Double Eyelid Surgery

Double eyelid surgery creates a crease that makes the eyes appear larger and more alert.  While Caucasians typically are born with a double eyelid crease, approximately 50% of Asians do not have a double eyelid crease. Therefore, double eyelid surgery is a highly specialized procedure performed mainly on persons of Asian descent. While the surgical technique of double eyelid surgery is not different between male and female patients, aesthetic considerations of the surgery such as the width and shape of the crease differs between the sexes. For example, most women want a slightly exaggerated eyelid fold to assist with the application of makeup such as eyeshadow while men desire a narrower and more masculine fold.  

Am I a Good Candidate For Double Eyelid Surgery?

• There are a number of factors that go into making a person a GOOD CANDIDATE for double eyelid surgery including:
• People without an eyelid crease who would like one in order to complement their features
• Patients who do have a crease but would like it to be more symmetrical or defined
• Patients who do not have ophthalmic conditions such as a detached retina, glaucoma  or dry eyes

Patients who are NOT GOOD CANDIDATES include:

• People with blood clotting issues, high blood pressure and thyroid problems
• Patients with unrealistic results expectations
• Patients with thick soft tissues on their eyelids
• Patients with existing lagophthalmos (inability to close the eyelids completely)

How is Double Eyelid Surgery Performed?

There are three techniques to create a double eyelid crease:

1. Full Incision – The surgeon makes an incision and cuts out some excess skin so the anatomy is in full view. The doctor then tacks down the fold with sutures. To create the crease, the skin is tacked into the deeper structure which is usually the tarsus (the cartilage on the eyelid) or the levator aponeurosis. The sutures are placed in three to five distinct spots on the eyelid and that creates the fold. Any swelling tends to last from two to six weeks so patients need to take that into account when planning time off work. There might be some scars due to the incisions.

2. Minimal Incision – Very small incisions are made on the eyelid and the sutures are put through those small incisions. Many times, the incisions are so small that it does not require sutures to close the skin. This technique has a faster healing time than a full incision and many patients have a normal appearance and return to work within one week. As with the full incision method, there might be some scars due to the incisions.

3. Suture Technique – There are various techniques that have been described for non-incisional upper blepharoplasty. Most of them involved small skin punctures and the use of durable sutures that are passed alternately through the dermis and the conjunctiva throughout the length of the eyelid.   The recovery time is short and typically no suture removal is needed. However, this technique is not a good option for all patients and this is especially true for patients with very thick eyelids with a lot of fat or patients with a lot of excess skin. The advantages of this technique are the lack of scarring and the natural appearance of the eyelid crease.

All three techniques are very effective. The suture technique and minimal incisional technique tend to be for younger patients who do not have much excess skin. Older patients who have excess skin drooping over the eyelid, may benefit from the full incision method to remove some of the excess skin.

Other Procedures:

Other conditions can be corrected in conjunction with the creation of the upper eyelid crease. For example, many Asians have ptosis which means their upper eyelid muscle is weak which gives them a tired appearance.  Ptosis is caused by weakness of the levator muscle of the eye or laxity of connective tissues of the eye. Some patients have ptosis surgery to tighten or strengthen the muscle underneath the eyelid to make the eyes look more open.  In addition, medial (the closer corner to the nose) epicanthoplasty and lateral (outer corner of the eye) canthoplasty are procedures that can open the corners of the eyes to make them appear larger.

What Is the Cost of Double Eyelid Surgery?

The cost varies per patient depending on the technique used, the area of the country where the procedure is performed and any fees charged by the doctor or the facility. In general, the surgery cost is $1200-$6000.

Recovery and Downtime

Both minimal and full incision surgeries take about an hour to complete while the suture technique takes less than an hour. The RECOVERY time is relatively short with all of the techniques. During the first week, sutures that are blue or black on the eyelids might be visible. One week after surgery, these sutures are removed for patients who received the minimal and full incisions. Typically, there is some residual swelling that can be camouflaged by eyeliner.

After the surgery, antibiotic ointment should be applied on the incision to facilitate healing. Patients should sleep with their head elevated the first week after surgery. There will be some swelling, tightness, sensitivity to light and vision changes for the first 5-7 days but all of these conditions will resolve naturally. Wearing dark sunglasses will protect the eyes from the sun and outside elements.

Results

Following the surgery, any incisions will more than likely be red and even slightly bumpy. There might be some small scars from the incisions that are pink. They will thin and fade in about six months and can be concealed with makeup.

In most cases, the results from double eyelid surgery are permanent. The results from the suture technique can be long-lasting but some patients may lose their eyelid crease if the suture comes loose or because of aging when the excess skin droops over the surgically-created crease. 

There are rare cases where patients are not happy with the results and request to have the surgery undone to return them to a monolid.  Double eyelid surgery can be reversed by resecting the crease and placing a spacer between the skin and the deeper structures to prevent it from forming again. Cadaveric skin and tissue from the palate of the patient can be used to span the space so the skin does not scar back down to create the crease.

Limitations and Risks of Double Eyelid Surgery

While wider folds may be desired to give a more dramatic result, there are some LIMITATIONS AND RISKS to the surgery and they include:

• A risk of unnatural looking results
• Prolonged swelling may be higher with more aggressive fold creation
• Variability in the distance between the eyebrows and lid junction because the fold takes up a lot of space between the eyelashes and the eyebrow
• Damage to the eyeball
• Asymmetry    

Consult With a Board-Certified Surgeon

Double eyelid surgery is a safe and versatile surgery for Asians and other patients with monolids. The surgery makes the eyes appear larger and gives them a more alert appearance. Thankfully, there are different techniques that can be customized to achieve the desired results for each patient. Potential patients should consult with a board-certified plastic surgeon to determine which double eyelid surgery technique is the best option to achieve their desired results.

Written by Cosmetic Town Editorial Team – MA

Based on an exclusive interview with Goretti Ho Taghva, MD in Los Angeles, CA