My eyelids are puffy and heavy, would the double Eyelid Surgery or removal of the fat/muscle treat it? (photos)

My eyelids are VERY puffy and heavy. It is especially bad when I smile. I know I would like muscle and fat removed to make my eyelids more flat. I dont really like the double eyelid look on me so should I ask for just fat removal? If I do get a double eyelid surgery, I think I would want a very tiny one, like the one in the photo. Would I also be able to get a parallel crease made instead of tapered? The outer corners of my eyes are very droopy as well.. would a double eyelid surgery fix that?


Doctor Answers (4)

Asian eyelid surgery can be customized according to your wants, anatomy, & a natural look, but a physical exam is needed first

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I also peronally answered your question this video on YouTube:

How Asian Eyelid Surgery is Customized for a Patient's Anatomy, Desires, & a Natural Look

Your concerns about a double eyelid surgery and the impact on the character of your face are things that someone with experience has heard. As a cosmetic oculofacial plastic surgeon focusing on Asian eyelid surgery, and in practice for 20 years, I could tell you that lot of discussion and a proper physical exam are needed. The questions you are asking can be answered to a degree with just photos, but nothing replaces the 3-dimensional aspect of appreciating the skin quality, fat volume, eyelid crease and the amount of hooding. In our practice, we actually place a Q-tip inside to create a fold to give us some idea of what to anticipate.

I always tell my patients that in cosmetic surgery literature, it is often quoted that 50% of Asian descent have a crease and 50% do not. Nature gives us a bit of space and permission to work in. When we fight too much, then we can get some unpredictability. A lot of our patients who come in who want a specific style often bring pictures of people who they admire and who they want to look like. But if their skin quality, anatomy and the position of the eyes is different then we have to come to some kind of customization that’s right for them.

I would anticipate from experience that someone like you would probably be better served from a tapered crease as well as extending relatively parallel without a flare in the outer aspect to address the hooding. This is something that can be customized with degree fat reduction and the amount of crease that you show. Again, this is a discussion that is best served by a physical examination. I suggest that you meet with experienced cosmetic surgeons and have this discussion.

The factors to also discuss have to do with whether or not you have extra skin. You can choose between an incision Asian eyelid surgery or a non-incisional. There are many choices and variables. With that understood, an examination would probably help you understand better what your choices are. Meet with a few doctors, get a sense of what is realistic, be sure you are comfortable with your choice, and that you have a sense of what you will look like when everything is settled. I hope that was helpful, I wish you the best of luck, and thank you for your question.


New York Oculoplastic Surgeon
4.5 out of 5 stars 26 reviews

Good candidate for Asian eyelid surgery

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thank you for your question
He do not have to dramatically change or look or create a visible double eyelid or crease.  You would however be best served with an incision technique with some fat removal.  This would need to be verified with the physical exam first of course.  The crease that you plan can be one that is so subtle no one else can see that it exists.  You will however go through a healing period of 10-14 days where the crease is higher and more noticeable when he would prefer.  Also based on the thickness of your skin which despite the fullness of your eyelid appears to be more of a medium thickness will cause some retention of fluid and swelling for several weeks or even months that will largely only be noticeable to you and will look very nice as time goes on but in the beginning may stress see a little bit so be prepared for that.  That being said I think your going to do very well.  As a surgeon who primarily performs Asian eyelid surgery and my practice 4 days a week I can tell you that you are most likely a great candidate so best of luck to you.  Make sure the surgeon's U interview have lots of photo evidence of their work.  Independent of the surgeon's race if they truly perform the surgery frequently they will have dozens if not 100s of photos to review and a very clear plan that is customize to your eyelids.

I'll attach a brief video that talks about crease selection and design depending on the patient's face

Chase Lay, MD
Double board-certified facial plastic surgeon
Asian eyelid surgery specialist

Chase Lay, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 38 reviews

Asian Eyelid Surgery

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With Asian upper eyelid anatomy, the lack of crease is because there is no attachment of the skin to the underlying muscle.  This allows fat to droop in the upper eyelid, causing the puffy eyelid appearance.  Creating a double eyelid crease with removal of some fat/muscle will leave a less puffy appearance.  A parallel crease can likely be made but an in-person evaluation would be best.  Please consult with a board certified specialist who can assist you with achieving the results you seek.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

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Heavy Upper Eyelids

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Dear asnxxx,

Asian eyelid surgery (ie. Asian upper blepharoplasty) can help reduce the puffiness and heaviness of your upper eyelids.

The double eyelid crease can be designed to suit your specific needs and preferences.

Please see an experienced, Board Certified, Asian eyelid surgeon for an evaluation.

Warmest wishes,
Larry Fan, MD

Larry Fan, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.