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Authored by: Dr. Sam Sukkar, MD on January 9th, 2026
Double eyelid surgery, also called Asian blepharoplasty, is a cosmetic procedure that creates a defined upper eyelid crease to make the eyes look larger and more open. It does this by connecting the eyelid skin to deeper structures so a permanent eyelid crease forms when the eyes open. For most patients, the result is a more defined eyelid fold, improved symmetry, and an eyelid appearance that better matches their aesthetic goals.
People usually consider a double eyelid procedure to reduce excess upper eyelid skin, soften a heavy or puffy look, or enhance a barely visible natural lid crease. Recovery often takes one to two weeks for most daily activities.
Double eyelid surgery creates a defined upper eyelid crease by connecting the skin to deeper eyelid structures. This technique helps the eyes look larger, brighter, and more open.
Different double eyelid surgery techniques incisional, non-incisional, and hybrid are chosen based on eyelid anatomy, and the amount of excess skin or fat present.
Ideal candidates have healthy eyelids, clear goals, and realistic expectations.
Double eyelid surgery is a type of eyelid surgery that creates an upper eyelid crease, converting a single eyelid into a defined double eyelid.
In many Asian eyelids, the upper eyelid skin attaches low or not at all to the levator aponeurosis, so there is no visible supratarsal crease. These single eyelids are often called monolids. Double eyelid surgery creates a new eyelid crease by linking the upper lid skin to the tarsal plate or levator muscle.
During the double eyelid operation, a lid crease is designed at a measured distance above the upper eyelid margin. They then use sutures, with or without incisions, to fix the eyelid structures together. This crease formation lets the skin fold into a double fold when the eye opens.
The procedure can also remove excess skin, excess fat, or thin strips of orbicularis oculi muscle to refine the upper lid. In some patients, this improves functional concerns such as mild visual obstruction from excess upper eyelid skin.
Asian eyelid surgery focuses on the shape, height, and stability of the new eyelid crease rather than simply removing sagging skin. Traditional upper blepharoplasty in non Asian eyelids usually targets skin laxity and bulging orbital fat due to aging.
In Asian upper blepharoplasty, the goal is often a natural, stable crease that matches the patient’s facial features and ethnic identity. A successful corrective Asian blepharoplasty preserves the characteristic eyelid anatomy while improving eye appearance. In some cases, the procedure may be combined with ptosis repair or a brow lift when brow ptosis or eyelid droop contributes to hooding.
Patients choose double eyelid surgery for many reasons, often blending cosmetic goals with practical concerns about eyelid heaviness or asymmetry.
Many Asian patients want a more defined eyelid crease so the eyes look brighter, larger, or more symmetrical. Some already have a faint or uneven lid crease and want a more stable, balanced upper eyelid crease.
Common aesthetic goals include reducing a puffy upper lid, softening prominent epicanthal folds, or matching the crease shape of the opposite eye. Others want to move beyond temporary tools like eyelid tape, which can irritate thin eyelid skin and offer inconsistent results.
For some, excess upper eyelid skin or excess fat on the upper lid gives a tired or sad appearance. Creating a reliable upper lid crease can reduce hooding and open the palpebral fissure slightly, which may help peripheral vision in select cases.
Emotionally, patients often describe feeling more confident with an eyelid appearance that matches how they feel inside. Being able to apply eye makeup more easily is a frequent bonus. When done thoughtfully, Asian blepharoplasty can support self expression rather than erase ethnic features.
Several surgical techniques can create a double eyelid, and each method suits different eyelid anatomy, skin thickness, and goals.
The incisional method is the most traditional form of upper eyelid surgery for creating a stable double eyelid. The planned upper eyelid crease is marked, followed by a continuous incision along that line.
Through this incision, excess skin, excess fat, and sometimes a strip of orbicularis oculi muscle can be removed. This allows reshaping of thick or sagging skin and better control of crease shape. The levator aponeurosis, tarsal plate, and skin are then sutured together for strong crease formation.
Because the incision method addresses excess upper eyelid skin, it is common in patients with skin laxity, thicker eyelid skin, or more significant hooding. It is also preferred when there is asymmetry, old scarring, or the need for revision surgery.
The trade off is a visible scar in the new eyelid crease, especially in patients with very thin skin. Over time, the scar usually softens and hides within the fold.
The non-incisional method, sometimes called the suture method, uses several tiny openings in the upper eyelid instead of a full incision. Through these small punctures, sutures are placed to connect the upper eyelid skin to the levator muscle or tarsal plate, creating a defined eyelid crease without cutting the skin.
Because there is minimal tissue disruption, visible scarring is uncommon and swelling often resolves more quickly. Many patients return to light activities sooner, and makeup may be allowed earlier depending on post-procedure instructions.
