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Asian Eyelid Surgery

Asian Eyelid Surgery - Featured Model

About 50 percent of the Asian population lacks a natural fold just above the lashes in the upper eyelid. Depending on the aesthetics of your face, this single-fold structure can prevent you from having the bright, defined eyes you desire. Asian eyelid surgery is designed to address the unique needs of those with single folds to provide the facial appearance you want.

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Asian Eyelid Surgery Techniques

Asian Eyelid Surgery

  • Candidates

    Candidates for Asian eyelid surgery should be in good physical health and have realistic expectations of their results. A potential candidate has small or non-existent upper eyelid folds, uneven folds, a fatigued or dulled expression due to a weakened eye-opening muscle, excessive inner eyelid skin (inner epi), or compensating forehead wrinkles, fatigue, or headaches.

  • Recovery

    The recovery time of incisional surgery is one to two weeks, while that of non-incisional surgery is two to three days.

  • Pain

    Pain is minimized during the procedure by placing you under IV anesthesia, which makes you sleepy and comfortable. Post-operatively, the minimal pain is controlled with simple TYLENOL®.

  • Maintaining Ethnicity

    It’s essential to maintain your ethnicity when performing any surgery. There are some differences between Asian and non-Asian eyelid folds. The Asian upper eyelid crease begins close to the eyelashes and gets larger until the midpoint of the pupil; after this point, the crease runs parallel to the eye. The non-Asian upper eyelid crease runs parallel to the lid margin and is 20 percent larger than the Asian eyelid crease. A thorough understanding of these ethnic differences helps Dr. Lee produce natural-looking results for his Asian eyelid surgery patients.

  • Appearing Tired and Sleepy

    The eyelid may not open all the way if the muscle is weak or becomes disconnected from the eyelid cartilage (the “tarsus”). This condition, called ptosis (“drooping”), can either be the result of aging or genetics and is routinely addressed during eyelid crease surgery by reattaching the muscle more firmly to the tarsus. The result is a brighter, more alert appearance.

  • Appearing Angry

    When the eyelid is unable to clear the upper one-third of your visual field, the frown muscles of the forehead have to kick in and help open up the remaining one-third of the visual field. These frown muscles can make you look angry. Eyelid surgery will open up the eyes to increase your visual field.

  • Downward-Pointing Eyelashes

    Many people (up to 50 percent) of all ethnicities have a common condition called ptosis, in which the eyelid muscle does not fully open the eyelid. One of the signs of ptosis is downward-pointing eyelashes. During eyelid surgery, the ptosis is corrected along with setting the eyelid crease, helping to get the lashes pointing outward in the correct orientation.

  • Inner Epi (Removal of a Mongolian Fold)

    An inner epi or medial epicanthoplasty is performed if there is excessive inner corner skin that interferes with a smooth crease formation. A newer technique called the redraping method makes incisions along the borders of the Mongolian fold and leaves very little visible scarring.

  • Eye Enlargement by Cutting Outer Corners

    This procedure works best on patients with eyes that overly slant upward. The attachment to the outer eye socket is lowered to a more horizontal position, effectively widening the eye. Less preferable is to drop a horizontal eye to a downward-slanting eye, which has the effect of increasing the visibility of the whites of the eye but can create an artificial, operated-on look.

  • Reasons for Fold Failure

    Double eyelid surgical methods can lead to fold failure for various reasons. Some incisional procedures fail because of limited dissection, while others fail because of the location where the skin/muscle is secured. For instance, the popular technique of securing the skin to the levator aponeurosis can lead to an imprecise crease and a higher rate of fold failure. This is why Dr. Lee additionally secures the skin to the tarsal plate and levator tendon when performing anchor blepharoplasty.

    Similarly, traditional suture techniques often fail because the sutures are merely buried in the lid, creating the potential for the sutures to tear through the soft tissue of the upper eyelid. The DST technique resolves these issues by securing the skin/muscle to the tarsal plate to create a more permanent crease with a far lower risk of fold failure.

    The two most common types of eye anatomy prone to fold failure are 1. Deep-set eyes and 2. Patients with eyelid ptosis (weak eyelid muscle). Deep-set eyes strain the incision line and have a higher risk of breaking it. Patients with ptosis have incomplete opening of the eyelid so that the crease cannot form very firmly and is prone to breaking.

  • Insurance

    In some cases, corrective eyelid surgery can be covered by insurance. Patients with a condition known as ptosis have a drooping eyelid that interferes with vision. This can be caused by a weakened levator muscle, seen in younger patients with congenital ptosis, or dehiscence of the levator from the tarsus, seen in older patients as part of the aging process. A visual field test can determine whether your ptosis is severe enough to have correction be covered by PPO health insurance.




Maintaining Ethnicity

Appearing Tired and Sleepy

Appearing Angry

Downward-Pointing Eyelashes

Inner Epi (Removal of a Mongolian Fold)

Eye Enlargement by Cutting Outer Corners

Reasons for Fold Failure



Asian Eyelid Surgery Concerns

  • Pitfalls

    Due to the wide variation of eyelid anatomy, the Asian eyelid procedure has a long learning curve for the surgeon. It helps to have a surgeon trained appropriately, preferably by a world expert, as Dr. Charles S. Lee was, and then having the experience of treating thousands of patients specifically in Asian eyelid surgery. This will maximize your chances of a good to great outcome.

  • Risks

    The chances of a poor outcome decrease with the skill and experience of the surgeon. Asymmetry or an unnatural look are the most common complications, but an experienced surgeon can point out whether your anatomy is more difficult than the typical patient’s. Patients with ptosis or protruding eyes are at higher risk for revision surgery. Certain patients have poor healing characteristics, especially those who bruise easily, smoke, or have very distensible joints.

