Double Eyelid Surgery

Reasons For Considering Blepharoplasty

Double eyelid blepharoplasty is the most popular aesthetic surgery in Taiwan and East Asia. It is common among Asians to be born with a single eyelid (monolid) and wish to pursue surgical improvements for these reasons:

Functional Reasons

Your eyelids are causing some interference with your vision.
Downward-pointing lashes are causing irritation on the cornea.
You are suffering from Drooping Eyelid (Ptosis) - weakness in the eye elevating muscle.

Cosmetic Reasons

Make your eyes look bigger by removing the droopy tissue / excess skin at the corners.
Increase the fold of your upper eyelid.
Improving visuals results from eye makeup.
Mismatching eyelids - you may have a mono eyelid and a double eyelid.

Choosing between the Main Methods of Eyelid Surgery

(Full) Incisional Surgery

Patients with thicker upper eyelids may appreciate the versatility of the Incisional approach. Your plastic surgeon will be able to adjust multiple factors in your eyelid - such as the removal of drooping skin, create bigger-looking eyes and achieve beautiful, permanent results.

Non-Incisional Surgery (Suturing, a.k.a DST - Double Suturing and Twisting)

The non-Incisional approach is often marketed as "scarless". It is popular with the younger generation seeking a more 'natural' look. This method adopts the buried suture technique which pulls your outer skin down to create the desired crease. However, this procedure is not permanent as the sutures are unable to last beyond 10 years.

The technique does not allow for removal of excess skin. Furthermore, sutures may not be strong enough to create a double fold for patients with thicker upper eyelid skins.

Partial Incisional Surgery

The partial-incision method is reliable and long-lasting without many of the drawbacks of the full-incision method. This is a simple, safe, and straightforward approach to double-eyelid creation that can be performed even by surgeons with relatively little experience in the technique.

Plasma Fibroblast (*new)

Plasma Fibroblast is a newer innovation that provides aesthetic improvements via a non-surgical / non-invasive procedure.

The treatment is delivered using a "plasma pen" that discharges tiny plasma flashes to the skin. This causes the target tissues to sublimate, meaning - solid target tissues changes directly into the gaseous state, causing no damage to surrounding areas or deeper skin layers.

Illustration of the Incisional Surgery approach

Procedures of the Incisional Method

Measurement and marking the desired double-eyelid line (red dotted line as shown above).
Administration of general and local anesthesia.
The plastic surgeon will make small incisions along the marked line.
Removal of excess skin, muscle and fat tissue within the marked line.
Stitching up the incision or achieve closure with skin glue.

2. Illustration of the Non-Incisional Surgery

Procedures of the Non-Incisional Method

Measurement and marking the desired double-eyelid line (red dotted line as shown above).
Administration of general and local anesthesia.
The plastic surgeon makes a series of tiny punctures along the red dotted line.
Sutures are introduced through these little holes, and helps tighten / crease the eyelid's skin.
The sutures are hidden beneath the skin and there's no need for removal.

Video Comparison of The Incisional and Non-Incisional Surgery

3. Illustration of the Non-Incisional Surgery
Compared to the Full Incisional method, only about one-third of the eyelid is incised. The key advantages include a faster recovery and less scarring. This is a very versatile method that produces a permanent crease and allows adjustment of the "eyelid's plumpness" because the surgeon is able to extract fats from the partial incision.

At the same time the patient will be able to retain the epicanthal fold (see image below), regarded as an essential Asian aesthetic quality of the eyelid. Should the patient wish to remove this epicanthal fold, then the full incision surgery is likely to be recommended.

4. Plasma Fibroblast (Plexr) technique - Suitable for those with existing but hidden Double-Eyelid

The Plasma Fibroblast technique is often used to tighten droopy double eyelids and by doing so, creates/enhances a double-eyelid crease.

It is not able to create a double eyelid from a single eyelid. Note that the effects are temporary and lasts between 12-18 months.

The procedure is far more iterative and dynamic, as it involves the plastic surgeon requesting the patient to open and close the eyes while applying the Plexr Pen device.

Consult your Plastic Surgeon

You should consult a qualified, experienced plastic surgeon to discuss these topics:

Your goals from the double-eyelid surgery
your medical history, including existing conditions and known allergies
suitability of the incisional, non-incisional and plasma techniques
risks and recovery, pertinent to your choice of technique

What are the Risks of Blepharoplasty ?

Medical Risks include:

General surgery risks, including bleeding, infection, and reaction to anesthesia.
Injury to eye muscles which can cause difficulty closing your eyes
Dry and irritated eyes.
Chemical eye injuries

Cosmetic Risks include:

Scarring (depending on technique)
Skin discoloration
Asymmetry - because the Surgeon is dealing with two separate surgical sites.

