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Procedure guide · Face
Asian BlepharoplastyAsian blepharoplasty creates or refines an upper eyelid crease in an eyelid that naturally has none, or has a partial one. It is not a Westernising operation: the aim is a crease in proportion to the individual eye, preserving the epicanthal fold and the natural eye shape. Surgery takes 60 to 90 minutes under local anaesthesia, swelling settles over 3 to 4 weeks, and the crease softens into its final height at 3 to 6 months.
An upper eyelid crease forms where fibres from the muscle that lifts the lid attach to the skin. When those attachments are present the skin folds as the eye opens; when they are absent or weak the lid is smooth, which is the single eyelid. This is a normal anatomical variation rather than a defect, and roughly half of people of East Asian descent have a natural crease of some kind, including partial creases that appear only over part of the lid.
Surgery creates the attachment that is missing. The incisional method opens along the planned crease, allows skin, muscle and fat to be adjusted, and fixes the crease to the deeper tissue, which is durable and works in thick lids. The buried suture method passes sutures through small punctures to form the same attachment without a continuous incision, recovering faster but relying on the lid being thin enough to hold it. The choice between them is determined by the thickness of your eyelid, not by preference.
The aim is proportion rather than a particular height. A crease that suits one eye looks startled on another, and the most common regret after this operation is a crease set too high because it was copied from a photograph. Surgeons who measure with the patient sitting upright and eyes open, and who err low, produce results that still look like the patient.
Surgeons look for these points at the consultation.
Asian blepharoplasty suits adults with a single eyelid, a partial or uneven crease, or a crease that has been lost with age, who want a defined eyelid in proportion to their own features, and who have healthy eyes and a clear idea of the crease height they want.
Reasons a good surgeon will ask you to wait or choose something else.
Asian blepharoplasty is avoided in dry eye, thyroid eye disease, previous eyelid surgery with scarring and bleeding disorders, and where there is a desire to change ethnic appearance driven by outside pressure rather than personal preference.
Ask your surgeon which technique they recommend for you and why.
Incisional Asian blepharoplasty opens along the planned crease, which allows skin, muscle and fat to be adjusted and the crease fixed to the underlying tissue. The standard where there is excess skin or fullness.
Suture Asian blepharoplasty uses two or three small punctures to pass sutures that create an internal attachment, forming a crease without a continuous incision. Suited to thin lids with little excess skin.
A short incision over the central lid combines some of the durability of the open method with less scarring, for lids with modest fullness.
The inner corner fold is adjusted to lengthen the visible eye opening. Performed only when specifically wanted, as it permanently alters a characteristic feature.
Step by step, from arrival to discharge.
The crease height is measured with you sitting upright and your eyes open, and shown to you in a mirror before anything is marked permanently.
For Asian blepharoplasty, local anaesthetic is infiltrated into both lids, with or without light sedation. You stay awake enough to open your eyes on request, which allows the crease to be checked during surgery.
Asian blepharoplasty either makes an incision along the marked crease and fixes the skin to the deeper layer, or sutures are passed through small punctures to form the same attachment internally.
In the incisional method a conservative amount of muscle or fat may be removed so the crease can fold cleanly in a thicker lid.
You are asked to open your eyes and the two creases are compared directly, with adjustments made before closing.
Very fine sutures close the incision and are removed at 5 to 7 days, or the puncture sites are left to heal without sutures.
Frequencies follow published guidance; your personal risk depends on your health and the surgeon.
The specific risks of this operation are aesthetic rather than medical. Eyes are safe; creases are not always right first time. The two failures that matter are a crease set too high, which reads as startled and is hard to undo, and a crease that fades because a suture technique was used on a lid too thick to hold it.
Both are decisions made before the operation rather than complications during it. A surgeon who measures the crease with you sitting upright and eyes open, who explains why they are choosing an incisional or a suture method for your lid, and who resists the height you saw in a photograph, is managing the risks that actually occur.
More prolonged than in other eyelid surgery: noticeable for 2 to 4 weeks, and the crease looks too high until it settles.
After Asian blepharoplasty the two lids rarely swell at the same rate, so early asymmetry is normal. True asymmetry is judged only after 3 to 6 months and may need a small revision.
Most likely with buried suture techniques in thicker lids; the crease becomes shallow or disappears and needs redoing, often with an incisional method.
Produces a staring, surprised look that is difficult to reverse. This is the main reason to be conservative about height and to be wary of copying another person’s eyes.
The Asian blepharoplasty crease incision is usually invisible once mature, but thicker skin can leave a firm line for several months, and epicanthoplasty scars at the inner corner are harder to hide.
If too much skin is removed the lid may not close fully at night, causing irritation. Usually temporary; rarely needs grafting.
This operation swells more, and for longer, than most people expect from a procedure that takes an hour. The crease always looks too high and too deep in the first weeks, which is a normal stage rather than a bad result, and it is the single most common reason patients panic early.
Judge nothing before 3 months. Plan 10 days abroad for suture removal, then expect to look slightly operated for a further 2 to 3 weeks.
Days 1-3
Cold compresses, head elevated, antibiotic ointment along the incision. Vision is fine but the lids feel heavy and look markedly swollen.
Days 5-7
External sutures come out at 5 to 7 days. The crease looks high and hard, which is expected at this stage.
Weeks 2-4
Most swelling has gone by 3 weeks and make-up can be worn over the crease once healed. The crease still sits higher than it will finally.
Months 2-3
Firmness along the line settles and the crease drops to a natural height. Contact lenses are comfortable again.
Months 3-6
The scar is invisible in the fold, the crease has reached its settled height, and any true asymmetry can now be judged.
After Asian blepharoplasty the eye looks more open and the lashes more visible, because the lid skin no longer rests on them. Make-up becomes easier to apply, which for many patients is the practical reason for the operation.
The early result is misleading. For the first weeks the crease sits high, looks deep and may appear uneven because the two lids swell differently. This is a normal stage and not a reason to seek correction. By 3 months the crease has dropped and softened, and by 6 months it has reached its settled shape and any genuine asymmetry can be judged.
An incisional crease is effectively permanent. A buried suture crease is durable in a thin lid but can fade over 5 to 10 years, and it can be redone or converted to an incisional crease if it does.
Price follows method and complexity. A buried suture crease in a thin lid is the shortest and cheapest option; an incisional crease with fat and muscle adjustment takes longer and costs more; adding epicanthoplasty increases it again.
Be cautious about comparing a suture technique quote with an incisional one as if they were the same operation. If your lid is thick, the cheaper technique is likely to fade, and the real cost becomes the revision.
Why quotes for the same procedure differ, so you can compare packages fairly.
Options to weigh before deciding, surgical and non-surgical.
Non-surgical products create a temporary crease each day. They cost little and are reversible, but can irritate the skin with long-term daily use.
Where the concern is hooding and excess skin in an eyelid that already has a crease, rather than creating a crease that was never there.
Where the lid itself sits low over the pupil, the underlying problem is the lifting muscle rather than the crease, and correcting it changes both.
Ask the same questions at every consultation so you can compare answers.
The crease is not chosen from a menu. It is worked out from the anatomy of the individual eye, and a careful assessment usually covers several things before any marking is made.
The first is how much lid there is to work with. The distance between the lash line and the eyebrow, the amount of skin resting on the lashes and the thickness of the tissue beneath it all limit how high a crease can sit before it looks forced. A lid with little skin cannot carry a tall fold without the lashes turning upwards or the fold collapsing back into a smooth lid.
The second is the position of the lid edge. If the upper lid already sits low over the pupil, or the eye looks sleepy in photographs, the surgeon needs to know whether the cause is excess skin, a heavy lid, or a weak lifting muscle. A crease alone will not fix a lid that does not lift properly, and creating one over an unrecognised problem can make the eye look more tired, not less.
The third is the shape of the eye as a whole. The slope of the eye, the depth of the socket, the position of the brow and the form of the inner corner all affect which crease looks natural. Surgeons commonly describe three broad shapes:
Which of these suits an eye depends largely on how the inner fold sits. A fold that is prominent tends to favour a tapered shape, because a parallel crease can look hard against it. This is also why the decision about the inner corner and the decision about the crease are linked, even though they are separate operations.
The fourth is what you are used to seeing. Many people judge their own eyes from the mirror at a particular angle, often looking slightly down. Surgeons therefore look at the eye in several positions: looking straight ahead, looking up, looking down and with the face relaxed. A crease that looks pleasing only when the eyes are wide open can disappear or fold awkwardly in ordinary conversation.
A good consultation also tests the proposal rather than just stating it. Common methods include:
The measurement is usually described in millimetres from the lash line, and it is a design decision, not a promise of an exact final result. Tissue swells, heals and settles, and the final height can differ slightly from the marked one.
Finally, the surgeon weighs your age, skin quality and the direction in which the lids are likely to change over time. Skin loses firmness, and a crease that is balanced today may need to allow for that. None of this removes the need for your own judgement. If a proposed height feels higher than you imagined, saying so before the operation is far easier than correcting it afterwards.
Photographs are the main evidence most patients have, and they are easy to misread. Photographs cannot show everything, but a few habits make them considerably more informative.
Check the timing. An image taken a few weeks after surgery shows swelling, and swelling makes a crease look higher and deeper than it will finally be. A photograph taken at 12 months tells you far more about the lasting outcome. If a collection shows only early images, it shows the stage that is least representative. It is reasonable to ask how long after surgery each picture was taken and whether later images exist.
Check that the conditions match. The same camera distance, lighting, head angle and facial expression should appear in both images. A slight lift of the chin, a wider smile or a brighter light can change how an eyelid appears. Make-up on one image and not the other is another common difference. Where conditions clearly differ, the comparison is weak.
Look at the eye in more than one position. A single frontal image with the eyes open shows only one view. Images with the eyes looking down, in a three-quarter view and with the eyes relaxed or nearly closed show whether the crease folds cleanly, whether the scar is visible and whether the two sides match.
Look for patients like you. The thickness of the lid, the shape of the inner fold and the quantity of fat vary a great deal. A result in a thin lid says little about what to expect in a thicker one. If your lids differ from those in the examples, ask for images of people whose anatomy is closer to yours.
Ask about selection. No surgeon publishes every result. Asking whether the pictures are consecutive patients or chosen examples does not insult anyone; it is part of reading the evidence. Honest practices can usually explain how images are selected and can discuss results that were less than ideal.
Notice what the images do not show. A photograph cannot tell you how the surgeon handled a problem, how long the person took to heal, whether a revision followed or whether the patient was satisfied. Speaking with a previous patient, where the practice permits it, can add information that pictures cannot.
Be wary of edited images. Heavy retouching, filters and unusual lighting can hide scars and smooth skin. Images that look uniformly polished, with no visible difference in the photographic quality between the before and after frames, deserve some caution.
Finally, keep a realistic idea of what a comparison can tell you. Someone else's result shows what a surgeon can do for someone else's eyelids. It does not predict your own outcome. The most useful role of photographs is to show how consistently a surgeon produces natural, proportionate creases over time, and whether the results look like the patient rather than like a template.
Not when it is done well. The operation creates a crease in proportion to your own eyelid and preserves the inner corner fold unless you specifically ask for it to be changed. Around half of people of East Asian descent naturally have a crease, so a double eyelid is not a Western feature. A surgeon who proposes a high crease plus epicanthoplasty as a default, rather than because you asked for it, is not the right surgeon.
The right method for Asian blepharoplasty depends on your eyelid, not on preference. Thin lids with little excess skin and no fat hold a buried suture crease well and recover faster. Thicker lids, fatty lids and lids with hooding need the incisional method, because sutures in that setting tend to loosen within a few years. A surgeon who offers only one method for every eyelid is choosing for their convenience.
Most people are presentable 2 to 3 weeks after Asian blepharoplasty with the swelling mostly gone, although the crease still looks higher and crisper than its final form. Complete settling takes 3 to 6 months.
An incisional Asian blepharoplasty crease is effectively permanent. A buried suture crease is durable in the right eyelid but can fade over 5 to 10 years, more quickly in thicker lids, and can be redone.
Lowering a crease is one of the harder revisions after Asian blepharoplasty. Releasing the old attachment means releasing the old attachment and preventing it reforming, and results are less predictable than the first operation. This is why conservative height at the first operation matters so much.
Glasses can usually be worn once you are comfortable, though the frames should rest lightly and should not press on the swollen lids or the healing line. Many patients find lighter frames easier in the first week.
Contact lenses are a different matter. They require pulling and touching the lid, which can distort a healing crease and carry a risk of infection, so they are avoided for the first 2 weeks, as the aftercare list on this page explains. If your surgeon advises a longer break, follow that advice. It is sensible to have a current pair of glasses ready before you travel for surgery.
A feeling of tightness or heaviness in the lids is common while the swelling is at its height. Slightly blurred or hazy vision can also occur for a short time, usually because of ointment on the lid margin or because the eyes are watering and feel dry.
Vision that is clearly worsening, severe pain that is increasing, or one eyelid becoming rapidly and markedly more swollen than the other should not be waited out. Contact your surgeon or the local emergency service the same day. Surgeons usually describe these warning signs before discharge, and it is worth asking for them in writing.
In the first days the lids are swollen and may not close completely, and this usually improves as the swelling goes down. Some patients notice mild dryness or a gritty feeling on waking during this stage.
Lubricating drops or ointment, when advised by the surgeon, help to protect the surface of the eye. A lid that visibly stays open at night after the first weeks, or eyes that feel increasingly sore and red, should be reported, because it can mean the skin has been shortened more than the eye tolerates. This is uncommon, and it is one reason surgeons are conservative about how much skin they remove.
Surgeons generally advise avoiding strenuous exercise, heavy lifting and anything that raises blood pressure sharply for around 2 weeks, because straining can increase swelling and bruising. Gentle walking is usually encouraged from the first days to support circulation.
Swimming, hot tubs and saunas carry a risk of infection and irritation while the incision is healing, so they are usually delayed until it has closed fully and your surgeon has agreed. Chlorinated water and heat can also irritate swollen lids. The exact timing depends on the method used and how you heal, so treat these figures as general guidance and follow the instructions you are given.
Every crease moves. Skin folds more deeply when the eye is wide open and flattens when it is relaxed, and tiredness, fluid retention, a salty meal or allergies can all make the lids puffier and change how the fold looks from day to day. This is true of natural creases as well as surgical ones.
During recovery these changes are more noticeable, because the tissues are still adjusting. A crease that looks different between morning and evening is not by itself a sign of a problem. A crease that looks consistently uneven after the swelling has settled, usually after several months, is the point at which a surgeon would reassess it.
It can be, and combining is often discussed with procedures that treat the same area or the same visit, such as brow or nose surgery. The reasons are practical: one anaesthetic, one recovery period and one trip. The reasons against are equally practical, because a longer operation, more swelling and a bigger recovery task can make it harder to judge any single result.
Surgeons usually advise against stacking several procedures when one of them depends on careful early assessment, as the crease does. Changes to the brow or the eye socket can also alter how the crease appears, so the order and the timing of the operations matter. Ask the surgeon to explain what is being combined and why, and whether staging is safer for you.
There is no single age. The operation is performed on adults, and surgeons generally prefer that the facial features have finished developing and that the decision comes from the patient. Younger adults often have thicker, fuller lids with firm skin, while older patients may have looser skin that needs more attention.
Age affects the plan rather than the eligibility. In an older lid, excess skin and a lowered brow are often part of the picture, which can make the incisional method more suitable. In a younger lid, a conservative crease usually ages more naturally. Health and eye condition matter more than the number, and a consultation will consider both.
Asian blepharoplasty changes the folds and the arrangement of the lid tissues, and it does not alter the eyeball or the focusing of the eye. Vision is not expected to change as a result of a well-planned operation.
The lid does protect the eye, so a lid that closes poorly, or tissue that irritates the surface, can cause dryness or discomfort. Surgeons therefore check the tear film, the way the lids close and the strength of the lifting muscle before operating. If you already have dry eyes, tell the surgeon. In some patients a low-lying lid is a sign of a lifting-muscle problem that is better treated on its own.
It does. Fresh scars react to ultraviolet light, and a line that is exposed to strong sun in the first months can darken and stay more visible than it otherwise would. Eyelid skin is also thin and burns easily.
Surgeons usually advise sunglasses and a wide-brimmed hat outdoors, and a mineral sunscreen on the area once the incision has closed and they have said it is safe to apply products there. Avoid sunbeds entirely during healing. This matters more for people whose skin tends to darken after injury, because pigment changes along a scar can last for months. Your surgeon can explain how long to take these precautions for your skin.
Almost everyone feels unsure at this stage. The lids are swollen, the crease sits high and hard, and the two sides rarely match, so the eyes can look startlingly different from what you expected. This is the part of recovery that this page describes as a normal stage, and it is not an accurate preview of the outcome.
Take photographs at the same time each day in the same light, rather than checking in a mirror repeatedly, which tends to magnify small differences. Keep your follow-up appointments and raise your concerns there. Contact the surgeon straight away only for warning signs such as increasing pain, a sudden change in vision, or marked swelling on one side. Decisions about correction are best made after several months.
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