Asian Blepharoplasty

Asian blepharoplasty—often called “double eyelid surgery”—is a cosmetic procedure designed to create or enhance the upper eyelid crease in people of East Asian heritage. In many East Asian populations, the natural upper eyelid may lack a distinct fold (the “monolid”), giving a single smooth eyelid appearance. Asian blepharoplasty adds or refines this crease for aesthetic balance, improved eyelid function, and cultural beauty ideals.

Anatomically, the eyelid crease forms where the levator aponeurosis—the tendon of the muscle that lifts the eyelid—attaches to the skin. In monolid eyelids, this attachment is either absent or loosely connected, so no visible fold appears when the eye opens. During Asian blepharoplasty, a surgeon modifies this anatomy: either by placing sutures (non-incisional techniques) or by creating small incisions to remove skin, muscle, or fat and then anchoring the skin to the levator aponeurosis (incisional techniques). The result is a natural-looking eyelid fold that can make the eyes appear larger, more symmetrical, and more “awake.”

This surgery must be bespoke: every patient’s anatomy, eyelid thickness, fat distribution, and aesthetic preference differ. A careful preoperative plan ensures the new crease’s height, depth, and shape harmonize with each person’s facial features. Asian blepharoplasty isn’t merely cosmetic; for some, it also corrects ptosis (drooping) or visual field obstruction caused by excess upper eyelid skin.

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Types of Asian Blepharoplasty

1. Non-Incisional (Suture) Technique
   Surgeons weave fine, permanent sutures through the eyelid skin and levator aponeurosis, creating a crease without cutting skin. Recovery is faster, with minimal scarring, but the fold may loosen over time, especially in patients with thicker eyelids.

2. Partial-Incision Technique
   This hybrid uses three to five small incisions along the planned crease. Through these “keyhole” cuts, excess fat and muscle can be removed, and the skin is anchored to the levator. It balances the benefits of non-incisional speed with improved durability.

3. Full-Incision Technique
   A continuous incision along the desired crease allows direct removal of excess skin, muscle, and fat. It offers the most permanent result and precise control of eyelid contour, ideal for patients with thick or fatty eyelids.

4. Epicanthoplasty
   Many East Asians have an inner corner skin fold (epicanthal fold) that can obscure the medial part of the eyelid crease. Epicanthoplasty reshapes or reduces this fold, often combined with blepharoplasty to create a more continuous, attractive crease.

5. Double-Fold Blepharoplasty
   This term broadly refers to creating any visible upper eyelid crease. It may use either sutures or incisions and is tailored to each patient’s desired crease height and depth.

6. Lateral Canthoplasty
   To improve the outer corner appearance, surgeons may perform a lateral canthoplasty—repositioning or tightening the corner of the eye. When combined with blepharoplasty, it can subtly elongate the eye shape.

7. Fat-Reduction Blepharoplasty
   Some patients have pronounced fatty “puffiness” in the upper eyelid. Through small incisions, excess preaponeurotic fat is removed or repositioned, refining the eyelid contour before crease formation.

8. Fat-Grafting Blepharoplasty
   Conversely, very thin eyelids may appear hollow. Surgeons can graft small amounts of fat into the crease or upper eyelid to ensure a smooth, natural fold once the crease is formed.

9. Combination Techniques
   Many surgeons blend elements—suturing, small incisions, fat removal, and fat grafting—to match eyelid thickness, patient age, and desired crease characteristics.

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Causes (Indications) for Asian Blepharoplasty

“Causes” in the context of blepharoplasty are better understood as the indications—the reasons someone chooses or needs this surgery:

1. Genetic Monolid
   An inherited eyelid without a natural crease, leading patients to seek a fold for aesthetic reasons or personal identity expression.

2. Asymmetrical Creases
   One eyelid has a fold while the other does not, prompting correction for facial balance.

3. Excess Upper Eyelid Skin (Dermatochalasis)
   Loose or drooping skin can obscure the crease and even impair vision.

4. Ptosis (Drooping Eyelid)
   Weakness of the levator muscle causes eyelid droop; blepharoplasty combined with levator tightening corrects this.

5. Upper Eyelid Fat Prolapse
   Bulging fat pads create a puffy appearance and can eliminate crease definition.

6. Desire for “Awake” Appearance
   A distinct crease often makes the eyes look larger and more alert, which many find attractive.

7. Age-Related Changes
   Over time, skin laxity and fat redistribution can flatten or erase a previously existing crease.

8. Makeup Application Difficulty
   Without a crease, applying eyeliner or eyeshadow precisely can be challenging.

9. Cultural or Personal Beauty Standards
   Many individuals seek a crease based on societal ideals or personal aesthetic goals.

