Asian blepharoplasty — commonly called "double eyelid surgery" — is one of the most commonly performed cosmetic procedures worldwide. It creates or enhances a supratarsal crease ("double eyelid") in patients who lack one or have a low, incomplete, or asymmetric crease. The goal is a natural-appearing eyelid that preserves the patient's ethnic identity while achieving a more defined, open appearance.
Asian blepharoplasty requires intimate knowledge of the differences between Asian and non-Asian eyelid anatomy. The aesthetic goals often differ substantially from Western upper blepharoplasty — a high crease that looks natural on Caucasian eyelids may look foreign or "operated" on an Asian eyelid. See also Blepharoplasty and Anatomy Overview for reference.
Anatomy of the Asian Eyelid
The defining anatomical difference between Asian and non-Asian eyelids lies in the attachment of the levator aponeurosis — the tendon of the muscle that opens the eye — to the skin and pretarsal orbicularis:
Non-Asian (Western) Eyelid
Levator aponeurosis sends fibrous septa to the dermis at the level of the tarsal plate — creating the supratarsal crease
Orbital septum fuses to the levator aponeurosis above the tarsal plate
Retroseptal orbital fat is confined behind the septum
Crease typically 8–12 mm above the lash margin
Asian Eyelid
Levator aponeurosis sends few or no dermal attachments — no crease forms ("single eyelid") or crease is low and incomplete
Orbital septum fuses to levator aponeurosis at or below the tarsal plate
Orbital fat descends into the preseptal space — filling the lid below the crease
Epicanthal fold: a skin fold at the medial canthus is common
~50% of East Asian individuals lack a supratarsal crease naturally
Caucasian (left) vs Asian (right) eyelid cross-section — lower orbital septum fusion and preseptal fat descent define the Asian eyelid
Crease Variation in Asians
Asian eyelid crease configuration varies considerably among individuals:
Absent crease (single eyelid): No visible crease — most common presentation in surgery-seeking patients
Low crease: A crease exists but is low (2–4 mm above lash margin), hidden within the lash line; considered aesthetically low
Incomplete crease: Crease visible centrally but fades medially and/or laterally
Multiple creases: Two or more incomplete parallel creases — unfavorable aesthetically
Nasally tapered crease: Crease begins above the medial canthus and tapers down; creates a natural, ethnic appearance
Parallel (non-tapered) crease: Crease runs parallel to the lash margin across the full lid width — may appear less ethnic in some patients
Aesthetic Goals
The desired outcome of Asian blepharoplasty must be individualized to the patient:
Create a defined, natural-appearing supratarsal crease at an appropriate height (typically 5–8 mm, lower than Western norms)
Preserve the patient's ethnic identity — the result should look natural for the patient's heritage
Improve the perceived size and openness of the eye
Achieve symmetry between the two eyelids
Address epicanthal folds if present (epicanthoplasty) when medially prominent folds compromise the crease
Remove excess skin only if present — unlike Western blepharoplasty, skin removal is minimal or absent in many patients
Surgical Techniques
Non-Incisional Suture Technique (Double Suture and Twist — DST)
The non-incisional technique creates a crease using buried sutures that replicate the levator-to-skin attachment without excising skin:
Several small punctures (3–7) are made along the planned crease line
A buried suture is passed through each puncture, anchoring the dermis to the levator aponeurosis or tarsus
No skin incision, minimal bruising, 1–3 day recovery, no visible scar
Limitations: The crease may weaken or disappear over months to years as sutures loosen or break. Best suited for younger patients with thin eyelids, minimal fat, and good skin elasticity. Not ideal for patients with excess skin or fat — the extra tissue prevents a clean crease from forming.
Incisional Technique (Open Method)
The incisional technique creates a durable crease through a skin excision along the planned crease line:
The crease line is carefully marked at the planned height, typically 5–8 mm above the lash margin
A small ellipse of skin (and sometimes orbicularis and preseptal fat) is excised
The levator aponeurosis is sutured to the skin/orbicularis at the crease line, creating the adhesion that forms the crease
Skin is closed with fine sutures; scar is hidden within the crease
Advantages: Durable, more reproducible result; allows precise crease height and shape; fat removal possible; suitable for all lid types including those with excess skin or fat.
Recovery: 7–14 days of swelling and bruising. Final crease appearance stabilizes over 3–6 months as swelling resolves and the crease softens.
Partial Incision Method
A hybrid approach using two to three short incisions (rather than a full-length incision) to allow fat removal and crease formation with less extensive dissection. Less morbidity than full incision; more durable than suture technique.
