About half of all Asians have upper eyelids that appear to be taunt and heavy from the eyebrow down to the eyelashes. That condition is simply known as a “single fold” eye. To create an eye that is more open and appears larger, many Asians request a cosmetic plastic surgery procedure known as “double eyelid surgery.”

Even within Asian families, some will have single eyelids while others have eyelids with a crease above the eyelashes. Many patients requesting double eyelid surgery tell me they were often envious of their brothers and sisters with the double eyelid. For women, a double eyelid also means that makeup goes on easier and looks better. Others simply enjoy having a more open, slightly larger eye with eyelashes that are easier to see.

Many prospective patients say a single eyelid makes them look sleepy or tired and that it makes their eyes look too small. Most Asian patients don’t want to change the natural almond shape of their eyes, but just have eyelids that are less heavy looking, with brighter eyes.

Double Eyelid Surgery Candidates

“Double eyelid” is applied to describe Asian eyelids where there is a defined upper eyelid fold above the eyelashes with and exposed eyelid platform. There is great variation in eyelids and not every eyelid has a double fold. The fold is created by a crease at the top of the eyelid platform under the fold. This crease represents a defined attachment between the eyelid skin and the tendon that raises the upper eyelid. The Double fold creates definition in the upper eyelid and it is generally considered desirable in both men and women. For women, the defined platform also creates a protected place to apply make up and further beautify the eyes.

The first thing to understand when considering double eyelid surgery is that everyone’s eyelids drop and sag with advancing age.

Some people experience functional problems with their eyes as a result of this natural sagging, making it difficult for them to read, drive and perform other activities. Blephaloplasty removes the unwanted extra skin and fat that causes drooping and sagging. The procedure also reshapes the overall look of the eyelid by reinforcing the muscles and tendons around the eyes. Many patients report, upon recovering from it, an enhanced appearance and a new lease on life due to their new look.

If you’re upper eyelids hang over your eyes and make it difficult for you to see, you should seriously consider this method. Your lids may have gotten in the way of natural vision in the past and provided a daily reminder to do something about it, well now is the time! It can correct the problem you may have struggled with for years.

If you’re interested in lower eyelid blephaloplasty, the reasons are probably cosmetic. Some people find ‘bags’ under the eyes unattractive and cumbersome, but they are not usually obstructive to vision.

Double eyelid surgery is extremely popular in most Asian nations and has been performed for many decades, long before the infiltration of Western media and before Hollywood movie stars became popular there.

Double Eyelid Surgery Results

The procedure is currently extremely popular among Asian movie stars because a larger, more open eye is a sign of youth and vigor among all nationalities. Consequently, many Asian patients requesting the procedure are in their teens, twenties, and thirties. Plastic surgeons have several methods available to create a double eyelid, with each offering its own advantages, depending on the patient’s anatomy and wishes.

Many prospective patients say a single eyelid makes them look sleepy or tired and that it makes their eyes look too small. Most Asian patients don’t want to change the natural almond shape of their eyes, but just have eyelids that are less heavy looking, with brighter eyes.

What Double Eyelid Surgery Does Not Do

Double eyelid surgery is not about westernizing the eyes, which is a common mischaracterization. Both the double eyelid and its absence are common in Asian people. Some people who don’t have a double eyelid wish to obtain one, but they worry that this means they have to “westernize” their appearance. This is not an accurate depiction although this was how the surgery was characterized in the past and is sometimes described in articles where the writer does not understand the purpose of the surgery.

Double fold surgery aims to create a natural appearance by creating a well defined upper eyelid fold. This is accomplished by creating a low crease and removing a small amount of skin, while leaving the rest of the eye’s natural appearance intact. Unfortunately, there are practioners who make the crease too high and take too much skin and this type of poorly designed surgery can harm the appearance. The key is to go to an very experienced eyelid surgeon who has thoroughly mastered the procedure and understands what needs to be accomplished. The goal is the conservation of normal eyelid structure while providing complementary eyelid definition in accordance with what you desire your eyes to look like.

Is Double Eyelid Surgery Right For Me?

An eye’s size is usually measured by how much of the white area, otherwise known as the sclera, can be seen. Eyes that appear small may be the result of upper eyelid ptosis, or “droopy” lids, or they may mean you have deep set eyes. Depending on your condition, the surgical approach will vary. Often the double eyelid surgery makes the eyes appear larger by adding definition and naturally framing the eye with aesthetic contours. As always, the best approach is a flexible one that relies on a careful physical examination and weighing the options to choose the best method. There is no standard surgery or procedure for small eyes – surgery must always be adapted to the individual circumstances.

If you are worried about other issues including asymmetry or a tired look, these are again best addressed on an individual basis. All aesthetic reconstructive eyelid surgeries must be tailored and adapted for the unique characteristics of your eyelid. For this reason, it’s best to find a doctor who specializes in eyelid treatment and who has helped people with widely varying eyelids obtain the best possible results. There are certainly procedures besides the double eyelid surgery that may be right for you and a doctor who understands the anatomy and variations in Asian eyes will be able to help.

