures on advanced Rhinoplasty techniques. Dr. Kwak is a Clinical Assistant Professor in Head & Neck Surgery at The New York Medical College and is also responsible for teaching in-training surgeons facial plastic surgery at Saint Vincent's Hospital and The New York Eye and Ear Infirmary.

In your experience, what's the most effective surgical technique for an Asian DES?

Asian double eyelid surgery is one of the most common cosmetic procedures performed on patients of East Asian decent. This procedure is done to create an upper eyelid crease. Approximately 50% of East Asians are born without a supratarsal fold (aka double eyelid crease).

This procedure can be performed using several techniques. But the major difference in techniques is whether the surgeon approaches this surgery using an incision or a suture technique (non-incision) to create a double eyelid fold.

Incisional technique

This is when an incision is made in the upper eyelid which is placed within the desired crease to be formed. The approach allows the best exposure to the upper eyelid anatomic structures and the surgeon can directly visualize specific changes made. There are some variations in this approach, such as limiting the size of the incision, or partial incision double eyelid surgery. This approach requires skin closure with sutures (stitches) to re-approximate the cut edges of the skin.

Pros: more predictable long-term outcomes, more control to create precise placement of the desired fold, able to address other anatomic factors to the eyelid (such as addressing upper eyelid fat deposits, excess muscle, and redundant upper eyelid skin).

Cons: increased healing time, increased potential for a conspicuous scar, and irreversible

Non-incision-suture technique

This technique involves the use of a suture to create the desired changes. The suture is passed through the upper eyelid structures in such a way, so as to create an upper eyelid crease, while positioning the suture to be concealed deep the upper eyelid skin. Typically this is performed without making an incision in the upper eyelid skin.

Pros: relative ease of performing the procedure, quick recovery time, reversible

Cons: Unable to address other structures in the eye (redundant skin, fat, or muscle), increased potential for loss of crease over time, increased potential for asymmetry, and higher rates of relapse (loss of fold).

While I perform both techniques, the approach I recommend is customized to each individual's concern. Factors, including your desired changes, your eyelid anatomy, and your lifestyle are all important consideration when determining which technique best suits you.

What is the healing time for this surgery?

Almost every perspective patient inquiring about Asian eyelid surgery, or double eyelid surgery, has concerns regarding healing time. Appropriately so, since many of my patients have highly demanding professions in the New York City metropolitan area.

For the incisional double eyelid technique, the typical postoperative healing time is as follows:

The first day after surgery, we have all patients return to our office to monitor their healing. At this time you can expect to have some swelling and potentially some bruising to the upper eyelid. Your eyelid crease height will be also exaggeratedly high, because of this swelling. On day 3-5, you will make a second post-operative visit to our office. On this visit, some or all of the skin sutures will be removed. On day 7, you will make a third post-operative visit to have any remaining skin sutures removed. At this time, most of the bruising has resolved and swelling to the eyelid has come down so that most patients feel very comfortable to return back to work. Week by week, the swelling in your eyelid will subside for up to 3-6 months after surgery, however most of the swelling will have resolved by one month after surgery.

The amount of bruising and swelling varies person to person, however to help minimize swelling after surgery, I recommend using ice packs to the eyes for the first 48 hours after surgery.

What are the various shapes that I can expect after a DES?

The most common cosmetic concern patients discuss with double eyelid surgery is the height of the crease/fold, which is the distance from your upper eyelid margin and the eyelid crease. I typically recommend a crease height of 2-3mm for most patients. In the central part of the upper eyelid the eyelid crease can take on two shapes: tapered or parallel. For the tapered shape the eyelid crease gradually tapers down to fuse with the upper eyelid margin. As for the parallel shape, the upper eyelid crease extends parallel to the upper eyelid margin maintaining a distinct crease shape.

One additional area of the eyelid which influences the shape of the upper eyelid and width of the eye appearance is the epicanthal fold. The epicanthal fold is present during early infancy in all ethnic groups. However in most ethnic groups as the face grows this fold becomes less apparent. In adulthood, the epicanthal fold is a unique feature to the Asian eye. The epicanthal fold is located on the middle portion of the Asian eyelid and is essentially redundant skin overlying the lacrimal lake (the pink portion of the central eyelid). The shape of the epicanthal fold can vary considerably, with a prominent fold creating a smaller appearance to the eye. An epicanthoplasty is a surgical procedure performed to change the shape of the epicanthal fold, typically to reduce this skin fold and to have more of the lacrimal lake showing, thereby increasing the overall width of the eye.

Edward S. Kwak MD
ESK Facial Plastic Surgery
170 West 12th Street
Spellman 5
New York, NY 10011
(212)-229-1100
(212)-229-1105 (fax)
www.eskfps.com

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