Monolid

Disease Description (Causes and Symptoms)

• Definition: A single eyelid (monolid) refers to a condition in which there is no double fold in the upper eyelid. Medically, this means that the adhesion that pulls the skin between the skin and the levator aponeurosis is weak or absent, so a crease (supratarsal fold) does not form.
• Causes/Pathophysiology:
  • Genetic and ethnic predisposition: Double eyelid formation tends to be less common among people of East Asian descent. The epicanthal fold (Mongolian fold), thick subcutaneous fat/preaponeurotic fat, and other factors affect fold formation.
  • Anatomical factors: Insufficient adhesion between the skin and levator aponeurosis, excessive fat, and characteristics of the eyelid skin (thinness or thickness) can interfere with double eyelid formation.
• Main symptoms:
  • In most cases, an appearance-related characteristic (absence of a double eyelid) without functional problems.
  • In rare cases, drooping skin or excessive fat may cause visual field impairment, fatigue, or drooping of the eyelid (ptosis).
  • Related complications (not a direct cause): When eyelid inflammation or irritation, such as entropion (a condition in which the eyelashes poke the eyeball), is present, vision or ocular surface problems may occur.
• Department: Mainly plastic surgery (blepharoplasty); collaboration with ophthalmology if necessary.

Treatment Methods

• Conservative (nonsurgical)
  • Makeup, double eyelid tape or glue (temporary methods)
  • No separate treatment is necessary if appearance-related or psychological discomfort is not significant
• Surgical
  • Buried suture method (non-incisional method): A method of creating a crease with sutures without making a skin incision. Suitable for young people with little subcutaneous fat. Advantages: small scars and quick recovery. Disadvantage: the crease may loosen over time.
  • Incisional method: A method of creating a double eyelid line by making a skin incision and excising or repositioning part of the skin, muscle, and fat. It can be applied to various eye shapes because fat removal and repositioning are possible. Advantage: a permanent result may be possible. Disadvantage: a scar along the incision (generally concealed naturally).
  • Combined surgery: Can be performed simultaneously with ptosis correction, lower blepharoplasty (removal/repositioning of fat under the eyes), medial canthoplasty (epicanthoplasty), and other procedures.
  • Anesthesia and recovery: Generally performed under local anesthesia, with a sedative if necessary. Sutures are usually removed 4–5 days after surgery.
• Medications/adjunctive treatment: Antibiotics and pain relievers may be prescribed after surgery, and cold compresses and eye drops may be used.
• Risks of complications and precautions
  • Bleeding/hematoma, infection, scarring, asymmetry, loosening of the double eyelid (especially with the buried suture method), overcorrection/undercorrection, dryness or excessive tearing, and, rarely, vision damage (extremely rare).
  • Avoidance of smoking and aspirin- or NSAID-class medications for 2 weeks before surgery is recommended (to reduce the risk of bleeding).
• Prognosis
  • With appropriate surgery, the rates of cosmetic and functional improvement are high. Because the non-incisional method may loosen, the revision surgery rate is relatively high.

Checklist Before an Outpatient Visit (Items to Bring and Example Questions)

• Items/information to bring
  • List of medications currently being taken (including anticoagulants)
  • History of previous ophthalmic or plastic surgery and test results, if available
  • History of allergies (medications, anesthetics, etc.)
  • Smoking status and any blood-clotting disorder or history of bleeding (e.g., gum bleeding)
  • Recent eye symptoms (visual changes, dry eyes, tearing, pain, or irritation)
  • Photos of the desired eye shape (reference images), including front-facing and side-view photos of both eyes
• Items to record in advance
  • When symptoms began and how they have changed (including whether there is asymmetry)
  • Attempts to create a double eyelid (experience using tape or glue) and the results
  • Expectations for surgery (natural appearance, more defined eyes, etc.)
• Example questions for patients to consider themselves
  • Have there been any recent decreases in vision or sensations of a foreign body?
  • Is the visual field obstructed by drooping eyelids?
  • Is there a family history of bleeding or blood disorders?

General Example Questions to Ask the Doctor

• "Given my eye structure (subcutaneous fat, ptosis, etc.), is the incisional method or the buried suture method most appropriate for me?"
• "How long is the recovery period after surgery, and when can I return to daily activities?"
• "What are the main complications of the surgery, and how often do they occur?"
• "How likely is the double eyelid line to loosen after surgery, and when can revision surgery be performed?"
• "If I have a systemic disease (such as thyroid disease or diabetes), how will it affect the surgery?"

Examples of Condition-Specific Questions

• "My eyes have a lot of subcutaneous fat and thick skin. Is it possible to create natural double eyelids with the buried suture method, or is the incisional method necessary?"
• "I also have ptosis. Can it be corrected at the same time as double eyelid surgery? If so, what additional risks are there?"

Additional Information

• Typical postoperative care: For 2–3 days after surgery, elevate the head with pillows and use cold compresses to reduce swelling; makeup can usually be applied the day after suture removal (4–5 days); return to daily activities is usually possible after around 1 week, although bruising and swelling may persist for 2–3 weeks.
• Department in charge: Plastic surgery (with collaboration with ophthalmology if necessary)