However, the non-incisional approach does not remove excess skin or significant fat. It works best for younger patients with thin eyelid skin, minimal sagging, and good levator function. In some cases, the created eyelid crease may loosen over time, which can require suture removal or revision.
Partial incision, or hybrid, techniques fall between the full-incision and non-incisional methods. This approach uses three to five small incisions along the planned eyelid crease, with sutures placed through these openings to secure the crease and create definition.
These techniques allow for limited removal of orbital fat or thin strips of muscle while keeping scars relatively short. For patients with moderate eyelid thickness or mild excess skin, a partial incision often provides a more stable and durable double fold than sutures alone.
Hybrid methods also allow finer control of the crease by adjusting the medial and lateral portions separately. This can reduce the risk of an unnatural appearance and help address concerns such as a low fusion point near the inner corner of the eye while still limiting scar length.
Good candidates for double eyelid surgery have suitable eyelid anatomy, clear motivations, and realistic expectations about benefits and limitations.
A patient’s medical history is first reviewed, including bleeding disorders, dry eye, meibomian gland dysfunction, or uncontrolled medical conditions. These factors can affect healing and comfort after eyelid surgery.
On examination, an assessment is made in the eyelid anatomy, including the upper lid margin position, levator function, skin thickness, and the amount of excess skin or excess fat. Brow ptosis, lower lids laxity, and lower eyelid position also influence the overall eye appearance.
Patients with thin eyelid skin and minimal sagging often do well with a non incisional method. Those with thicker skin, significant sagging skin, or previous eyelid procedures may need an incisional method or upper blepharoplasty. When true ptosis is present, ptosis repair may be recommended at the same time.
The evaluation also considers whether a patient’s goals can realistically be achieved. Some Japanese women, for example, may prefer a very low, tapered crease that preserves the natural Asian eyelid character, while others may request a higher, parallel crease for a more dramatic change.
Patients should understand that natural eyelid asymmetry is common and that perfect symmetry is not achievable. The final appearance may also shift slightly as swelling resolves and scar tissue matures over time.
A good candidate recognizes that double eyelid surgery can enhance eye appearance but cannot guarantee a specific celebrity look. Being prepared for a healing period that includes temporary swelling and bruising is essential before the final result becomes visible.
On surgery day, patients can expect careful marking, anesthesia, and a stepwise approach tailored to their chosen technique.
After check-in and consent review, the planned eyelid crease is re-drawn and the design is confirmed with the patient. Pre-operative photographs are usually taken at this stage. In the operating room or office procedure room, the area is cleansed and sterile drapes are applied. Local anesthesia is then injected into the upper eyelid to numb the skin and deeper tissues.
For the incisional method, the planned incision is made, excess skin and orbital fat are adjusted as needed, and fixation is created between the skin, orbicularis oculi muscle, and tarsal plate. For the non-incisional method, buried sutures are placed through small puncture sites to form the crease.
Once the crease is secured, any incisions are closed with fine sutures along the eyelid crease. Ointment is applied, and the patient rests briefly before discharge with written post-procedure instructions.
Most double eyelid surgeries use local anesthesia, sometimes combined with mild oral or intravenous sedation. This approach keeps patients comfortable and allows real-time assessment of crease position during the procedure.
The exact duration depends on whether the surgery is incisional, non incisional, or partial incision and whether other procedures like ptosis repair or brow lift are added. Many stand alone double eyelid procedures take about 30 to 90 minutes for both eyes.
After surgery, patients spend a short time in recovery before going home the same day. They must have an adult escort for safety, especially if sedation was used.
Healing after double eyelid surgery happens in stages, and knowing what to expect can reduce anxiety during the early swollen phase.
In the first week, most patients experience swelling, bruising, tightness, and mild discomfort around the upper eyelids. The eyelid crease may look higher or more dramatic than expected at first.
These changes usually improve noticeably between days three and ten. It is normal for the two eyes to heal at slightly different speeds, leading to temporary asymmetry. Mild dryness, light sensitivity, and watery eyes can also occur.
Warning signs that require a prompt call to the post-opt care team include sudden severe pain, rapidly increasing swelling, heavy bleeding, pus like discharge, or vision changes. Fever or worsening redness may indicate infection and needs urgent review.
Cold compresses in the first 48 hours, combined with keeping the head elevated, can help reduce swelling and bruising. Most patients feel comfortable returning to desk work after about a week, though this varies.
For incisional methods, sutures are usually removed around five to seven days after surgery. After suture removal, gentle scar care may begin as directed, sometimes including massage or silicone products.
Scars often appear pink or firm at first but typically soften and fade over several months. Because the visible scar lies within the new eyelid crease, it usually becomes difficult to see when the eyes are open.
Most patients enjoy long lasting changes in eyelid appearance after double eyelid surgery, though aging and individual healing can alter results over time.
For incisional techniques, the connection between skin, muscle, and tarsal plate tends to be durable. Many patients keep a stable upper eyelid crease for many years.
Aging continues after surgery, so skin laxity and sagging skin may gradually increase. Some patients later choose an upper blepharoplasty to address age related excess skin while preserving the original double fold.
Revision surgery may be considered if there is persistent asymmetry, an undesired crease height, or loss of the crease on one or both sides. Is recommended to wait several months to a year before deciding.
During revision planning, eyelid anatomy gets reassesses, scar tissue, and levator function. They may switch from a non incisional method to an incisional method for more secure crease formation.
Most patients undergoing revision aim for a more natural crease shape, smoother lid margin contour, and better balance between the upper eyelid and lower eyelid.
Double eyelid surgery, or Asian blepharoplasty, is a cosmetic procedure that creates a defined upper eyelid crease. The eyelid skin is connected to deeper structures such as the tarsal plate or levator muscle, allowing it to naturally fold into a permanent double eyelid when the eyes open.
Good candidates have healthy eyes, suitable eyelid anatomy, and realistic expectations. People with thin skin and minimal sagging may suit a non-incisional method, while those with thicker or droopy skin often need an incisional approach. A thorough evaluation of eyelid position, brow position, and medical history is essential.
Most patients experience swelling and bruising for the first week, with noticeable improvement by days three to ten. Many return to desk work in about one to two weeks. Scars and crease shape continue to refine over several months, and final results are usually judged after three to six months of healing.
Common temporary effects include swelling, bruising, mild pain, dryness, and short-term asymmetry. Less common but serious complications include infection, significant bleeding, problems fully closing the eyes, or an unnatural-looking crease. In some cases, undercorrection or multiple creases require revision surgery. Choosing an experienced surgeon reduces these risks.
Yes. Eyelid tape, eyelid glue, and some temporary thread techniques can create a short-term double eyelid effect without surgery. However, results are not permanent and may irritate the thin eyelid skin over time. For a stable, long-lasting crease, surgical double eyelid surgery remains the most reliable option.
Double eyelid surgery can create a defined upper eyelid crease, refine excess skin or fat, and enhance the overall eye appearance when performed thoughtfully. Success depends heavily on proper candidate selection, a clear discussion of desired outcome, and great skills in Asian blepharoplasty techniques.
Anyone considering this cosmetic procedure schedule a consultation, and understand the full recovery timeline and risks. With realistic expectations and expert care, most patients achieve a natural looking double eyelid that aligns with both their features and their personal sense of beauty.
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Board-Certified Plastic Surgeon Dr. Sam Sukkar, MD, FACS, and the The Clinic for Plastic Surgery Team provide advanced eyelid surgery solutions to refresh and restore the appearance of the eyes.
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Dr. Sam Sukkar, MD, FACS is a highly respected Board-Certified Plastic Surgeon in Houston, Texas, known for his expertise in advanced cosmetic and reconstructive procedures. As the founder of The Clinic for Plastic Surgery, Dr. Sukkar has set a new standard for excellence, performing over 20,000 procedures with a focus on delivering natural, refined results.
Dr. Sukkar earned his Doctor of Medicine (M.D.) degree from Louisiana State University School of Medicine in 1992 after graduating summa cum laude with a Bachelor of Science in Microbiology. He then completed an intensive General Surgery Residency at the University of Texas Hermann Hospital before being selected for a highly competitive Plastic Surgery Fellowship at Northwestern University in Chicago, one of the most prestigious training programs in the country.
With more than 20 years of experience, Dr. Sukkar is a Diplomate of the American Board of Plastic Surgery and a Fellow of the American College of Surgeons (FACS). He is also an active member of the American Society of Plastic Surgeons (ASPS) and the Houston Society of Plastic Surgery (HSPS). His dedication to innovation and continuing education has solidified his reputation as a leading expert in aesthetic surgery, specializing in breast surgery, body contouring, facial procedures, and non-invasive treatments.
Dr. Sukkar’s expertise has been recognized by Houston Magazine, naming him one of Houston’s “Top Docs for Women,” and he has been featured among RealSelf’s America’s Top Doctors. Committed to his patients, he prioritizes personalized care, ensuring every individual feels informed, comfortable, and confident in their aesthetic journey.
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Cover Image Illustration by: Dr. Sam Sukkar, MD, The Clinic for Plastic Surgery.
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