Why do my eyes get puffy to the point where it looks like I have monolids?

Namjoonie,There are a number of reasons why you can wake up with puffy lids. You may wish to see your primary care doctor to rule out: thyroid, diabetes, high blood pressure.  Other common causes include allergies, high salt intake with water retention, and blepharochalasis (rare).  CheersHugo

It may just be normal puffiness from lying flat at night after salty foods, alcohol, etc.  But if it's pretty bad go see and ophthalmologist or your PC.  That being said, if your crease is low then the double eyelid being obscured in the morning may also be normal.Chase Lay, MD

Thank you for the question. You submitted a question without any photos but you ask about a situation I think I can assist you with. You describe that you’re Asian and you typically have double eyelids, but there are times when you wake up a little more swollen so they become monolids which last up to 2 weeks.

I can give you some understanding of this based on my experience. I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. One of my areas of specialty is Asian eyelid surgery for both primary and revisional surgery, and I’ve been practicing in Manhattan and Long Island for over 20 years. I have done a lot of different variations to help our patients achieve their desired look.

Your situation is not unusual, and it comes down to basically understanding some anatomy. A double eyelid or an Asian crease occurs in around 50% of people of Asian descent, where a little fold occurs so you see more of the eyelid, from the eyelashes or the margin to the crease. The opposite is the monolid, where you don’t see a crease and just have the top of the eyelid platform and there’s no defined fold. What differentiates one from the other are anatomical attachments between the levator muscle that lifts your eyelids. The levator muscle has fibers that come over it that attach to the skin. When somebody has a strong crease, it means they have a strong attachment, and if somebody has some variability, often it is because they have multiple fine attachments that are a little weak, or they don’t have a strong or any attachment at all, but the crease they see is just passive folding of the skin.



When I perform Asian eyelid surgery, there are basically 2 techniques: incisional surgery where an incision is made to remove skin and address fat, or non-incisional surgery where little openings are made so the skin and the muscle are attached using stitches. Either procedure is intended to engage the skin with the levator muscle to create a more consistent, permanent connection. In your situation, with puffiness or waking up with some fluid, you can be may be straining these connections which are not strong enough to bounce back and create a consistent crease. I’ve had patients report  when they are a little dehydrated, their crease gets deeper. In other situations, it could be from allergies, sinuses, or salt intake that can make the eyes puffy and cause the crease to be less obvious. Again, understanding the principles of Asian eyelid surgery should give you an idea on why you have some variability. Basically, it is the anatomy of the muscle attaching to the skin. If you have a stronger attachment, then even with swelling, the crease will still eventually be a little stronger and you won’t have an absence of crease for 2 weeks.



I think you should look into why you have swelling when you wake up if you feel it’s a little unusual. If you want to have a constant double fold, then you may want to consider Asian eyelid surgery. We have patients who before they had this procedure, put a little strip of tape that is specially designed to create a crease, just to see how they like the crease, and how it looks when we work on deciding to make a nasally tapered fold and a parallel crease -something like this may be worth considering. You may want to discuss this option, or something more permanent for a more consistent look by meeting with qualified cosmetic surgeons who do a lot of eyelid surgery.

In summary, the fluid may be causing stretching, or just a natural volume occupation of this area so the double fold doesn’t form, or you may have a situation where an Asian eyelid procedure is considered if this is a desired look you want to be more consistent with. I hope that was helpful, I wish you the best of luck and thank you for your question.