Over 1.7 million people worldwide underwent eyelid surgery in 2023, according to a survey by the International Society of Aesthetic Plastic Surgery. The procedure is particularly popular in East Asia and South East Asia, where it is the most commonly requested cosmetic surgery.
Approximately 50 per cent of Asians are born without a defined upper eyelid crease. Although the ‘monolid’ or ‘single eyelid’ is perfectly natural, not everyone feels it suits their face. Aesthetic preferences vary widely.
Asian eyelid surgery, often called ‘double eyelid surgery’, is a surgical technique focused on creating an upper lid crease that is not apparent prior to the procedure.
What Makes Asian Eyes Unique?
While there is no single definition of ‘Asian eyes’, there are several distinctive attributes that many people of Asian heritage share.
The monolid, or lack of supratarsal crease, is the most recognisable. This feature is commonly seen in East Asians (Chinese, Korean and Japanese). Asians who have a natural double eyelid tend to have a smaller, less well-defined and lower-positioned fold in comparison with Caucasians. The crease may also be broken up into several smaller folds.
Another distinguishing feature of Asian eyes is the amount and location of periorbital fat. The upper lid crease can be obscured by fat that descends over it, creating the illusion of droopy eyes (ptosis). Thicker fat pads in the eye area can also lend Asian eyes a ‘puffy’ appearance.
A third notable characteristic of Asian eyes is the presence of an epicanthal fold. The epicanthal fold is a skin flap that covers the inner corner of the eye, further contributing to the monolid appearance. Variation occurs in the shape of this feature.
How Is Double Eyelid Surgery Different From Traditional Blepharoplasty?
Double eyelid surgery is a cosmetic procedure primarily undertaken by people of Asian descent to reshape the skin above the eye, creating a supratarsal crease. The goal of the procedure is to enhance the eyes while preserving each patient’s unique facial aesthetic and ethnic identity. In most cases, double eyelid surgery aims to improve eye-region aesthetics.
Other forms of eyelid surgery (blepharoplasty) are similar to double eyelid surgery in terms of techniques and goals, but there are subtle variations. Rather than focusing on creating an eyelid crease, these types of blepharoplasty often concentrate on reducing signs of ageing in the eye area. Blepharoplasty can address:
- Heavy, loose or hanging skin in the upper eyelids
- Drooping skin in the lower eyelids
- Fat cushions creating puffy eyelids
- Loosened muscles around the eyes
- Bags beneath the eyes
- Limited space for makeup application
Blepharoplasty can also be undertaken for medical reasons. Called ‘functional blepharoplasty’, this type of procedure can reduce discomfort from overused forehead muscles, reduce irritation caused by friction between folds of excess skin and improve vision that has been compromised by heavy upper eyelid skin reducing field of view
Is the Point of Double Eyelid Surgery to Look ‘Westernised’?
It is a common misconception that all Asian patients who have double eyelid surgery want to look more Caucasian or ‘westernised’. Most double eyelid surgery candidates are not looking to fit Eurocentric beauty ideals, which can result in an unnatural appearance. Instead, they simply desire a change from their natural facial features.
Patient wishes are carefully discussed during the initial consultation to ensure the surgeon and patient are on the same page about the goals of the procedure. It can be helpful to bring photos to the consultation to illustrate what a desirable outcome looks like for you.
What Techniques Are Used for Double Eyelid Surgery?
Double eyelid surgery is a delicate procedure that requires a personalised approach and incredible attention to detail. Every patient has unique preferences, so each surgical plan is customised. Double eyelid surgeries fall into two primary categories — incisional and non-incisional — with further variations.
Full Incision Technique
The full incision or ‘open’ technique is best suited for patients with excess skin and fat in the upper eyelid. The incision extends most of the length of the new supratarsal crease, allowing the plastic surgeon to excise skin and fat and perform ptosis correction if necessary. This is a versatile technique that allows for the greatest degree of adjustment. Although it does leave a scar, it is usually not overly obtrusive.
Partial Incision Technique
The partial incision technique is similar to the full incision technique, but the incision is made smaller to reduce scarring. This option may be chosen by patients who do not want a significant amount of skin and fat removed from the eyelid. Partial incision double eyelid surgery may also be an alternative to the non-incisional technique for patients who want the reliable and durable results of open surgery without the longer scar of the full incision technique.
Non-Incisional Technique
The non-incisional or ‘suture’ technique is the least invasive double eyelid procedure. The plastic surgeon creates a series of small punctures in the skin where the fold will be, then places sutures through the holes and tightens them until the crease forms. The advantages of this approach are less postoperative swelling and no incisional scar. The disadvantage is that it is not as resilient as incisional methods and may come undone over time.
Incisional vs. Non-Incisional: Which Technique to Choose
Our surgeons generally recommend incisional techniques over non-incisional eyelid surgery for a variety of reasons. However, there is no single approach that applies to every person’s face or preferences. Our team is here to assist you in making an informed decision, and we will discuss the considerations below with you in detail.
Incisional Double Eyelid Surgery
Pros:
- Permanent Results: Creates a durable, long-lasting crease.
- Addresses Multiple Concerns: Ideal for removing excess skin, reducing puffiness caused by fat pads and correcting mild ptosis (eyelid droop).
- Highly Customizable: Allows for precise control over crease height and shape.
- Best for Thicker Skin/Fat: Generally considered the gold standard for patients with thicker eyelid skin or more pronounced fat deposits.
Cons:
- Longer Recovery: Involves more initial swelling and bruising compared to the non-incisional method.