  • Cost

    The cost of Asian eyelid surgery with Dr. Charles Lee may vary depending on the patient’s needs and the selected surgical approach. A price quote will be provided during your consultation with Dr. Lee.





Frequently Asked Questions

  • What techniques are used in Asian eyelid surgery?

    Asian eyelid surgery can be either incisional or non-incisional. Anchor blepharoplasty is an incisional method of creating a crease, giving the patient a double eyelid. To achieve this, the skin is cut, tissue is excised, and the skin is attached to a firm structure within the eyelid (tarsus, AKA tarsal plate). While many doctors simply attach the skin to the levator muscle, Dr. Lee prefers to additionally attach the skin to a deeper structure, the tarsal plate, along with the levator muscle. Whereas the levator muscle moves with the eyelid, the tarsal plate is static. Attaching the skin to both structures allows for greater precision when placing the crease and also reduces the possibility of fold failure. Medial epicanthoplasty, another incisional technique, is often used in conjunction to crease surgery to remove any excess inner fold skin (Mongolian fold) and allow the new eyelid crease to fold more smoothly.

    The Double Suture and Twisting (DST) technique is a non-incisional method of creating a crease in the eyelid. Instead of being cut, the eyelid is simply stitched together. While the DST technique requires specific conditions in the patient to work to its full potential, it is an excellent technique for younger, qualified patients, as it is less invasive and involves less swelling and a shorter recovery than incisional techniques.

  • What are the limitations of DST suture-only surgery?

    1. 1. Small crease height. No skin is removed, so the crease will be smaller and more mobile than an incision technique. There is less control over the final size and shape.
    2. 2. Limited ptosis repair. If you have asymmetry of the eyes, and particularly if one eye is droopier than the other, there will be more limitation in how evenly the eyes can be matched up to each other. The resting tension of the eyelid-elevating muscle can be adjusted from the undersurface of the eyelid and incorporated into the DST procedure, but the correction is more difficult to control precisely, as can be done with an incision approach.
  • Can BOTOX® Cosmetic help with the excess forehead wrinkles and an angry look?

    If the angry look is a by-product of having your upper visual field blocked, then you need to correct the eyelid surgically. BOTOX® Cosmetic will reduce the frown lines at the expense of dropping the brows and a return to a loss of your upper visual field.

  • My upper eye socket is hollow and my brows are very high. Why is this? Can I use fillers and BOTOX® Cosmetic for this?

    Frequently, a retracted brow is caused by its attempt to help open a weak upper eyelid. This also creates an upper eyelid socket hollow. Correction requires adjusting the upper eyelid muscle tension and then repositioning the eye fat, which has been sucked up under the eye socket. BOTOX® Cosmetic will have the unwanted effect of drooping the eyelid; fillers will create a similar problem by making the upper eyelid heavier and burdening the already-weak eye muscle.

  • What types of eye anatomy are more difficult to operate on and at higher risk of a poor outcome?

    Eyes that bulge forward are at risk for creasing at the wrong location. Similarly, patients with ptosis requiring correction at the time of crease surgery are also at risk for this. In these instances, there is not much clearance between the elevating muscle and the overlying skin. Therefore, the muscle can “catch” the upper lid skin as it is opening. For these reasons, very little fat should be removed for patients with at-risk anatomy. In some cases, fat grafting to the upper lid is necessary to create more distance between the skin and the moving muscle.

  • What is ptosis?

    This is a droopy eyelid. The cause of this is related to either a weak eyelid muscle (which you are born with) or a detachment of the muscle from the tarsus (the cartilage skeleton of the lid margin), usually associated with aging. Ptosis, in Dr. Lee’s opinion, is more common in Asians, affecting as many as half the patients undergoing Asian eyelid surgery. Depending on the cause, the muscle needs to be reattached (if detached), or it needs to be strengthened/shortened so that the eyelid is in the proper position at rest.

  • Will I end up sleeping with my eyes open?

    This is not likely to happen unless you have ptosis requiring significant shortening of your eyelid muscle. In many such cases of ptosis repair, the eyes will be able to close over time.

What techniques are used in Asian eyelid surgery?

What are the limitations of DST suture-only surgery?

Can BOTOX® Cosmetic help with the excess forehead wrinkles and an angry look?

My upper eye socket is hollow and my brows are very high. Why is this? Can I use fillers and BOTOX® Cosmetic for this?

What types of eye anatomy are more difficult to operate on and at higher risk of a poor outcome?

What is ptosis?

Will I end up sleeping with my eyes open?

Before & After Photos

Patient Testimonials

I know several people who had work done on the face and body by Dr. Charles Lee of Beverly Hills. I can say that every one of them looks terrific. They are the best advertisement for Dr. Lee, and the reason why I went to him for my eyelid surgery. Now, I look terrific too…
Dear Dr. Lee
I wanted to take this time to express my deepest gratitude to your for the epicanthoplasty you did for my eyes. It takes such tremendous precision, skill and experience to do what you did and I am truly pleased with the results. Not only are you one of the world’s finest surgeons, you are also compassionate. I admire your keen eye and mastery as a surgeon…
I had kind of puffy eyes and didn’t think double eyelid surgery would help with that, but Dr. Lee somehow gave me not just beautiful double eyelids but took away the puffiness! Now, even my profile has changed: The side view of my eyes used to look like I had been crying for hours but no more! Dr. Lee is truly gifted and I wish I had gone to him years ago instead of agonizing about it for all that time…

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