Asian Eyelid Surgery – Double eyelid surgery


Asian eyelid surgery is a popular procedure among Asian descendents around the world, including their countries of origin. Seeking the “double eyelid” gives the upper eyelid a visible crease or fold when the eye is open. It has been estimated that 50% of the Asian population don’t naturally have the double eyelid fold.

Considered to be a desirable aesthetic feature among many Asian cultures, this procedure for the upper eyelid makes the eyes appear more open, less tired, and easier to apply eye shadow. Dr. Amiya Prasad, a highly respected Oculofacial plastic surgeon for over twenty years uses his expertise in eyelid surgery (Asian Blepharoplasty) to provide patients with natural looking results.

asian eyelid surgery

This Asian lady in her mid-20s had no eyelid crease, and wanted them for as long as she could remember. The incisional technique for Asian double eyelid surgery was needed for a stronger connection as she did have little extra skin, but her taut, young skin needed a strong anchor to create the crease. She also had some fat above her eyelid that was preventing her eyelid crease from forming, so some fat also needed to be excised. After surgery, she had the option for the first time in her life to use eyeshadow.

Asian eyes vary in terms of the epicanthal fold, amount of skin, fat and other important structural elements. One procedure does not fit all.  Oculoplastic surgeon Dr. Prasad has extensive experience with Asian eyelid surgery and has performed double eyelid blepharoplasty for many of his Asian patients from all over the world.

Asian Blepharoplasty – natural looking Eyelid Crease

Creating a natural-looking double eyelid must take into account factors such as the age and gender of the patient. An important decision before  Asian Blepharoplasty is determining whether you are a candidate for an incisional or a non-incisional procedure.

double eyelid surgery-Male

This gentleman in his mid-40s had partially formed eyelid creases, but were barely visible. Since no fat was preventing his subtle crease from forming, a non-incisional approach was appropriate, and no skin needed to be removed. His results were eyelids with a round, natural shape, that brightened up his whole face.

If you’re a candidate for an incisional procedure, it’s critical to avoid removing too much skin or fat which is a common technical error made by surgeons less familiar with Asian eyes. Successful surgery begins with a design planned prior to the procedure. We have helped many Asians who have had eyelid surgery ended up dissatisfied with their appearance. Dr Prasad performs many Asian eyelid revision surgery procedures.

Asian Eyelid – Difference in Anatomy

One of the most frequent errors made by plastic surgeons performing Asian eyelid surgery results in  “Americanizing” or “Europeanizing” the eyelids, which results in a very unnatural appearance. The Asian eyelid is different from the “Western” or “Occidental” eyelid in many ways, which is why Asian eyelid surgery (blepharoplasty) is so unique. It is important to know that Asians do not only have one type of eyelid:

Asian eyelid- no crease

Among the 50% of Asians having an eyelid crease, there can be variability as to the symmetry and definition of the eyelid creases. Some people report that the crease can change where one day they have a crease and the next day the crease is not as defined. Many Asian patients come to address their desire to have a stable and single crease to enhance the appearance of their eyes.

Asian eyelid-partial crease

The position of the fold to be created varies from patient to patient, Dr Prasad will show you where the fold can be placed to achieve a natural look. Depending on your anatomy, the fold can be positioned 2-3 mm above the lid (fine crease), 4-6 mm(medium crease) or 7-10 mm( deep crease). This is a function of the amount of skin which overlaps the position of the actual crease which can vary from 6.5 to 10 mm. In contrast, blepharoplasty (eyelid lift) in Caucasians is generally performed to reveal more of the eyelid and can be 10 mm or higher.

