For monolids, is it possible to have ptosis correction / fat and skin removal without creating a dramatic double lid?

Personal consultation is necessary to determine what and how much should be done. Blepharoplasty can be customized to the individual.

You seem to be describing skin overhang and possibly brow encroachment into the orbit. This condition is best corrected with excision of excess skin, possibly combined with stabilization for the brow to prevent brow descent. On Asian eyelids, a double eyelid crease needs to be set prior to skin removal in order to maximize the chances of a symmetric result. The crease can be set to your desired height, based on how much of a crease you want showing. If you want almost none, that can be done as well. Ptosis repair is done as part of the double eyelid surgery through this incisional route.

Generally, there are two common approaches to ptosis repair: anterior and posterior. In Asian eyelids with no crease, there is usually a small platform just about the lashes. It is possible to enter the eyelid low, leave the small, low platform and perform an anterior levator resection ptosis surgery. If skin does need to be removed, it can be done without making a high crease. It is also possible to do a posterior ptosis repair. This is called a mueller's muscle conjunctival resection ptosis repair. The effectiveness of this surgery very much depends on the ptosis you have. Again if you need some skin removed anteriorly, this can be performed at the same time.