10. Trauma or Scarring
    Previous injuries or surgeries may have distorted or removed the natural crease.

11. Congenital Eyelid Malformations
    Rare congenital conditions can leave the eyelid without a fold or with an irregular crease.

12. Occupational Needs
    Actors, models, and performers may require a crease for on-camera work or to meet industry norms.

13. Improved Eyelid Function
    In some cases, a better-defined crease helps with eyelid closure dynamics and tear distribution.

14. Psychological Well-being
    Enhanced self-confidence and body image after achieving the desired eyelid appearance.

15. Revision of Prior Blepharoplasty
    Correcting unsatisfactory results—too high, too low, uneven, or disappearing creases—from earlier surgery.

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Symptoms (Patient Complaints) Before Surgery

Although blepharoplasty itself has no “symptoms,” patients often report these complaints or functional concerns:

1. “My Eyelids Feel Heavy”
   Excess skin or fat makes the eyelid feel weighed down, especially later in the day.

2. “I Can’t See the Crease”
   Monolid appearance means no visible fold when the eyes open.

3. “One Eyelid Looks Different From the Other”
   Asymmetry in crease height or presence can be bothersome.

4. “My Upper Vision Is Blocked”
   In severe dermatochalasis, the eyelid encroaches on the superior visual field.

5. “Eye Makeup Smudges”
   Without a crease, eyeliner and eyeshadow can crease and migrate.

6. “I Look Tired or Sad”
   Hooded eyelids and lack of crease can give a fatigued appearance.

7. “I Get Frequent Headaches”
   Overuse of forehead muscles to lift drooping lids may cause tension headaches.

8. “My Eyelids Rub Together”
   Excess skin may irritate the opposing eyelid surface, leading to discomfort.

9. “My Eyes Water Constantly”
   Poor eyelid apposition or tear-film disruption from altered eyelid contour.

10. “I’m Self-Conscious in Photos”
    Lack of a crease can feel like an unwanted difference in appearance.

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Diagnostic Tests and Evaluations

Before surgery, a thorough evaluation ensures safety and optimal results. These assessments fall into five categories:

Physical Exam

1. Visual Acuity Assessment
   Standard eye chart testing to confirm normal or corrected vision.

2. Slit-Lamp Examination
   Microscopic inspection of eyelid skin, ocular surface, and tear film quality.

3. Margin-Reflex Distance 1 (MRD1)
   Measures the millimeters between the corneal light reflex and the upper eyelid margin, evaluating droop.

4. Palpebral Fissure Height (PFH)
   Vertical distance between upper and lower eyelid margins to assess eyelid opening.

5. Eyelid Crease Height Measurement
   Distance from the lash line to the proposed crease when the eye is open.

6. Levator Function Test
   With the frontalis muscle relaxed, the patient looks down then up; the excursion of the eyelid indicates levator strength.

7. Skin Pinch Test
   The surgeon pinches redundant upper eyelid skin to estimate how much should be removed safely.

8. Lid Laxity (Snap-Back) Test
   The lower eyelid is gently pulled away from the globe and released to assess its elasticity—important if lateral canthoplasty is considered.

9. Bell’s Phenomenon Check
   Observes upward rotation of the eye when the patient closes their lids; critical to ensure corneal protection post-surgery.

Manual Tests

10. Distraction Test
    Measures lower eyelid’s horizontal laxity by pulling laterally; guides canthal tightening decisions.

11. Eyelid Closure Force Test
    Patient closes eyes against gentle resistance to assess orbicularis muscle strength.

12. Fat Pad Prolapse Maneuver
    Gentle pressure on the upper eyelid fat pads while the patient looks downward; helps gauge fat removal extent.

Lab and Pathological Tests

13. Complete Blood Count (CBC)
    Screens for anemia or infection risk.

14. Coagulation Profile (PT, aPTT)
    Ensures normal blood-clotting to minimize bleeding complications.

15. Blood Glucose (Fasting)
    Detects diabetes, which can impair healing.

16. Thyroid Function Tests (TSH, T4)
    Uncontrolled thyroid disease can cause eyelid swelling or retraction and affect surgical planning.

Electrodiagnostic Tests

17. Orbicularis Oculi Electromyography (EMG)
    Rarely used, but assesses muscle and nerve health if neuromuscular disease is suspected.

18. Facial Nerve Conduction Study
    Evaluates nerve integrity if prior facial trauma or paralysis affects eyelid function.

Imaging Tests

19. Orbital Ultrasound (B-Scan)
    Visualizes soft-tissue structures and fat pads, helping to plan removal or repositioning.

20. High-Resolution CT or MRI
    In complex cases—such as prior trauma or suspected masses—imaging maps the orbital anatomy in detail.

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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: July 13, 2025.