Double Eyelid Surgery

Double eyelid surgery, or Asian blepharoplasty is a unique procedure used to create or enhance an upper eyelid fold in those who lack the fold from birth or who have weak or uneven folds. Common in people with Asian ethnicity, the absence of an eyelid fold is due to an anatomic difference in the eyelid structure when compared with those with a natural crease. 


There are several techniques that are possible for creation of a natural and beautiful eyelid fold, however the first step is to understand what results are desired and what will look natural to suit the facial characteristics.


Unlike conventional upper eyelid blepharoplasty, where the goal is simply for skin reduction and freshening of the tired eyelid appearance, double eyelid surgery actually involves reducing only a minimal amount of skin and using the excess to create a fold that will enhance the eyes and provide the appearance of larger, more defined eye shape.


Dr Ahn specialises in double eyelid surgery or Asian blepharoplasty in Sydney and through his Korean background and additional specialist training at a number of highly reputable clinics and hospitals in Seoul, South Korea, has developed an extensive knowledge and technical expertise in how to create these results for you. 

Why is the Asian eyelid unique?


The Asian face has many unique characteristics and as such, in assessing the eye region, we must take into account the overall facial profile to consider the natural balance between the eyes, nose mouth and chin areas. Creating strong, high upper eyelid folds while the rest of the facial features remain small and soft can look unnatural and too obvious, while most that consider double eyelid surgery want others to wonder 'has she or hasnt she?'


Asian eyelids contain thicker skin, muscle and more fat than a Caucasian eyelid with a natural fold. In fact, the very first attempts at creating an upper eyelid fold therefore tried to replicate Caucasian folds which are much higher and the results looked very unnatural. Higher folds are only suited to eyes that have thinner skin and less upper eyelid fat with a deeper facial profile and over the years we have developed an understanding of the factors that create a beautiful eyelid.


The results that you wish to achieve will vary depending on individual preference and during your consultation Dr Ahn will use his experience in double eyelid surgery and Asian facial aesthetic analysis to help you make the decision through the process. Unlike many may believe, double eyelid surgery, or Asian blepharoplasty surgery is not simply about dissecting the eyelid to create a fold!


Surgical techniques of Asian blepharoplasty

Incisional double eyelid operation


Traditional double eyelid fold creation relies on an incision along the line of the desired eyelid crease. The advantage of this technique is in its versatility. By creating an incision, Dr Ahn is able to reduce skin excess and remove excess muscle and orbital fat that is preventing upper eyelid fold creation.


Assessment of whether this technique is suitable for you is conducted during your consultation. If you have concerns about your eyelids feeling heavier or blocking your vision, or have always disliked how puffy your eyes appear, chances are that you may require an incisional Asian blepharoplasty by Dr. Chris Ahn. Although less common (20%) in younger patients, due to its ability to adjust multiple factors in the upper eyelid, the incisional double eyelid surgery can sometimes be the best choice for you to achieve beautiful, natural eyelid shape with permanent results.


Unlike the non-incisional technique, the reason that incisional surgery is permanent is that it creates an adhesion plane between the skin and the deep tissues of the upper eyelid that forms a tether point for the upper skin to fold over thereby creating an eyelid crease. This adhesion is created through your body's own healing from the surgery and therefore does not rely on a suture only to create the fold. Sutures inevitably will fail with time, whereas these adhesion tether points are permanent and will not fail. The technique allows scar formation between the skin and the tarsal plate 


Having control of these factors does come at a cost however - the most significant disadvantage of this technique being that due to the dissection required, the duration of post operative swelling is generally longer than non-incisional surgery and therefore it can take longer for your swelling to reduce and up to six weeks before your final results can be expected.


Nevertheless, if this techique is right for you, Dr. Ahn will explain the reasons why and guide you through your decision. By providing the ability to finely adjust eyelid thickness and modify crease shape, incisional double eyelid surgery may be recommended as the best option to achieve natural results



Non-incisional double eyelid operation


A newer development for Asian blepharoplasty (double eyelid surgery) is to use a non-incisional method which relies on a permanent suture to create a tether point.


Although the scar from incisional double eyelid surgery is usually very faint and invisible with the eyes open, non-incisional Asian blepharoplasty takes this one step further, by making the entire procedure scarless even with your eyes closed.


The procedure involves making five small puncture holes, through which a permanent sutures in introduced that pulls your outer skin down on to your tarsal plate (the fibrous structure that provides framework to your upper eyelid). As there is no dissection involved, the distinct advantage of this technique is that the procedure is shorter (one hour versus two) and has faster resolution of swelling that traditional incisional surgery. Many patients will have minimal swelling by 3 days post operatively and most will disappear by 2 weeks after your operation. 


The procedure however is not permanent - on average it will last 10 years. It also does not allow for any removal of excess skin and is not strong enough to create a double fold in those with thicker upper eyelid skin so it has its limitations. Failure of the suture after a period of time will not necessarily prevent your ability to have the procedure again however and some may go on to have further non-incisional surgery rather than converting to an incisional Asian blepharoplasty.


During your consultation, Dr. Ahn will use his expertise in double eyelid, or Asian blepharoplasty surgery to assess whether this option is best for you and your desired results. Generally, younger patients who are able to create folds artificially through stickers or glue are good candidates for a non-incisional double eyelid technique while those with thicker skin or requiring removal of drooping skin will have a better outcome from traditional incisional blepharoplasty.




Beautiful Asian eyes - what are the key characteristics?