Eyelid multi creaseEyelid with double crease

 Candidates for Double Eyelid Surgery

If you’re someone who wants to have a more defined eyelid crease, you may be a candidate. It’s important to understand that age can be a factor in the type of crease and the method of surgery required. For example, a 60-year-old woman would likely need a different type of surgery when compared to a 30-year-old man.

asian eye surgery-Incisional procedure

This gentleman in his mid-20s had very slight eyelid creases with a weak fold, and one of them didn’t span the entire width of his eye. A little fat that prevented a more defined crease from forming was removed, as well as some extra skin through the incisional technique of double eyelid surgery. He was able to achieve clearly defined eyelid creases that covered the entire width of his eyes, and a more open look.

How to prepare for surgery

As with most cosmetic surgeries, its important that you be in good health. Management of conditions such as blood pressure and diabetes are also important. Prior to surgery, we routinely review current medications and make sure our patients avoid any medication or supplement that is a blood thinner. During your consultation, Dr. Prasad will guide you in preparing for your procedure.

How is the double eyelid surgery done?

The Asian eyelid surgery consists of reshaping the upper eyelid. During your consultation with Dr. Prasad, various factors will be evaluated including:

  • Your skin thickness and quality
  • Your fat volume under the skin
  • Your healing from past procedures
  • Your unique anatomy around your eyes
  • Your age
  • Your gender

Dr. Amiya Prasad will customize the procedure to create the fold. Depending on the amount of extra skin and fat under the upper eyelid, Dr. Prasad will choose to perform a non-incisional or an incisional procedure.

Technically, the non-incisional technique is still surgery, but instead of making an incision and removing skin from the upper eyelid, small openings are made in the skin. A stitch is passed through in a way to attach the upper eyelid skin to the underlying levator muscle muscle, which is responsible for lifting the eyelid. This will result in the eyelid skin folding in when the eyes are opened.

asian blepharoplasty-Surgery method

This lady in her early 30s wanted her eyelid creases to be more defined and symmetrical. She had a particular issue with her eyelid creases not reaching the inner corners of her eyes. Being young and with existing but not fully formed eyelid creases not hidden by fat, Dr. Prasad chose the non-incisional approach to Asian eyelid surgery to deepen her creases, and extend the visible fold to the inner corners. He also extended and raised the eyelid creases slightly in the middle part of the eyelid and outer corners for more symmetry between two eyes, giving her subtly more alluring look.

If there is extra skin and fat on the upper eyelid, an incisional approach is used to create the fold. After Dr. Prasad draws the appropriate pattern, an incision will be made in the upper eyelid area. Typically, a small volume of fat will be removed in order for the crease to be defined with the intention of avoiding creating a “hollow” area.

How long does double eyelid surgery take?

Dr. Prasad performs double eyelid surgery in approximately 1 hour. However preparation time and immediate post-operative recovery means you’ll be at the clinic for approximately 3 hours. The time of the surgery can be longer when performed with other procedures.

The Asian blepharoplasty is performed at our offices, located in Manhattan and Garden City, Long Island in our operating facilities certified by The Joint Commision.

Dr Prasad-Asian eye surgery

Anesthesia

The procedure is performed under local anesthesia with intravenous or IV sedation (LITE IV sedation). Our patients are comfortable and appreciate being able to avoid general anesthesia.
When appropriate, Dr. Prasad will have select patients open their eyes during the surgery (there is no pain or discomfort) to see how the eyelid crease has formed. This allows Dr. Prasad to adjust the procedure for best results.

Dr. Prasad performs Asian eyelid surgery on patients coming from all over the world.

Recovery & follow up

Following your double eyelid surgery, you will be seen in about 1 week for removal of sutures (for incisional surgery).  Swelling after Asian eyelid surgery is common and can make the eyelid crease appear too high. You will see Dr. Prasad regularly after your procedure to make sure you are healing properly.

korean eyelid surgery-After procedure
korean eyelid surgery-After procedure

While Asian double eyelid surgery is known for a healing process that can take up to year, most often marked by temporary swelling of the eyelids, healing time can be reduced. Using quick recovery techniques such as doing the surgery under local anesthesia instead of general anesthesia, and specific instructions by Dr. Prasad for immediate and short-term aftercare, the time for temporary swelling after eyelid surgery can be reduced. While reduced recovery from eyelid surgery is hard to guarantee with variables specific to individual patients, Dr. Prasad has generally minimized post-surgery swelling among Asian eyelid surgery patients with his experience in precision surgery, and years of development of faster recovery for the convenience of his patients.

The healing process for an Asian eyelid surgery can appear to be longer than non Asian patient. Swelling between the eyelid crease and the eyelid margin can persist for months and even a year.

Factors which can affect the recovery process include allergies, sinus conditions as well as having sensitive skin. Dr. Prasad will see you throughout your recovery period to assist you during this time.

How long does the result last?

The result from the blepharoplasty are long lasting. The long term appearance can be affected by your age as well as other medical and environmental factors. As with any cosmetic surgery procedures, revision surgery may be required. Dr. Prasad is committed to helping you achieve your desired results and will counsel you prior to surgery about your expected results.

asian double eyelid-Male

This gentleman in his mid-50s was not only lacking an eyelid crease, but also suffered from a weak eyelid muscle that stretched with age causing his upper eyelid to droop. A drooping eyelid due to a defective or weakened levator muscle that lifts the eyelids is called ptosis, and weakening, stretching, or detachment due to age is known as acquired ptosis. Ptosis can affect vision, so it is more than just a cosmetic problem. Dr. Prasad performed ptosis correction surgery, which is a specialized procedure only performed by oculoplastic/oculofacial surgeons, to shorten the muscle so the upper eyelids can lift up to open and close normally, and no longer obscure his vision. In addition, he also performed an incisional Asian double eyelid surgery to create a double fold eyelid crease.

Blepharoplasty or Epicanthoplasty?

There is often confusion about the best procedure to enhance your eyes. Blepharoplasty and epicanthoplasty are commonly used terms. Blepharoplasty is the medical term for eyelid surgery for both the upper and lower eyelids. In Asian patients, the aim of the upper eyelid blepharoplasty is to create a crease in the upper eyelid using different techniques.

Located in the inner corner of the eye, the epicanthal fold, also referred as “mongoloid fold”, and is prevalent among the Asian population. An epicanthoplasty is a procedure to change the epicanthal fold so the inner corners of the eyes (inner canthus) is revealed. The eyelid crease can look longer and the eye can appear wider.

oculofacial Surgeon-Dr Prasad

If you are considering Asian/ double eyelid surgery, you can contact us at Prasad Cosmetic Surgery in New York, at Manhattan’s Upper East Side at (212) 265-8877 or Garden City, Long Island at (516) 742-4636


Frequently Asked Questions (FAQs)

Do I need Asian Eyelid surgery or Ptosis surgery?

The upper eyelid position is critical for making the eyes look more open. Creating a crease can be effective if the upper eyelid is in a good position. If the upper eyelid is low or drooping, this is a condition called “ptosis”. Asian eyelid surgery can be performed at the same time as ptosis surgery.

Can Asian blepharoplasty be combined with other procedures ?

Yes, the procedure can be combined with a canthoplasty, epicanthoplasty, ptosis surgery and under eye bags surgery (lower eyelid blepharoplasty).

What is the difference between Almond eye surgery and Asian eyelid surgery?

The Almond eye surgery is a customized procedure which can be performed in non-asian patient to create a natural looking almond shaped eye. Similar procedures can be performed for Asian patients to create an attractive shape.
If interested about the Almond eye surgery, refer to our Almond eye surgery page

How much does the Double eyelid surgery cost?

The Asian blepharoplasty is a procedure that is customized from patient to patient and may be combined with other procedure. Cost for surgery includes surgeon’s fee, anesthesia fee, and facility fees. Dr. Prasad is committed to performing surgery in the safest way at his Joint Commission Certified facilities. Contact us for a consultation to learn more details about the surgery. We do not accept health insurance.

Why is the Double Incision Asian Eyelid Surgery the Most Complex?

