Q: Sources & studies

Cho, In. “Revision Upper Blepharoplasty.” Seminars in Plastic Surgery , vol. 29, no. 03, Aug. 2015. International Society of Aesthetic Plastic Surgery, 2021, ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2021. Korea Gallup, 2015, Survey on Appearance and Perception of Plastic Surgery . Nguyen, Marilyn, et al. “Asian Blepharoplasty.” Seminars in Plastic Surgery , vol. 23, no. 03, Aug. 2009.

Question 1

What is double eyelid surgery?

Accepted Answer

Double eyelid surgery creates a crease in an upper eyelid that has none, or adds more definition to an existing but subtle crease. “Without a crease, the eyelid skin folds just above the lash line, making the eye appear smaller,” explains Dr. Mitesh Kapadia, a board-certified oculoplastic surgeon in Boston.

Turning the upper eyelid from a monolid (“single eyelid”) into a double eyelid, with two defined sections divided by a crease, makes eyes look larger, rounder, and more open. This procedure can also reduce the puffy and tired look that can come with hooded lids, by removing extra skin and fat.

In some cases, a double eyelid procedure can even improve vision.

Double eyelid surgery doesn’t affect the lower lids, but it can be combined with lower eyelid surgery (blepharoplasty) to remove loose skin, excess fat, or reposition the fat pads to eliminate under-eye hollows.

Sometimes called Asian eyelid surgery or an Asian blepharoplasty, the procedure is particularly popular with patients of East Asian descent, half of whom don’t have an upper eyelid crease. It’s the most commonly performed cosmetic procedure for East Asian patients, helping make eyelid surgery the third most popular type of plastic surgery worldwide, according to the International Society of Aesthetic Plastic Surgery.

Though the procedure is most popular among women, about 5% of patients are men, reports Dr. Chase Lay, a board-certified facial plastic surgeon in San Jose, California,. “They come for the same reasons as women—to achieve better symmetry and more alert-looking eyes and, in some cases, to relieve a feeling of heaviness on the lids,” says Dr. Lay.

RealSelf Tip: While some consider this procedure to be an attempt at Westernization of the Asian eyelid, the first description of the procedure was actually published in the late 1800s, long before a strong Western cultural influence in East Asia, according to one article. The initial operation was intended to create a more expressive look, as single eyelids with no distinct crease were thought by some to be “monotonous and impassive.”

Question 2

What are the pros and cons of double eyelid surgery?

Accepted Answer

Pros

This one-hour outpatient procedure is performed in a surgeon’s office under local anesthetic with sedation, so you’re awake but drowsy and relaxed.
Scars are typically disguised in your new eyelid creases.
Along with creating an upper eyelid crease, this type of cosmetic surgery can also lift sagging or drooping eyelids and remove excess skin or fat.
It creates a more significant “platform” for eye shadow and makes eyeliner application easier.
Because lids without a crease often overhang the eyelashes and make them appear shorter, this procedure may even make your lashes look longer.
Double eyelid surgery has high patient satisfaction. Reviewers on RealSelf give it an type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating, with many praising natural-looking results with a relatively quick recovery.

Cons

You can expect some bruising and swelling for at least the first week of recovery.
Though the procedure can make your eyes look bigger, it will not make more of the eye itself visible. To “enlarge” the eye and enhance your eye shape, surgeons often need to tighten the muscles that help open the eyes (which enlarges the vertical opening of the eye) or open the inner and/or outer corners of the eyes, procedures known as epicanthoplasty and canthoplasty, respectively. Your surgeon should be able to show you with a mirror how you’d look with these eyelid procedures.
Double eyelid procedures have a higher revision rate than traditional blepharoplasty; globally, it’s as high as 10%. The main reasons for revision are one crease ending up “stronger” than the other, or the height of the creases being slightly different, according to Dr. Kapadia. Asymmetric folds, the most common complication after double eyelid surgery, occur in as many as 35% of cases, and some reviewers on RealSelf rated their procedure “Not Worth It” because of asymmetrical results. “Double eyelid surgery is really different from traditional eyelid surgery, so it’s important to find a surgeon with Asian-eyelid experience,” notes Dr. Kapadia.