It is interesting to see how the defining characteristics of an attractive Asian eye have changed over the years. When double eyelid surgery first began, it was initially believed that closely matching a Western eyelid fold was key. If you look back at photos from this era, the results appear unnatural - with many eyelid folds being far too high. Although the height of the folds match Western eyes, what was not taken into account was the fact that the Asian face has a generally flatter contour and especially around the eyes there is more fat content causing a high fold to have an artificial and unnatural appearance.


Over the years the trend has moved towards a more natural appearing eyelid fold that creates definition and highlights the beauty of the eye aperture. The key to this is in 3 factors.


Eyelid Crease Height.

For a natural appearance, the eyelid crease height should be no more than 6-8 mm in most Asian women. This is significantly lower than in Western blepharoplasty which is typically at 10 mm. A thin double eyelid fold naturally complements the Asian eye, and provides depth while not acting against the naturally fuller upper eyelid in the Asian population


Infold vs Outfold

In an infold crease, the double eyelid fold blends in with the inner corner of the eye and provides a gentle start to the upper eyelid fold heightening the natural appearance. Different Asian backgrounds will find this more or less appealing however and some desire a more distinct, stronger eyelid fold in which case an outfold may be a better option. Here the fold begins above the inner corner of the eye and remains separate throughout.


Inner / outer epicanthoplasty

Many Asian eyes have an additional inner fold that obstructs vision of the innter corner of the eye and can make the eye appear round and smaller. This fold is created by connective tissue or muscle fibres that are nor required functionally. For an attractive eye shape, the inner tear duct area should be slightly visible from frontal view. Inner epicanthoplasty is a procedure designed to release this fold and allow proper visualisation of the corner of the eye which can make the eye appear longer and more defined. This procedure is typically combined with double eyelid surgery.


Your initial consultation for a blepharoplasty will begin with a discussion regarding your goals for the operation. Be as detailed as possible and come prepared with any questions that you would like answered about the procedure. You will also have photos taken for the consultation Dr Ahn will be able to use instruments to simulate the desired changes to allow you to gain a better idea of how your eyes will appear post operatively. Dr. Ahn will explain the procedure and possible complications in detail and you will be required to attend a secondary consultation prior to finalising your decision to allow you to ask any further questions you may have.

All surgery carries risks and those specific to this procedure will be discussed with you during your consultation and also provided in your consent paperwork. Possible risks of an double eyelid procedures include:

  • Bleeding
  • Infection
  • Scarring
  • Asymmetry
  • Numbness
  • Blurred vision
  • Failure of fold formation
  • Improper crease position
  • Injury to muscle (ptosis)
  • Blindness (rare)


Whatever the desired outcome, it is important to realise that individual results will vary based on your own anatomy, facial shape and desired eyelid shape. Achieving a natural and well balanced result that suits your own facial aesthetics is the most important outcome and this will be discussed with you during your consultation and assessment by Dr. Ahn. Contact us to discuss your goals and to learn more about what can be achieved for you.

Before and after photos

Before and after photos of non incisional double eyelid Asian blepharoplasty operation in patient in her 20s. Shown 1 week post operation. Infold crease, medium height

Before and after photos of incisional (open) double eyelid Asian blepharoplasty operation in patient in her mid 30s. Shown 2 weeks post operation. Infold crease, low height

Before and after photos of non incisional double eyelid Asian blepharoplasty operation in patient in her early 30s. Shown 6 weeks post operation. Pre-existing mild crease. Changed to full crease, medium height

Before and after photos of non incisional double eyelid surgery ( Asian blepharoplasty) operation in a patient in her early 20s. Photos shown 3 months post op with natural, scarless results

Before and after photos of non-incisional scarless double eyelid surgery operation in a patient in her 20s combined with medial epicanthoplasty to release heavy inner corner skin folds creating a natural infold double eyelid crease shape

Before and after photos of incisional double eyelid surgery with ptosis correction in a patient in her 30s to improve eyelid functional opening and to create a natural appearing double eyelid crease with lifted eyelid appearance

Before your consultation

It is recommended that you approach your consultation after reading through the information provided and having some idea of the results that you would like to achieve. Photos of examples can help, but it must be understood that everyone's anatomy is unique and the results that can be achieved will be dependent on a number of factors that include the shape of your eyes, the thickness of the upper eyelid tissues including fat and muscle content and whether there is any pre-existing weakening of the eyelid function. 


Although the some of the differences in Asian blepharoplasty, or double eyelid surgery techniques can be on factors such as recovery time, swelling and the presence of scars - these are not the only aspects that need to be considered. During your consultation, after determining the results that you desire Dr Ahn will perform and examination of your eyelids and determine the best technique to achieve those results for you. 


Please be aware that Asian blepharoplasty or double eyelid surgery in Sydney is a cosmetic procedure and subject to the restrictions within New South Wales on cosmetic surgical operations including a mandatory 7 day cooling off period between your consultation and procedure. 


You will be scheduled for a complimentary second consultation to clarify any questions that you may have prior to your operation. We recommend that you consider a second opinion from an independent Specialist Plastic Surgeon prior to your secondary consultation and operation.


Please also take the time to read through the documents below as they will be discussed with you prior to the procedure and will provide you with more information regarding the operation and post operative management.


We look forward to seeing you at your consultation.

Standard Procedure consent form
Surgery, Procedure or Treatment Consent.
Adobe Acrobat Document 419.9 KB
Non-incisional Asian blepharoplasty double eyelid surgery standard post operative protocol
Non-Incisional Double Eyelid Surgery.pdf
Adobe Acrobat Document 135.4 KB
Incisional Asian blepharoplasty double eyelid surgery standard post operative protocol
Incisional Double Eyelid Surgery.pdf
Adobe Acrobat Document 322.8 KB