Double Eyelid Surgery Overview

Asian blepharoplasty is a relatively simple and quick plastic surgery procedure that involves removing a tiny bit of excess skin, some under-skin tissue, and a tiny amount of fat pads. The procedure itself is similar to conventional upper eyelid surgery. However, Asian double eyelid plastic surgery requires the surgeon to have intimate knowledge of where to make the incisions, how much tissue and fat to remove, and where to place the crease.

The majority of Asian blepharoplasty procedures are done as outpatient surgery, so most patients can return home the day of their procedure.


Double eyelid surgery is usually performed under local anesthesia with I.V. sedation. The patient’s eyelids are completely numb during surgery so that he or she senses only a little pulling and pressure. General anesthesia is not helpful because the surgeon must ask the patient some questions — and receive clear answers — during the procedure. A surgeon trained and experienced in the double eyelid operation usually needs about an hour to perform his work.

Double Eyelid Surgery Incision

Exact surgical technique will vary surgeon to surgeon depending upon his or her training, experience, and preferences. Likewise, variations in preexisting patient eyelid-facial anatomy will require a customized approach in each individual.

Because Asian skin is said to be “more reactive,” incisions are best make with a scalpel instead of the laser to minimize scarring.

The skin is incised with a scalpel at a height dictated by measurements of certain existing anatomical landmarks. The incision may be tapered into the epicanthal fold towards the nose (if desired) and/or flared slightly upwards at its outer end (if desired).

Most typically, a small strip of skin above this initial incision is excised using scissors. The amount of skin removed varies depending upon the proposed height of the new crease as well as preexisting anatomical conditions. In some cases, no skin is removed.

The incision is carried deeper into the eyelid through the orbicularis muscle and orbital septum until the orbital fat is exposed.

Small strips of orbicularis muscle and orbital septum are excised. The amount and location of orbital fat removed has a significant influence on the height, shape, and depth of the new crease. In most cases, no fat is removed.

The levator aponeurosis (tendon) is identified just beneath the fat. In contrast to an older form of incisional double eyelid surgery known as “anchor blepharoplasty,” the levator aponeurosis is not aggressively exposed or detached from its connection to the tarsal plate, a step that is, in our opinion, unnecessary to formation of a natural-appearing crease and invites a higher incidence of serious complications such as ptosis, lid retraction, or peaking of the eyelid margin.

Closing the Incisions

Wound closure employs a “deep-fixation” technique to create an attachment between the aponeurosis and the dermal layer of skin. Following suture removal, internal scars at these points of fixation act much like “spot welds.”

The final crease height and shape are the result of both selective tissue removal and precise internal tissue rearrangement. The operation may be used to create tapered, parallel, lateral flare, and, rarely, semilunar shaped creases or to correct incomplete or multiple creases. The incisional approach is considered the “gold standard” in Asian double eyelid surgery.

While some older incisional methods create deep fixation through the use of permanent internal stitches sewn into the tarsus, we have found this approach to be less stable and more likely to cause crease irregularity and scarring. We have developed our own method of deep fixation that leaves behind no suture fragments.

After Double Eyelid

Aesthetic double eyelid surgery has the effect of making you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your eyelid surgery. Incisions will fade over a number of months until they become barely visible.

The results of aesthetic double eyelid surgery are long-lasting, but they may be affected by your heredity and lifestyle factors.

Removal of fat from your eyelids, which is usually the cause of puffiness and bags, is permanent, and these conditions generally will not recur. The skin continues to age, however, and skin laxity along the fine wrinkling of the eyelid area may, at some point, return. Sometimes loss of tone in the forehead causes additional sagging of the eyebrows which mimics a recurrence of drooping upper eyelids. if this happens, correction may require a forehead lift or a secondary eyelid procedure.

Even though the aging process continues, patients are usually happy with their appearance for many years following double eyelid surgery. Some patients find that they want to make additional improvements at a later time.

Double Eyelid Surgery Recovery

Post-surgical discomfort is very mild; many patients find that Tylenol is adequate, although they have recourse to stronger pain killers. Sutures are removed on the fourth or fifth day; most bruising is gone after a week while vigorous exercise should be delayed for about ten days.

While some swelling, bruising, and discoloration can be expected for the week or so after the Asian blepharoplasty procedure, following the surgeon’s post-operative directions for eyelid surgery recovery will minimize these side effects and help the eyelids heal quicker.

When You Return Home

If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur after breast augmentation, you may require hospitalization and additional treatment.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

Double Eyelid Surgery Post-Op Care

After undergoing eye rejuvenation surgery, certain eye creams can help maintain the youthful appearance. and aid in the healing process of the eyelid.

Double Eyelid Surgery Risks

Asian blepharoplasty, like all surgery, has risks and benefits that should be understood upfront. While a bad reaction to anesthesia is not a common complication, it can occur. Asian blepharoplasty is also a more complicated surgery than traditional blepharoplasty, one that takes longer and requires going deeper into the eyelid to perform. Complete recovery after double eyelid surgery may take up to six weeks, though the average time may be half as long.

Other risks of Asian blepharoplasty include those commonly associated with traditional eyelid surgery: scarring, swelling, droopy eyelids, sagging eyebrows, asymmetry and general dissatisfaction with the cosmetic results.

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