- Visible Scar: Leaves a fine scar along the crease line (though it is typically well-hidden when the eye is open and fades over time).
- Less Reversible: Making significant changes after healing is more complex.
Non-Incisional Double Eyelid Surgery
Pros:
- Minimal Scarring: No linear external scar, only tiny puncture marks that are difficult to see.
- Faster Recovery: Generally involves less swelling, bruising and downtime compared to the incisional method.
- Potentially Reversible: The sutures may be removable, allowing the eyelid to return closer to its original state, especially if done early.
Cons:
- Not Suitable for All: Less effective for patients with thick skin, excess fat pads or significant skin laxity.
- Potential for Crease Weakening: The crease may lessen or disappear over time in some individuals (though modern techniques have improved longevity).
- Limited Correction: Cannot remove excess skin or fat.
What Type of Anaesthesia Is Used for Double Eyelid Surgery?
Double eyelid surgery is performed under general anaesthesia or local anaesthesia with intravenous sedation (‘twilight anaesthesia’). With general anaesthesia, you are completely asleep and unaware during the procedure. With twilight anaesthesia, you receive local numbing injections and medication through an IV line that makes you feel relaxed, drowsy and often unaware of the procedure. Your surgeon will discuss the best option for you during your consultation.
How Long Is the Recovery After Double Eyelid Surgery?
While everyone heals differently, here is a general recovery timeline for double eyelid surgery:
Immediately After Surgery
Expect swelling, bruising and tightness. Your vision might be slightly blurry. Discomfort is usually manageable with prescribed pain medication. Rest with your head elevated and use cold compresses to minimise swelling.
First Few Days
Swelling and bruising often peak around day two or three before starting to subside. Continue to apply cold compresses and follow your surgeon's instructions for cleaning the incision line (if applicable). Avoid strenuous activity.
Week 1
A significant portion of the swelling and bruising should have resolved, but your eyelids will still look puffy. You might feel comfortable returning to desk work or light activities at this point. Continue to avoid anything strenuous.
Weeks 2-4
Swelling continues to decrease steadily, and the new crease becomes more defined. Bruising typically fades completely. You might be able to start wearing contact lenses and light eye makeup towards the end of this period. Continue avoiding heavy lifting and vigorous exercise.
Months 1-3
Most of the noticeable swelling resolves, revealing a clearer picture of the surgical outcome. The incision line (for the incisional method) starts to soften and fade, transitioning from pink/red towards your natural skin tone. The crease continues to settle.
Months 3-6
Healing continues at a microscopic level. Swelling becomes negligible and the incision line matures further. The final result of your double eyelid surgery is typically apparent by six months, although subtle changes can continue for up to a year.
How Long Does Double Eyelid Surgery Last?
The potential longevity of the procedure depends on which technique is used.
With the incisional method, the new eyelid crease is considered permanent. This is because the technique fundamentally alters the eyelid's structure by creating a direct adhesion between the skin and the underlying muscle. The internal scar tissue creates a durable fold that should not disappear on its own.
The non-incisional suture technique can last many years for suitable candidates. However, it is less predictably permanent than the incisional approach. The crease relies on buried sutures holding the tissue folds together. Over time, the crease can soften or even disappear, necessitating a touch-up or conversion to an incisional technique.
Is Double Eyelid Surgery Popular Among Asian Men?
Yes, both men and women seek double eyelid surgery. Although the surgical techniques do not change based on the patient’s gender, the aesthetic goals and approach often differ for male patients. A surgeon experienced in male Asian blepharoplasty understands these nuances and will tailor the crease height and shape to maintain a masculine appearance.
What Other Forms of Eyelid Surgery May Suit Asian Patients?
More eyelid procedures are available to address different anatomical features and functional concerns sometimes present in individuals of Asian descent.
Medial Epicanthoplasty
This procedure targets the medial epicanthal fold, which is the vertical fold of skin extending from the upper eyelid down towards the inner side of the eye, near the nose. This feature is common in people of East Asian heritage. Surgically modifying or reducing the fold exposes more of the inner corner of the eye (medial canthus), including the lacrimal caruncle (the pink nodule). This can create the appearance of wider, longer eyes.
Ptosis Correction
This functional procedure treats ptosis, the medical term for drooping of the upper eyelid margin (the edge where the eyelashes grow). True ptosis occurs when the levator muscle, which is responsible for lifting the eyelid, is weakened, stretched or detached. Repairing or tightening this muscle elevates the position of the eyelid margin, allowing more of the iris and pupil to be visible. In some cases, ptosis correction also improves the upper field of vision.
What Is the Cost of Double Eyelid Surgery?
Providing an exact price without a consultation is impossible, as the cost is tailored to the individual procedure. However, we can offer average costs for Asian eyelid surgery in Sydney:
- Upper Eyelid Surgery — $6,000 to $8,000
- Lower Eyelid Surgery — $12,000 and $14,000
- Upper and Lower Eyelid Surgery — $15,000 to $20,000
If you’d like to learn more about what factors into those fees, the benefits and risks of medical tourism, and financing options for Asian plastic surgery, we invite you to read this guide.
For More Information About Double Eyelid Surgery in Sydney, Get In Touch
There is no standardised approach to Asian eyelid surgery, because no two people have the exact same anatomy or aesthetic taste. The specialist plastic surgeons of Asian Plastic Surgery take great care to customise each double eyelid procedure. They are passionate about helping Asian patients from Sydney and all around Australia receive the care they deserve.
If you are considering double eyelid surgery, please contact us here to schedule a consultation.
