Asian Eyelid Surgery is very popular with Asian-Americans. Asians are increasingly asking their plastic surgeons for wider and rounder eyes. Other Asian patients who have mono-lids (no crease in the eyelid) are seeking to have a fold created to achieve a double-eyelid. In the United States, eyelid surgery ranks as the third most poplar plastic surgery done by Asian Americans, behind nose reshaping and breast augmentation.

For those Asians with a double eyelid, the crease curves: it starts out small and near the eyelashes at the corner of the eye, and then gradually becomes larger, reaching its maximum at the center of the eye. The crease then continues in a parallel slope downward away from the nose.

Suture Methods: There are various techniques that can be used to achieve the double-eyelid. The first one, often called the “suture method” involves making small incisions inside the lid along the new crease line and placing tight sutures underneath the skin. The skin is lifted and folded back to create the fold.

The suture method has the advantage of being less invasive than other double-eyelid methods as little surgery is involved, the procedure costs less, and can be performed quickly, often in as little as fifteen minutes. Despite these advantages, the suture method has some serious drawbacks in that the result is not long-lasting and the crease fades away after several years because the sutures weaken after a few years.

In some cases, the sutures can break after a few months and lead to the disappearance of the crease. This method also results in a less natural look, as the newly-created crease is always there and does not go away when the eyes are closed or when one blinks.

Furthermore, the crease created by the suture method does not follow the shape of the patient’s eye as closely as the full incision method (discussed below), and the resulting double-eyelid looks more “Western” than Asian. Finally, the suture method has another key limitation in that future eyelid surgeries that are necessary to do once the crease fades are more difficult and expensive to perform because of the formation of scar tissue resulting from the incisions. For these above reasons, the suture method is less favored by many plastic surgeons compared to more effective and long-lasting incisional methods.

Incisional Methods: Today, the “gold standard” in double-eyelid surgery is the full incision method, where a crescent-shaped incision is made along the new crease line, and in the process small strips of muscle and orbital septum are removed and in some case also some fat. The amount of tissue removed affects the height and shape of the newly created crease. Then, the two sides are sutured together permanently. The incision method is a superior technique because of the long-lasting results that it produces and there is no risk of sutures breaking since they do not play a role in creating the crease. The incision method is more natural-looking and does not have the problem of creating a permanent crease, as when a person closes or blinks their eyes the crease disappears.

Double Standard Twist: There is also a hybrid method called the Double Stranded Twist (DST) method that combines the suture and incisional techniques, where a series of small incisions are made to remove fat, while the lid is still lifted through the use of sutures. This technique leads to longer-lasting results than the less invasive suture method and patients reportedly do not experience weakening of the sutures and loss of their crease. According to an article in the American Society for Aesthetic Plastic Surgery (ASAPS) peer-reviewed journal, the results from the DST method have lasted as long as 10 years. Furthermore, the procedure is said to be “virtually scar free.”

Following an eyelid surgery, patients may experience swelling. Bruising can also occur and last anywhere from one to two weeks to a month. There may also be uncomfortable side effects on the eyes, such as gumminess, burning, itching, or sensitivity to light. Patients are mobile after a few days, and after two weeks, these side effects begin to subside. Scars may show slightly for at least six months, at which point they fade away.