Epicanthoplasty
The epicanthal fold — a skin fold at the medial canthus — is common in Asian individuals and may obscure the medial crease or give the eye a narrow appearance. When the epicanthal fold is prominent, epicanthoplasty is performed concurrently with double eyelid surgery:
Medial epicanthoplasty releases and re-drapes the epicanthal fold, exposing the medial canthus
Techniques include the Z-plasty, Y-V plasty, and skin re-draping methods
Goal: reveal the inner corner of the eye and allow the crease to reach the medial canthus naturally
Scar placement within natural creases minimizes visibility
Recovery
Non-incisional: 1–3 days of mild swelling; return to normal activities in 2–3 days
Incisional: 7–14 days of notable swelling; sutures removed at 5–7 days; most patients presentable in 10–14 days
Crease may appear high or unnatural initially — it should always be evaluated in the context of post-surgical swelling
Final result appreciated at 3–6 months as swelling fully resolves and crease matures
Asymmetry in the healing phase is common and usually resolves spontaneously
Revision Asian Blepharoplasty
Unsatisfactory results from prior Asian blepharoplasty — including a crease that is too high, too low, asymmetric, or an unnatural-appearing "Westernized" result — are among the most challenging cases in oculoplastic surgery. Revision requires careful analysis of the existing anatomy, scar tissue, and prior operative details. Conservative, staged revision is generally preferred over aggressive re-operation.
Frequently Asked Questions
What is Asian blepharoplasty?
Asian blepharoplasty (double eyelid surgery) creates a supratarsal crease in eyelids that lack one — a feature found in approximately 50% of East Asian individuals. The goal is to create a natural-appearing crease that enhances the eye without erasing ethnic identity. It can be performed with suture techniques (no incision, faster recovery) or incisional techniques (more durable results).
What makes oculoplastic surgeons better for Asian blepharoplasty?
Asian eyelid anatomy differs from Western anatomy in the distribution of orbital fat and the attachment of the levator aponeurosis. A thorough understanding of these structural differences — and the ability to address concomitant ptosis — makes ASOPRS-trained oculoplastic surgeons ideally suited for Asian blepharoplasty. Results that respect ethnic anatomy require deep anatomical knowledge.
What is epicanthoplasty?
Epicanthoplasty modifies the medial canthal fold (epicanthal fold) — a skin fold at the inner corner of the eye common in Asian anatomy. It can lengthen the horizontal appearance of the eye. It is often combined with double eyelid surgery but is not always necessary or desired, depending on the patient's individual anatomy and aesthetic goals.
What is the difference between non-incisional and incisional Asian blepharoplasty techniques?
Non-incisional (suture) techniques create a supratarsal crease by placing small sutures without making a visible skin incision, resulting in minimal scarring and a quicker recovery. Incisional techniques involve removing a small amount of skin and tissue through a precise incision, allowing for more dramatic crease definition and longer-lasting results, though with a slightly longer healing period. Dr. Annunziata will recommend the best approach based on your eyelid anatomy, desired crease height, and aesthetic goals. Both techniques can produce beautiful, natural-looking results when performed by experienced oculoplastic surgeons.
What should I expect during my Asian blepharoplasty consultation?
During your consultation, Dr. Annunziata will examine your eyelid structure, skin elasticity, and current crease definition to assess your candidacy and discuss your aesthetic goals. They will explain both surgical options, review before-and-after photos of similar cases, and discuss realistic outcomes tailored to your facial features and ethnic characteristics. Dr. Annunziata will also review your medical history, current medications, and any previous eyelid procedures to ensure your safety. This is an excellent time to ask questions and address any concerns about the procedure, recovery, and expected results.
What is the typical recovery timeline after Asian blepharoplasty?
Most patients experience mild swelling and bruising for the first 1-2 weeks, with significant improvement by the end of week three, though complete resolution can take 4-6 weeks. Non-incisional procedures generally have a faster recovery, allowing many patients to return to light daily activities within 3-5 days, while incisional techniques may require 7-10 days before resuming normal routines. You should avoid strenuous exercise, heavy lifting, and activities that increase eye pressure for at least 2-3 weeks. Dr. Annunziata will provide detailed post-operative care instructions, including proper eyelid hygiene and any prescribed medications to optimize healing and results.
Who is a good candidate for Asian blepharoplasty?
Ideal candidates are individuals with Asian or mixed Asian eyelid anatomy who desire a more defined supratarsal crease, either for aesthetic preference or to create a crease where one does not naturally exist. Good candidates should be in overall good health, have realistic expectations about outcomes, and be non-smokers or willing to quit smoking during the healing period. Age is not a barrier—candidates range from young adults seeking their first procedure to mature individuals looking to refresh their appearance. A consultation with an experienced oculoplastic surgeon is essential to evaluate your specific eyelid anatomy and determine whether you would benefit from this procedure.
