Asian blepharoplasty refers to a surgery that introduces an eyelid crease in Asian eyes. A high percentage of Asians tend to have puffy upper eyelids with no folds. As a result, they may appear tired and sleepy. Most patients seeking this type of surgery aspire to modify their looks without changing their ethnic appearance. 

The first instance of double eyelid operation occurred in the late 1800s. As recorded in Japanese literature, it entails the case of a patient with a crease in only one eye since birth. On the other hand, English literature references Sayoc and Millard as the earliest in describing the procedure. Millard, in his work, employed the use of orbital lipectomy in creating creases. He aimed to achieve a westernized look as per the patient's request.

Leabert Fernandez introduced stitching pretarsal skin to the levator expansion. The technique is a distinguishing trait in double eyelid surgery today. Also, it is the most common method in incision Asian blepharoplasty. Other than suturing skin to the levator expansion, Robert Flowers later developed securing creases to the tarsus for distinct lines and smooth pretarsal surface.

Also Known As

  • Double Eyelid Surgery


Preparation & Expectation Before Surgery

A quick session with the doctor to determine the suitable surgery method may be necessary. Through this session, the doctor may require personal medical information that would facilitate the best results.

The procedure may require avoidance of any anticoagulant medication beforehand. Patients might, as well, need to consider not having any meal hours before surgery. Smoking could cause complications or slow up the healing process. Therefore, individuals that smoke may also need to avoid it weeks before surgery.

Patients may experience unclear vision after surgery. For this reason, it would be necessary for one to organize for someone to accompany them home.

Types, Purpose & Procedure

Surgery is done under local anesthesia and may involve one of three approaches. They include; beads method, buried suture, and incision method.

The incision method is useful to several patients. It treats sunken eyes, removes wrinkles, and can enable widening or narrowing of eyelids. It is also suitable for those seeking to change eyelash direction to an upward angle. The limitation to this method is it retains visible scars that show when eyes are closed. Exceptions are patients with red, exceedingly white, or oily skin.

Beads and buried sutures method have no concerns about incision scars since skin incision is not involved. However, in the beads method, a patient with poor skin quality may have slightly conspicuous stitched scars.

In a buried suture approach, there is a likelihood of the crease disappearing with time. This instance is mainly observed in patients with excess fats in the upper lid. Beads method, on the other hand, results in severe swelling that lasts longer compared to other methods.

Compared to men, a high number of women undergo double eyelid surgery. It is mainly for cosmetic reasons. However, it also helps to;

  • Improve droopy eyelids
  • Remove wrinkles 
  • Expand double eyelid width.


Before commencing surgery, the doctor will carry out an eyelid evaluation and an assessment to determine asymmetry. The eyelid evaluation should incorporate;

  • Levator and forehead muscle function. 
  • Eyelid shape and skin quality
  • Level of the eyebrow
  • Fat tissue volume in the upper eyelid.


The doctor will also notify the patient of the duration of swelling associated with each method. 

Incision approach- In this method, a doctor begins by marking skin and making an incision. He then removes muscles underneath the skin, followed by fat tissue over the tarsus. The doctor continues to clear fats until he establishes the levator aponeurosis. Seaming of the skin then follows.

Beads approach- The technique involves the use of silk or 3-0 polyester. A doctor passes six sutures through the opposite side of the eyelid to the marked line. They are then knotted and stitched through beads to prevent damaging skin. The seams ought to cause an inflammation that results in scarring, which ultimately creates the crease.

Buried suture approach- This entails making four holes along a marked line. Measurement of the distance from the upper eyelid to the four holes follows. The doctor then makes a line of similar width in the conjunctiva with two shallow incisions. Through the cut, he inserts clear nylon into the surface holes. He then pulls it back and shallowly passes it to the next hole. The two surface holes and incision points are connected then the clear nylon is buried into the eyelid.

Risks, Side Effects & Complications

There may be risk of infection which would slow the healing process. The area around the eye may also be prone to swelling and visible scarring. Side effects are rare with this surgery but some patients may experience pain and inability to close eyelids. 

Possible complications associated with Asian blepharoplasty are;

  • Ectropion
  • Uneven eyelid crease
  • Divided creases


Aftercare, Recovery & Outcome

Aftercare possible recommendations include;

  • Enough rest after surgery.
  • Use of painkillers to relieve pain.
  • Ointment application on the stitched area.
  • Minimal physical activities for some weeks.
  • Use of cold compresses to reduce swelling.
  • Removal of sutures after about a week.


Swelling may ease in 10-14 days for the incision method, 2-3 weeks in beads method, and 7-10 days with the buried suture method.

All the approaches can bring out desirable outcomes when proper selection is made. However, there's a possibility that the double eyelid will disappear with time in buried suture and beads method.