Question 3

How much does double eyelid surgery cost?

Accepted Answer

Your surgeon’s level of experience, their reputation, and their practice location will affect your price. You’ll also pay more for a more complex procedure.

This surgery differs from a standard blepharoplasty and requires detailed knowledge of Asian-eyelid anatomy, so seeing an experienced surgeon is especially important. Choosing based on price alone may leave you with a complication that necessitates revision surgery, at additional cost to you.

Insurance may cover some of the cost of this procedure if you have severely drooping lids that impair your vision—a medical condition known as ptosis. Your surgeon will be able to perform a visual field test to see if you’d qualify for insurance coverage.

See our complete guide to double eyelid surgery costs

Question 4

Double eyelid surgery before and after pictures

Accepted Answer

The double eyelid surgery photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Question 5

How does double eyelid surgery work?

Accepted Answer

Before your surgery, you’ll have a consultation with your doctor to discuss the look you’d like to achieve—the crease size, shape, and position that best compliments your features and facial structure.

“The better idea you have about what you’re trying to accomplish, the more helpful it is in making a surgical plan,” says Dr. Brian Biesman, a board-certified oculoplastic surgeon in Nashville. “There are different types of upper-lid creases, and there may be cultural preferences for the look of the crease.”

Asian eyelids typically have more fat than non-Asian eyelids, so to retain the “Asian” appearance of the lid, much less fat is typically removed from the lid than it would be for non-Asian patients.

Many Asian patients also have epicanthus, eyelid skin covering the inside corner of the eye. You may choose to have the epicanthus eliminated, or you can retain it, creating a more subtle change in appearance.

To help make sure you’re on the same page as your surgeon, bring photos showing your desired outcome. “This can be a good starting point, especially if you have some features in common with the person in the photo,” says Dr. Lay.

Double eyelid surgery is an outpatient procedure that takes about an hour. Here’s what to expect on the day of your surgery.

First, your surgeon will carefully measure your upper lid and use a pen to mark the best location for a natural-looking crease.
They’ll give you local anesthesia, to numb the area thoroughly, and oral sedation. The anesthetic shots can reportedly be extremely painful, but once they take effect, you shouldn’t feel discomfort during the procedure.

Your surgeon will then use one of these techniques to create the crease.

The open technique (or incisional technique)

This is the most commonly performed technique.

The surgeon makes an incision parallel to the lash line, just above the desired crease, and removes a crescent-shaped strip of upper eyelid skin and excess fat.
“Several internal stitches attach the incised skin to the underlying tendon and/or cartilage, and then a surface suture stitches the skin back together, to create the crease,” says Dr. Charles Lee, a board-certified plastic surgeon in Beverly Hills, California.
This technique is the most reliable and effective, and nearly everyone is a candidate for it.
Though the incision technique leaves a small (albeit well-hidden) scar, it creates a strong, usually permanent eyelid crease.
The main disadvantage is a longer recovery time, with several weeks of swelling—and often several months’ wait to see the final result.

The suture technique (or non-incisional technique)

This surgical technique is less common.

The surgeon makes a series of three to six small incisions in the skin for sutures to pass into the connective tissue and muscle below, to “literally quilt a crease into position,” explains Dr. Lay.
The sutures are hidden underneath the skin and left permanently.
Recovery is quicker, since there are no incisions.
Results are more easily reversed, if you don’t like them.
However, results are considered far less reliable. “It may last six months or 60 years,” says Dr. Lay.
The suture technique works best for very young patients with thin eyelid skin who don’t need extra skin and fat excised and don’t wear contact lenses.

With either technique, you’ll be able to walk out on your own after your surgery, but you’ll be groggy enough that you’ll need to have a friend or family member accompany you home. Expect to take it easy that first day.

Question 6

Will double eyelid surgery lower the eyebrows?

