Double Eyelid / Asian Blepharoplasty
Body area: eyes
Overview
Double eyelid surgery — also called Asian blepharoplasty — creates or refines a supratarsal crease on an upper eyelid that is naturally single-lidded or has a low, inconsistent, or partial crease. The procedure is designed for patients of East Asian, Southeast Asian, and other Asian descent whose anatomy differs structurally from a typical Caucasian upper eyelid (lower or absent levator-skin fusion, fuller pretarsal fat, a distinct medial epicanthal fold). Done well, the result is a natural, anatomically appropriate crease that complements the patient's existing features — not a Westernized eyelid.
Who is it for?
Adults of Asian descent who want a defined, symmetric upper-eyelid crease — whether they currently have no visible crease (single eyelid / monolid), an inconsistent or partial crease, an asymmetric crease between the two eyes, or a previous double-eyelid result they want refined.
Technique overview
The surgeon evaluates eyelid skin thickness, pretarsal fullness (orbital fat and orbicularis muscle), levator function, and the medial epicanthal fold to choose between an incisional, partial-incision, or non-incisional (suture-based) approach. A small amount of skin, fat, and muscle may be conservatively removed to set a crisp crease, and the levator aponeurosis is engaged at a precise height so the crease is anatomically natural — typically 6–8 mm above the lash line, customized to the patient's face and aesthetic goals. The medial epicanthal fold is preserved by default and only modified (epicanthoplasty) when specifically requested.
What this procedure cannot do
Double eyelid surgery creates or refines an upper-eyelid crease — it does not address brow position (a brow lift), true eyelid ptosis (a separate levator procedure), under-eye bags (lower blepharoplasty), or skin texture and pigmentation around the eyes. It also does not change eye size or fundamentally alter the shape of the palpebral fissure unless combined with epicanthoplasty or lateral canthoplasty, which are distinct procedures with their own risks. Achieving perfectly symmetric crease heights is one of the most difficult goals in eyelid surgery, and a meaningful percentage of patients (commonly cited at 10–20% across published series) ultimately need a touch-up or revision for asymmetry, crease loss, or crease-height adjustment. The non-incisional technique is faster to recover from but is not durable for every patient — particularly those with thicker eyelid skin or significant pretarsal fullness — and may need to be redone or converted to an incisional technique years later. Patients should choose a surgeon who routinely performs Asian blepharoplasty as a distinct procedure, not as an adaptation of Western upper blepharoplasty.
Scars and incisions
The full-incision (incisional) technique uses a fine incision along the planned crease line. The scar is hidden within the new crease itself and typically becomes virtually invisible at 6–12 months as it pales and the crease folds over it. The partial-incision technique leaves a short central scar (4–8 mm) within the crease that fades similarly. The non-incisional (suture) technique uses tiny needle entry points along the lid that leave no meaningful scarring. Epicanthoplasty, when performed, leaves a small scar at the inner corner of the eye that is generally well-concealed but visible on close inspection in the first 3–6 months.
Recovery
Most patients return to work and social activities in 7 to 14 days. Bruising and swelling peak at 2 to 3 days and resolve substantially within 2 weeks. The crease initially looks too high and too defined — this is expected and settles over 2 to 3 months as swelling resolves. Final crease shape stabilizes at 4 to 6 months. Strenuous activity is held for 3 weeks; eye makeup is typically resumed at 2 weeks.
Longevity of results
The full-incision technique produces a permanent crease that, when set at the correct height and fixed properly, generally lasts a lifetime — the same anatomic fixation as a high-quality Western upper blepharoplasty. The partial-incision technique is also durable for most patients. The non-incisional (suture) technique is less predictable long-term: some patients keep the crease for decades, while others see partial loosening or loss within 5–10 years, particularly with thicker lids or heavier upper-lid weight. Patients who lose a non-incisional crease can usually convert to an incisional revision with good results.
Typical price range
$3,500 - $8,000
Common goals
- Create a natural, well-defined supratarsal crease
- Improve eyelid symmetry between left and right
- Refine a partial, multiple, or inconsistent crease
- Make eye makeup application easier and more even
- Reduce the heavy, hooded appearance of a low-set crease
Risks
- Asymmetry between the two eyelids
- Crease too high, too low, or shaped incorrectly
- Loss of crease (more common with non-incisional)
- Visible scarring within the crease (typically fades)
- Multiple or inconsistent creases (so-called triple-fold)
- Lagophthalmos (incomplete eyelid closure)
- Dry eyes
- Need for revision (real and discussed up front)
How to choose a surgeon
Asian blepharoplasty is a distinct procedure with its own anatomic considerations — choose a surgeon who explicitly lists it as a focus area, not one who treats it as an adaptation of standard upper blepharoplasty. Look for board certification by the ABPS, ABFPRS, or American Board of Ophthalmology (with oculoplastics fellowship training), and ask how many double-eyelid procedures they perform each year, what their personal revision rate is, and how they decide between incisional and non-incisional techniques for a given patient. Ask to see before-and-after photos at 3–6 months showing patients with similar eyelid anatomy and skin thickness — not just a single representative photo. Be cautious of providers who push a one-size-fits-all crease shape or who advertise dramatic Westernized results: a thoughtful surgeon designs each crease for the individual face.
Frequently asked questions
Will this make my eyes look Western or non-Asian?
Done well, no. The goal of modern Asian blepharoplasty is a natural, anatomically appropriate crease that complements your existing features — typically a parallel or in-fold crease that respects your epicanthal fold and eye shape. A Westernized result (very high crease, removed epicanthal fold, dramatically larger-looking eye) is the result of an outdated approach or a surgeon mismatched to the patient. Choose a provider whose before-and-after photos show natural, varied creases — not uniform Westernized ones.
Incisional or non-incisional — how do I choose?
The right technique depends on your eyelid anatomy, not your preference for recovery time. Thicker eyelid skin, significant pretarsal fullness, skin excess, or prior eyelid surgery generally call for an incisional approach because suture techniques won't hold reliably. Thin, soft eyelid skin with minimal fullness and no skin excess may do well with non-incisional. Your surgeon should walk you through what they observe in your anatomy and which technique they recommend for you — and why. Be wary of providers who only offer one technique.
Will my epicanthal fold be removed?
Not by default. The medial epicanthal fold is part of your natural eye shape, and most modern Asian blepharoplasty preserves it. Epicanthoplasty is a separate procedure performed only when specifically requested or when the fold is anatomically obscuring crease formation. Discuss your preferences explicitly during consultation — your surgeon should not modify the fold without discussing it with you first.
How natural will it look at 1 month vs. 6 months?
Initially the crease looks higher, deeper, and more defined than it eventually will — this is expected swelling, not the final result. Most of the swelling resolves by 6–8 weeks, but the crease continues to soften and settle through 3–6 months. Patients commonly worry the crease is too high at 2 weeks; this nearly always settles. Final, stable appearance is judged at 4–6 months.
What if the two creases come out asymmetric?
Small asymmetries are common in the first 3 months due to uneven swelling, and most settle without intervention. True structural asymmetry — different crease heights, shapes, or definition — happens in a meaningful percentage of cases (often cited at 10–20%) and can usually be addressed with a touch-up or revision after 6 months of healing. A thoughtful surgeon discusses the realistic revision rate up front rather than after the fact.
Editorial disclaimer: This page is educational content reviewed by the MDcontour editorial team. It is not medical advice, diagnosis, or treatment, and it does not establish a doctor–patient relationship. Always consult a board-certified plastic surgeon about your individual situation.