The Asian eyelid is different from the Caucasian eyelid in many ways, which is why Asian eyelid surgery (Asian blepharoplasty) is so unique and complex. Asian eyes require delicate finesse with the typical epicanthal fold that lies in front of the eye so that proper rejuvenation does not mar the natural beauty of this type of eye.

Asian individuals also often seek the “double eyelid fold” procedure, which gives the upper eyelid a visible crease when the eye is open. One of the most frequent mistakes that plastic surgeons have made is “Americanizing” or “Europeanizing” the eyelids. This results in a very unnatural appearance.

In my cosmetic surgery guide “The Fine Art of Looking Younger,” I address the topic Asian Eyelid Surgery in more details.

Excess Fold of Skin Left After a double eyelid surgery?

Swelling after a blehparoplasty is normal and 2.5 weeks is early in the postoperative period. Swelling can be variable and can last for up to a year.I have performed the double eyelid surgery for more than 15 years in New York City. You will probably benefit most by discussing your concerns with the operating surgeon .

How often do Asians experience unnatural results After an eyelid surgery?

Whether you are considering Korean eyelid surgery, Chinese eyelid surgery or Japanese eyelid surgery, the common desire is typically to have the eyes appear more open. Many of my clients come to me for revision surgery after previous Asian Eyelid surgery with other surgeons.

If you do research on the internet, you will find many different styles and techniques for the Double Eyelid Surgery. Non-incisional procedures as well as incisional procedures can be customized to your needs. When creating a natural appearance in the asian eye, the age and gender of the patient must be taking into account.

It’s critical to avoid removing too much skin or fat which is a common technical error made by surgeons less familiar with Asian eyes.Proper surgery begins with a design which is drawn prior to the procedure. Many Asians who have had eyelid surgery are not happy with scars which appear outside the natural crease and are difficult to manage.

What Technique Can Be Used to Minimize Scarring Following an Eyelid Surgery?

Asian eyelid anatomy is unique. Planning the shape of the crease is critically important. After making an incision with a scalpel or laser, I perform Asian blepharoplasty using surgical scissors to remove the skin. In Asian blepharoplasty the fat prevents a crease from forming properly. Using the incisional technique, I open the septum to allow the fat to come forward. Once the fat has come forward, a specific amount is removed.

It’s very important to leave enough fat behind to prevent a crease from becoming too high or create a hollow. After the fat is reduced ,the levator aponeurosis is revealed. Proper attachment of the skin to this structure is critical to creating a crease or double fold. In the procedure, sutures are placed carefully with attachment to the levator aponeurosis thereby creating a double fold. At the completion of the procedure, the sutures are placed.  Ice compresses are used immediately to minimize the small swelling up to 2 days.

Can I Have Surgery for an Epicanthic Fold?

Creating an Asian epicanthal fold and making the eyes more puffy are atypical surgical procedures (and one which I would advise against as the results may not look natural).

The use of makeup can sometimes help to achieve this look. It’s important for you to meet with the specialist who can guide you with the types of procedures that realistically will benefit you.

Cheapest and Best Way To Get Asian Eyelid Surgery?

The double eyelid surgery performed on Asian patient is very complex and requires knowledge so your results come out the way you want. If having the money is an issue for the surgery, you may want to reconsider having the surgery done now.

I recommend doing your research, finding a qualified and experienced eyelid surgeon who understands the anatomy of the Asian and eye, and inquire about financing options.

Will the Puckered Spot on Blepharoplasty Incision Resolve?

The puckering and small bump is not all uncommon in the healing process of any upper eyelid surgery. It may even be a bit more common as an Asian Blepharoplasty (creating a crease in the upper eyelid where there was none before) needs that extra securing in the stitching process to achieve the correct result.

I completely understand a patient being nervous about any concept of imperfection after surgery, please remember that we do not heal overnight, nor do we heal evenly. I do this procedure regularly, usually the puckering resolves itself in less than a month.