Accepted Answer

This procedure can have a brow-lowering effect for people who have used their eyebrows to open up their eyes over the years.

“Removing the upper eyelid fold that rests on the eyelashes will reduce the stimulus to lift the eyebrows,” says Dr. Kenneth Steinsapir, a board-certified oculoplastic surgeon in Beverly Hills, California. “For this reason, the forehead will relax, and the eyebrows will settle after upper eyelid surgery.”

It can be hard to predict the result, but Dr. Steinsapir says it’s generally considered very helpful because it also helps to soften the look of the brow.

Question 7

How long does double eyelid surgery recovery take?

Accepted Answer

Recovery time depends on the type of procedure you have.

A suture-only technique typically results in mild swelling that lasts two to three days. Apply light ice packs or cold compresses as often as your surgeon recommends, to help reduce this swelling. Patients can often return to work and regular activities within 12–24 hours.
After incisional or open surgery, you’ll likely have visible sutures and swelling for up to two weeks, with some lingering swelling for up to six months post-op. Sutures come out 5–14 days after surgery. “Most people look decent in two to three weeks, and you can camouflage the healing with light eye makeup,” says Dr. Lay. Light exercise, such as walking, is okay a few days after surgery. Still, you’ll be asked to refrain from strenuous activity for up to three weeks.

Question 8

How soon will you see your results?

Accepted Answer

You’ll see your initial results from double eyelid surgery within two to three weeks, as the worst of the swelling resolves. Expect subtle changes over the next six months, while the rest of the swelling dissipates.

Keep in mind that swelling makes the lid crease appear higher than where it will end up. As the swelling decreases, the crease will settle into its intended position.

There’s a small, usually barely visible scar in the eyelid crease, along the incision line, which continues to fade for 12–18 months post-surgery.

Question 9

Is double eyelid surgery permanent?

Accepted Answer

Your results should last decades, particularly if your surgeon used the incision method—but they can diminish over time. Eventually, the aging process can lead to sagging or hooding.

Question 10

What are the risks of double eyelid surgery?

Accepted Answer

As with any surgical procedure, there are possible complications from double eyelid surgery, such as infection and bleeding.

Other risks and potential side effects of Asian blepharoplasty include:

difficulty closing your eyes
dry eye and irritation
damage to eye muscles
double or blurred vision

Vision impairment or loss is extremely rare, but it is possible.

“The most common undesired result is unevenness of the two eyes. This is usually caused by slight asymmetry of the eyelid-opening muscle, which can be quite subtle to detect,” says Dr. Lee. “Frequently, it will even out over time, but it can be disconcerting in the immediate postoperative period.”

If you’re unhappy with your final results, revision surgery is usually possible. A skilled surgeon can correct asymmetry, creases placed too high or too low, and folds that are too deep or shallow.

Question 11

Are there alternatives to double eyelid surgery?

Accepted Answer

Double eyelid surgery really is the only way to create a permanent lid crease.

For those who aren’t ready for surgery, tape or glue can create a temporary eyelid fold. Just be aware that daily use of tape or glue can stretch or irritate the eyelid skin.

If you just want to remove excess skin for a more open look (without adding a crease), traditional eyelid blepharoplasty would be a better choice.

Question 12

Sources & studies

Accepted Answer

Cho, In. “Revision Upper Blepharoplasty.” Seminars in Plastic Surgery, vol. 29, no. 03, Aug. 2015.

International Society of Aesthetic Plastic Surgery, 2021, ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2021.

Korea Gallup, 2015, Survey on Appearance and Perception of Plastic Surgery.

Nguyen, Marilyn, et al. “Asian Blepharoplasty.” Seminars in Plastic Surgery, vol. 23, no. 03, Aug. 2009.

DOUBLE EYELID SURGERY

BEFORE & AFTER PHOTOS

Charles S. Lee, MD, FACS

Karyn Repinski

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BEFORE & AFTER PHOTOS

Charles S. Lee, MD, FACS

Karyn Repinski

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS