Double Eyelid Surgery: Infold vs. Outfold

Double Eyelid Surgery: Infold vs. Outfold

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Double eyelid surgery is a specialised area of focus at Asian Plastic Surgery. When performing this procedure, Dr Ellis Choy considers several factors, including your natural facial structure, your skin quality and your personal preferences. His goal is to create a double eyelid fold that fits with your existing features. 

He offers two primary techniques for double eyelid surgery, the infold and outfold methods. Each has distinct characteristics, and the choice depends on anatomical considerations and your desired outcomes. We will cover these options in more detail and explain what influences the selection of one method over the other. 

What Is Double Eyelid Surgery? 

Double eyelid surgery is a procedure commonly performed for Asian patients that creates a visible crease in the upper eyelids. The crease divides the eyelid into two distinct sections. Double fold eyelid surgery is performed on individuals who wish to modify a monolid or a low-set natural crease.

Understanding Infold Crease Design

The infold crease design, or the nasally-tapered crease, is a type of double eyelid fold that narrows as it approaches the inner corner of the eye. This is influenced by the presence of the epicanthal fold, a skin fold that covers the inner corner of the eye and partially blocks an area known as the lacrimal lake. This shape is common naturally in individuals of Asian descent, and is a more anatomically consistent option for double eyelid surgery.

Infold double eyelid surgery is the more commonly used approach today because it maintains an Asian aesthetic rather than westernising the patient’s look. The result is a more subtle and tapered upper lid fold that preserves ethnic characteristics. It is also selected when a narrower, inward-angled crease is best suited to the patient’s eye anatomy. 

Understanding Outfold Crease Design

The outfold crease design creates a parallel upper eyelid crease that runs at a consistent distance above the lash line. Unlike the tapered shape of the infold, the outfold does not narrow toward the inner corner of the eye. This crease shape is more commonly found in individuals of caucasian descent and was a common choice among Asian patients seeking a more westernised appearance ten or twenty years ago. 

Outfold double eyelid surgery may still be suitable for those who prefer this style, but there are more considerations that should be evaluated. The surgery can sometimes create a sense of disharmony between the western eyelid shape and natural Asian aesthetics. Other factors such as skin thickness, eyelid flexibility and the natural position of the eyelid crease can influence whether this approach is right for you.

Factors to Consider When Choosing Infold vs. Outfold Techniques

Cosmetic surgery is a highly personal matter, and we want to consider the patient from the very first appointment. During your consultation, we will talk about everything from how much time you have available for recovery to what kind of results you hope to see once healing is complete. While this is not a comprehensive list of everything we will discuss during your appointment, some of the factors we will consider when choosing our surgery technique include:

Skin Thickness

Skin thickness directly affects how the eyelid crease holds after surgery and the longevity of results. Thicker skin can place more tension on the newly created fold and increase the likelihood of crease regression after an outfold design. The infold technique generally adapts better to thicker eyelid skin because the crease is anchored closer to the inner eyelid structures. Thinner skin is more malleable and may be more suitable for the outfold technique. 

Facial Anatomy

The chosen crease style should match the overall structure of your face, including your brow position, eye shape and orbital bone contour. Infold creases complement Asian features by creating definition without disrupting natural proportions. Outfold creases sit higher on the eyelid and can draw attention away from the eye’s natural contour if they contrast sharply with the rest of the facial structure. Precise crease height and shape are important when creating symmetry between the eyes.

Cultural Identity and Preference

Some patients prefer to keep features that align with their ethnic background, while others are looking for a different aesthetic. Today, the infold method is becoming a more common choice for Asian patients as modern aesthetics shift toward preserving ethnic characteristics. Both methods are valid options depending on what you want, but cultural context and personal goals will be discussed carefully during your consultation process.

Longevity and Stability

We always consider longevity and stability when choosing double eyelid surgery techniques. We will consider your facial anatomy, skin quality and the optimal placement of the crease to find an option that will be stable and last as long as possible. We will also work with you to help you form reasonable expectations about the type of results you can get from both types of surgery. 

Double Eyelid Surgery and Epicanthoplasty

When creating a strong inner fold, Dr Choy may perform a medial epicanthoplasty. This is a procedure that adjusts the small skin fold near the inner corner of your eye to expose more of the eye’s inner area. We can extend the appearance of the eye horizontally and create a smoother, more continuous crease toward the nose by opening this part of the eyelid.

The Next Steps in Your Eyelid Surgery Decision

Dr Ellis Choy primarily advocates for double eyelid surgery techniques that support natural Asian eyelid anatomy rather than creating a more western-style crease. In most cases, this means favouring an infold design that complements features commonly seen in Asian facial structure.

That said, crease design is a personal choice, and we take time to discuss all of the options available to you. We always listen to what you want from your surgery. Dr Choy has performed both types of surgery many times and knows how to customise each procedure to the patient, their anatomy and their goals.

To learn more about double eyelid surgery at Asian Plastic Surgery, call us on 02 8985 9850 or reach out through our website. We are happy to serve the community of Sydney, NSW, Australia.

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