Causes, Prevention, and Treatment
Sanpaku is a Japanese word that translates to “three whites”. Sanpaku eye is a condition in which the white of the eye, or sclera, is visible from three sides of the eye rather than the usual two sides. (1)
Humans generally have the iris, the colored part of the eye, structurally situated at the middle of the eye covered by upper and lower eyelids with no scleral show above or beneath. However, when the sclera is visualized beyond the left and right side of the iris, it is believed to signify that the synchronization between the mind, body, and soul is off and there’s remarkable neurological instability. Sanpaku eyes are symbolic of certain physical and/or psychological imbalances in the body in Oriental Medicine.
Types of Sanpaku Eyes
There are mainly two types of sanpaku, these are:
Individuals with either of these conditions are believed to be accident-prone and tend to entice violent activities by Japanese superstition.
Yang Sanpaku(Sanpaku Above)
These are the sanpaku eyes where the sclera is visible above the iris. Yang sanpaku is supposedly an indication of mental imbalance in individuals who are unhinged and filled with uncontrollable aggression such as psychopathic, murderers, or serial killers. (2)
Yin Sanpaku(Sanpaku Below)
These are sanpaku eyes with sclera visible beneath the iris. Yin sanpaku is believed to represent a certain physical imbalance in the body and is supposedly present in substance abusers, alcoholics, and individuals who indulge in sugar-rich foods and grains.
In Western Medicine
In a healthy human face, the sclera doesn’t appear above or below the iris. When the appearance of the sclera is exaggerated and it appears beyond the usual, it is medically termed as a “scleral show”. If the sclera is exposed above the iris, it’s an “upper scleral show” and if it is exposed below the iris, it’s called the “lower scleral show”. Western medicine states that such an appearance, most likely, is caused by various health-related/medical conditions rather than an indication of any personality trait. (3)
How Do Sanpaku Eyes Affect Facial Aesthetics?
As there’s excessive visualization of the sclera, the whites of the eyes become readily noticeable. Sanpaku eyes are usually creaseless which makes the eyes appear more distant and older. Individuals with sanpaku eyes are often mistaken for having squints as the eyelids appear to meet at the bridge of the nose. Sanpaku eyes are pretty similar to a surprised expression, so these create a “surprised look” even when the individuals are not. Additionally, sanpaku eyes’ appearance has long been depicted as someone who is being deceitful. Hence, this condition creates rather unpleasant effects on individuals aesthetically.
Billie Eilish shown below is a very prominent example of Sanpaku eyes, with her sclera being exposed below the iris, giving her a characteristically disinterested look. This can work to an aesthetic advantage to differentiate one’s face, but in many cases, as Sanpaku eyes form from some form of bone-structure weakness (scleral show or a weak midface), the eyes are paired with a host of other undesirable characteristics such as a ‘bug-eyed’ look.
What are the causes of Sanpaku eyes?
Many health and wellness-related conditions can result in sanpaku eyes. Some of the conditions that are believed to be commonly associated with this appearance are:
- Fatigue (4)
- High blood pressure
- Bad posture: causes improper eye muscle balance
- Poor blood circulation to the head over time
- Endocrine imbalance
- Physical trauma (5)
- Congenital craniofacial anomalies
- The complication of plastic surgical procedures such as Blepharoplasty or Liposuction (6)
How are Sanpaku eyes treated?
Nowadays, it is commonly believed that sanpaku eyes are a result of the downward pull or the drooping of the eye muscles. Individuals with round-shaped faces and thin skin are more prone to suffer from this condition. Varieties of natural remedies and surgical treatments are available to reduce this unusual appearance and achieve a more balanced look.
Some of the most common ways to minimize the appearance of sanpaku eyes are:
- A healthy diet and hydration
- Adequate sleep
- Regular exercise
- Balanced body weight
- Eyesight exercises
- Routine eye care
- Avoid dark eyeshadows
- Treatment of medical conditions
Hyaluronic acid fillers
HA fillers have vast uses in aesthetic dermatological treatments for rejuvenation and beautification, as well as in treatments. HA fillers can improve the scleral show as well as provide elevation of the lateral corner of the eye in correspondence with the medial corner by adding volume, expanding the local tissue, and raising the lateral corner of the lower eyelid. (7)
A board-certified plastic surgeon can evaluate your condition and help you decide the best possible surgical procedure to get rid of this unsightly appearance. Plastic surgery is the most definitive treatment of sanpaku eyes. However, thorough examination, treatment of underlying causes if any, and weighing in risks and benefits by the surgeon are crucial before going under the knife.
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- Burley, D. T., Gray, N. S., & Snowden, R. J. (2019). Emotional modulation of the pupil response in psychopathy. Personality disorders, 10(4), 365–375. https://doi.org/10.1037/per0000313
- Loeb R. (1988). Scleral show. Aesthetic plastic surgery, 12(3), 165–170. https://doi.org/10.1007/BF01570927
- Bhola, R., Saxena, R., Sethi, H. S., Sharma, P., Panda, A., & Sen, S. (2006). Bilateral dissociated vertical deviation in a case of congenital hereditary endothelial dystrophy. Indian journal of ophthalmology, 54(1), 41–42. https://doi.org/10.4103/0301-4738.21614
- Tenzel R. R. (1981). Complications of blepharoplasty. Orbital hematoma, ectropion, and scleral show. Clinics in plastic surgery, 8(4), 797–802.
- Bravo, B., Totti, J., Gelpi, B., Bianco de Souza, S., & Bravo, L. G. (2018). Use of Hyaluronic Acid Fillers to Correct Scleral Show: A Review of Technique. The Journal of clinical and aesthetic dermatology, 11(6), 38–40.