Why is the Double Incision Asian Eyelid Procedure the Most Complex?

How do I interview surgeons? How many surgeries should a surgeon have completed successfully should I consider as a possible surgeon for my eyes?

Doctor Answers (5)

Asian Eyelid Surgery with Natural Results

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Great question. In my cosmetic surgery guide "The Fine Art of Looking Younger," I address this topic for Asian Eyelid Surgery for you. The Asian eyelid is different from the Caucasian eyelid in many ways, which is why Asian eyelid surgery (Asian blepharoplasty) is so unique and complex. Asian eyes require delicate finesse with the typical epicanthal fold that lies in front of the eye so that proper rejuvenation does not mar the natural beauty of this type of eye. Asian individuals also often seek the “double eyelid fold” procedure, which gives the upper eyelid a visible crease when the eye is open. One of the most frequent mistakes that plastic surgeons have made is “Americanizing” or “Europeanizing” the eyelids. This results in a very unnatural appearance. 


New York Oculoplastic Surgeon
5.0 out of 5 stars 20 reviews

Asian eyelid surgery and how to identify the right person

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There are many ways to determine the right surgeon for you. Training is important. I would look at their credentials to see what sets them apart from others. You could do a lot of these surgeries and still not be a good asian eyelid surgeon. Talent is important. I would most importantly find someone that will listen to your needs and find out what you really want accomplished. Someone who doesn't listen may not achieve what you want no matter how well the surgery is done. The surgery is complex because of the intricate anatomy and also the precision that is required to achieve a good result.

Philip Young, MD
Bellevue Facial Plastic Surgeon
3.5 out of 5 stars 29 reviews

Finding a asian eyelid surgeon

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Your eyelid anatomy will determine the degree of difficulty of your procedure. Some eyelids are easier to do than others. The most difficult aspect of this procedure is related to underlying asymmetries which the surgeon will need to compensate for in order to get a nice result. You'll obviously have a wider range of surgeons to pick from if your eyes are easier to perform.

Certainly some surgeons have superior talent/ artistry/ intelligence which shortens their learning curve, so it's difficult to say what is the magic number. One of my old professors were at 4000 eyelids and 40 years of surgery, yet still found each case unique and challenging. Best of luck to you!

Charles S. Lee, MD, FACS
Los Angeles Plastic Surgeon
4.5 out of 5 stars 36 reviews

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Asian Eyelid Surgery Expertise

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Asian eyelid surgery is complex for a few reasons.

1.  Asian eyelid anatomy is different from Caucasian in that a wall called the septum, which holds eye socket fat back, attaches more infeiorly in the eyelid in Asians.  The result is a more full upper eyelid, sometimes with an absent crease or fold but often with with a hidden fold which brings me to important point number 2.

2.  Not all Asian eyelids are alike.  The anatomy and crease position (if there's on at all) varies.  This is where the true expertise, artistry, and experience becomes important.   Any facial plastic or oculoplastic can tell you the generalities of Asian eyelid anatomy vs. Caucasion anatomy.  We all learned that.  What you need to ask is this.

3.  Many good eyelid surgeons do it infrequently.  They could do it successfully, the question becomes, can they deliver your specific requests.

The surgeon should be doing this regularly.  My patient population is primarily Asian and this procedure is the bulk of my practice.  The surgeon should be able to show you several examples of eyes and what he did differently for each one.   In my experience no two pairs of Asian eyelids have been the same.  One patient has asymmetric folds.  One has more fat in thier eyelids.  One has thinner skin.  Etc.

If they describe a procedure that they have performed "successfully several times" being done the same way then I'd ask to see the photo evidence.   They should show you eye surgeries tailored to the patients requests.

Finally, be conservative with fat removal.  Especially if you are young.  It's a classic move to remove fat in the upper eyelid on Asian patients because the eye looks less full or swollen faster.  In the long run the remaining fat and scar tissue will atrophy and your eyes may look hollow.  If the surgeon comments on fat removal for all his/her patients seek other opinions just to be sure.

Hope that helps and best of luck.

Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 36 reviews

Double asian eyelid surgery is not the most complex surgery.

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The problem is that most eyelid surgeon who perform this procedure have only a very poor understanding of what they are doing.  When you understand what you are doing, this is a wonderful, very gratifying surgery that makes individuals very happy.  One of the biggest issues with this surgery is that it requires a level of precision and understanding of upper eyelid anatomy that is simple out of the grasp of many practicing eyelid surgeons.  One might be able to get away with such a weak understanding of the eyelid when performing surgery on say a caucasian eyelid but this lack of skill immediately shows up after asian double fold surgery.  An asian eyelid surgeon needs to understand a few things: 1) the crease height must be much, much lower than what is described in the text books, 2) As the eyelid heals, the crease creeps up as much as 1-2 mm. 3) The upper eyelid skin and orbicularis oculi muscle must be supported to the exposed levator aponeurosis to support the upper eyelid lashes.  In many cases, co-existant upper eyelid ptosis must also be addressed. 

Unfortunately numbers seem to be irrelevant.  Every week I several new Asian eyelid consults.  Most of these people seem me after they have gotten into trouble.  Most of these are related to threaded eyelid surgery, crease asymmetries, and upper eyelid ptosis.  Although there are not single surgeons who standout, almost every prior surgeon has large practices and performs hundreds of these eyelid surgeries every year.  This makes it very difficult to recommend a simple criteria for finding the right surgeon.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 14 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.