How Often Do Asians Have Their Eyelids Touched Up?

With Asian Eyelid Surgery, common reasons for revision include: removing too much skin or fat (which is a common technical error made by eyelid surgeons less familiar with Asian eyes).Another reason for a revision is unhappiness with scars appearing outside of the natural crease which are difficult to manage.

The Asian eyelid has some very important anatomical differences from non-Asian eyes. Ethnicity, age, gender and skin quality, general health need to be considered when developing a proper strategy for an eyelid surgery.

What will the surgery for an Asian Eyelid feel like?

At my practice in New York, I perform the blepharoplasty under local anesthesia with light IV sedation (or “twilight” sedation). The  patient has virtually no pain. Cold compresses are used for 2 days. The quick recovery approach to the double eyelid surgery optimizes the patients experience with minimal downtime.

Is a Brow lift ever recommended with eyelid surgery for “Westernizing” eyes?

Deciding if you need an eyebrow lift is usually based on if the eyebrows have become lower than when you were younger. If you’ve noticed that your eyebrows have gotten lower with time and you’re getting lines in your forehead trying to keep your eyebrows lifted, you may be a candidate for an brow lift.

However, only with a proper consultation with a qualified cosmetic surgeon who understands the balance of the face and can understand the look you would like be able to tell you what is a realistic option for you.

Is it ok to do a second revision after 1 month?

Wait 6 Months for revisional Asian Eyelid Surgery . Four weeks after the procedure is still very early , you still have swelling and need to finish healing before having another procedure. I suggest waiting a minimum of 6 months for additional surgery if you are still unhappy with your incision and folds.

Why Might It Take Up to Two Months to See Results from a double eyelid surgery?

Depending on the extent of surgery and the type of double eyelid surgery done, the healing time will vary to form your double eyelid crease. Swelling or inflammation after Asian eyelid surgery is normal and in the postoperative period.

At my practice in New York, non-incisional procedures as well as incisional procedures can be customized to your needs to suit your goals and lifestyle.

I Just had double eyelid Surgery but why don’t I have a crease?

It is unusual not to see any crease following the double eyelid surgery. If you didn’t had fat removed but just had multiple poorly-defined creases before surgery, then it is normal to not see the defined crease until swelling resolves. Communicate with your doctor to understand what’s going on with the healing after the procedure.

I Want Epicanthoplasty. Can I Get the Skin Squeezed to Eliminate the Folds?

There are several procedures which are designed to reduce epicentral folds. In younger people, I’m particularly concerned about the healing and the long term scarring after epicanthic fold surgery. This factor is important to consider before making the decision to do this type of Asian eyelid surgery.

Asian eyes require delicate finesse with the typical epicanthal fold that lies in front of the eye so that proper rejuvenation does not mar the natural beauty of this type of eye.

Would Epicanthoplasty Leave a Scar?

The Asian eye anatomy is unique. Scarring can be minimized when performing an epicanthoplasty by beginning with a unique design and proper planning for the patient prior to the surgery. Although some scarring is likely, proper surgery by a qualified and experienced cosmetic surgeon is recommended for the removal of epicanthic folds to get the results you want.

Eyes Appear Asymmetrical. One Eye Doesn’t Barely Has a Fold. What Can I Do?

A proper consultation with an Oculofacial cosmetic surgeon is necessary to determine how to fix the asymmetry of your eyes and to better understand the complexity of your situation. Asian eyes require delicate finesse with the typical epicanthal fold that lies in front of the eye.

Is There a Difference Between a Double Eyelid Surgery and Blepharoplasty Surgery?

Blepharoplasty is a general term for an eyelid surgery. A Double Eyelid Surgery is a type of blepharoplasty which creates a visible crease in the upper eyelid when the eye is open, also know as Asian eyelid surgery.

This change to the upper eyelid makes it easier to apply makeup and is considered to be a desirable aesthetic appearance in many Asian cultures.

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