Lower eyelid aging changes were involved in the transformation of the three parts of the orbicularis oculi muscle, the relaxation of the suborbicularis retaining fasciae, the disappearance of the preseptal adipose tissue area due to orbital fat herniation, and the indistinctness of the palisade structure of the retinacula cutis.
About 90% of blepharoplasties performed in Japan include the double eyelid procedure. The reasons for the popularity of this procedure relate to changing concepts of beauty among the Japanese people. Facial anatomy contributes to the appearance of sleepiness and lethargy in the flat, monotone Japanese face. The narrower eye opening does not allow for the maximum viewing of the cornea. The shortened lateral canthus presents a facial balance that is not considered as attractive as one with an extended lateral canthus. The double eyelid procedure corrects these features, producing a face that is considered more beautiful.
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