Post-Op Recovery

Most patients experience minimal pain after surgery.
Degree of swelling is dependent on the amount of trauma incurred. For example, an incisional surgery involving the removal of fat, muscle and skin will cause more swelling than a non-incisional / partial incisional procedure.
For incisional surgeries, stiches are typically removed after about 5-6 days.
Patients can return to work after a week and resume physical activities after 2-4 weeks.

How much does it cost?

The costs heavily depends on the complexity of the surgery, the choice of anesthesia and the country where the plastic surgeon is located. Should you consider going to a foreign country for medical treatment, you'll have to factor in necessary costs of travel, accommodation and perhaps a translator. Medical concierge services (such as this) may be helpful to deal with logistics and complexities.

Double Eyelid Surgery

Other (nonsurgical) techniques for double eyelids

You can get double eyelids without seeing a doctor, using items such as eyelid tapes and eyelid glues which can help produce a temporary crease on your eyelids. They are conveniently available at drugstores and beauty product shops.

Advantages

These products provide a quick, temporary and removable result.
Avoids the costs and risks from surgery.

Disadvantages

They require daily application which is not only inconvenient, they can also cause skin irritation.
It may be awkward when they fall out of position.
Eye injury can occur if you accidentally get glue into your eyes.
Allergic reactions are also possible.
Hygiene is critical. Make sure to change eyelid tape daily and keep the area around your eyes clean.

Before and after pictures

to update

Deciding Your Preference on Upper Eyelid Height

It may be helpful to scroll through Images of people with 4 Different Eyelid Designs and Double Eyelid Height (upper eyelid) to arrive at a conclusion of your own preference: Low, Middle or High Upper Eyelid.

These images came from an academic research on more than 400 people of different cultures, surveying their preference on photographs of 19 women.

While the survey results concluded that both Chinese and non-Chinese people prefer the medium-height upper eyelid crease to be the most beautiful, this is quite a subjective preference. You are encouraged to conduct this comparison exercise yourself by checking out this Google Document, and consider your own aesthetic preferences.

The Effect of “Single” vs “Double” Eyelids on the Perceived Attractiveness of Chinese Women

Is the Double Eyelid Surgery a painful process?

Most of the time, patients do not experience pain because the surgeon will administer general and local anesthesia before the surgery.
After the operation, you should expect mild discomfort such as blurred vision, itchiness, tightness or dry eyes, but these symptoms will subside during the recovery phase.

Improved Double Eyelid Surgery Technique

Proposed method minimises scarring for the Incisional Double Eyelid Surgery

Method: Levator aponeurosis is used as “connecting tissue” to provide lifting strength for the upper eyelid, and “skin adhesion” is induced between levator aponeurosis and skin in a plane manner. Postoperation evaluation includes stability of double eyelid, asymmetry, double fold curve, and scar formation.

Results: A total of 119 patients were operated on in this study. 90% showed good fold curve (double eyelid), and 75% of patients had no prominent scar.

Conclusions: This novel surgical technique utilized pretarsal levator aponeurosis as the connecting material to bridge levator muscle and upper eyelid skin; by establishing a direct force transmission mechanism, palpebral crease is created in a more natural way in terms of anatomy and physiology. Furthermore, skin adhesion is formed between levator aponeurosis and dermis in a planar manner, allowing for more stable palpebral crease and more preserved orbicularis oculi in-situ, thereby minimizing eyelid scar formation.

Using Levator Aponeurosis to Create Double Eyelid.pdf

Improved Double Eyelid Surgery Technique

Map of Double Eyelid Surgeons and Clinics:

Korea, Singapore & Malaysia.

Check out important resources here:

Google Drive: https://drive.google.com/drive/folders/1LsZ9mjJXmKNpsnO1Ym7hihzWuIkYQmhm?usp=sharing

Double Eyelid Surgery

Reasons For Considering Blepharoplasty

Functional Reasons

Cosmetic Reasons

Choosing between the Main Methods of Eyelid Surgery

(Full) Incisional Surgery

Non-Incisional Surgery (Suturing, a.k.a DST - Double Suturing and Twisting)

Partial Incisional Surgery

Plasma Fibroblast (*new)

Illustration of the Incisional Surgery approach

Procedures of the Incisional Method

2. Illustration of the Non-Incisional Surgery

Procedures of the Non-Incisional Method

Video Comparison of The Incisional and Non-Incisional Surgery

4. Plasma Fibroblast (Plexr) technique - Suitable for those with existing but hidden Double-Eyelid

The procedure is far more iterative and dynamic, as it involves the plastic surgeon requesting the patient to open and close the eyes while applying the Plexr Pen device.

Consult your Plastic Surgeon

What are the Risks of Blepharoplasty ?

Medical Risks include:

Cosmetic Risks include:

Post-Op Recovery

Advantages

Disadvantages

Proposed method minimises scarring for the Incisional Double Eyelid Surgery

Map of Double Eyelid Surgeons and Clinics:

Korea, Singapore & Malaysia.

Check out important resources here: