Concerns with Upper Eyelid Fold - 56

Upper Eyelid Fold

Almost half of the people born in certain Asian countries have monolids, or eyelids that lack a crease. Asian blepharoplasty is a surgical procedure used to create upper eyelid folds in those who do not naturally have them. This is generally thought to increase physical attractiveness and bring out the innate beauty of Asian eyes and faces.

The Skinny

Content Reviewed by AEDIT Medical Advisory Board


An estimated 50% of Southeast and East Asian women and men are born with minimal or absent supratarsal creases in their eyelids, meaning they do not have natural eyelid folds above their eyelashes. Many Asians feel that their creaseless eyelids detract from their standards of beauty and prevent others from noticing how attractive their eyes truly are.

Well-defined upper eyelid folds are considered universally attractive and represent important components of overall facial beauty. Therefore, it is very common for people of Asian descent with single eyelids to have a double eyelid blepharoplasty surgery performed.

This procedure is commonly referred to as Asian eyelid surgery. It involves removing excess fat tissue and skin that cause the eyelids to look heavy, puffy, or aged. In some cases, this surgery is needed to expand the field of vision that the excess tissue blocks.

The term blepharoplasty refers to a plastic surgery technique that corrects deformed or disfigured eyelids and is performed to enhance the aesthetics of the eye region in general.

The upper eyelid blepharoplasty procedure surgically creates a supratarsal crease in those with monolid eyes or “Asian eyes”. It is the most commonly performed surgery in Asia, and the 3rd most common in the world.

The goal of double eyelid blepharoplasty is not to uphold Western beauty ideals, but rather to bring out the natural beauty of the Asian facial structure.

This article explores the evolutionary reasons that so many people of Asian descent are born with monolids. It also reviews the most common surgical procedures used to create upper eyelid folds in those with monolids. Some temporary at-home methods for creating the appearance of an eyelid fold are also discussed.

The Specifics

Evolution of the Asian Monolid

People in South and North Korea, northern China, Japan, and some other eastern Asian countries have ancestors who lived more than 8,000 years ago. They descended from Siberian hunter-gatherers.

These early explorers lived in and traveled through various climatic zones, exposing them to high winds, dust storms, blinding blizzards, and extreme heat. Sweating, squinting, looking downward, and maintaining warmth in the brow all affected the way that their eyes developed evolutionarily.

Compared to the look of the Caucasian eye, the classic Asiatic eye appearance is marked by:

  • Strong forward projection of the zygomatic arches (cheekbones directly beneath the eyes)
  • Relatively large epicanthic folds (upper eyelid folds) in those that have them
  • Round, flattened eye sockets
  • Flattened nose bridge
  • Tight, smooth skin

In those without an epicanthic fold, the eyes appear fuller, as if they are constantly puffy. They also commonly have a slit-like look, which is caused by the palpebral fissure being relatively narrow. Mild soft tissue drooping (ptosis) of the eyelid is also common

Although the topic is still controversial, many anthropologists believe that the distinctive traits of the Asiatic eye evolved due to a combination of sexual selection and continentality factors. As Asiatic peoples migrated into eastern Asian from the Stone Age onward, they experience drastic changes in temperatures, precipitation, humidity, exposure to sunlight, and other climatic variables.

Traveling would have been difficult enough without having to deal with extreme climate changes. While their bodies would have been largely covered, their eyes were likely not. The eyes had to endure the hotness and brightness of the sunshine beating down from the sky in the warm months, and then, reflecting up from the snow in the cold months.

Some experts assert that the thick fat pads common in Asiatic eyes developed due to exposure to extreme temperature changes. The fat pad could be useful for keeping the brow warm during the winters and cool during the summers.

Sexual selection is another likely cause for the evolution of the Asiatic eye. What is considered attractive today (a double eyelid fold) has not always been a beauty marker. Like other beauty trends, the concept of an ideal Asian eyelid has evolved over time.

In the past, the Asian monolid was considered the most beautiful, and as such, it was likely used as a prerequisite during the selection of sexual partners and spouses.

Today, for most Asians and Asian-Americans, monolids are no longer desired. The current ideal Asiatic eyelid has a supratarsal crease, making double-eyelid blepharoplasty a very popular surgery in both Asian and the United States.

Eyelid Surgery: Asian Blepharoplasty & Double Eyelids

The techniques for creating upper eyelid folds have evolved significantly over the decades. In the past, plastic surgeons attempted to create a westernized Caucasian facial appearance in their Asian patients. However, this is no longer true.

Today, plastic surgeons realize that Caucasian-style eyelids appear unnatural in those of Asian descent. Modern surgery trends have shifted to create more traditional Asiatic-like eyelids.

Note that there is not a lot of differences between the lower eyelids between Asians and Caucasians, making the need for lower eyelid corrections comparatively rare.

Asian Blepharoplasty There are two techniques to perform an Asian blepharoplasty to create a natural looking crease in those with monolid eyelids. Both of these surgical approaches may also be referred to as double eyelid surgery. The two methods are:

  • Open Incisional Approach
  • Partial Incisional Suture Approach

Both approaches are effective for appropriate candidates. The plastic surgeon will determine which approach to use based on several factors relative to an individual patient.

Asian Blepharoplasty Open Incisional Approach An open incisional Asian blepharoplasty involves making an incision into the skin of the upper eyelid. Excess skin, muscle, and fat are removed as necessary to reduce the volume of tissue inside the eyelid. A natural looking supratarsal eyelid crease is creating with internal sutures within the eyelid.

This is the most effective and permanent approach to correcting Asian monolids. It is the preferred method in China, Taiwan, Korea, Vietnam, Japan, and various other Asian countries. This surgery is typically performed without the need for general anesthesia, is a quick outpatient procedure, and causes little downtime during recovery. It can also be effective for addressing problems with muscle and/or skin laxity.

Asian Blepharoplasty Partial Incisional Suture Technique A partial incisional/suture ligation approach to double eyelid surgery creates an upper eyelid fold without making an incision. Instead, sutures (stitches) are used to draw the tissue of the eyelid together to form a crease. Then, the sutures are tied off and placed so the healing skin develops overtop them, making them invisible. This method creates an appearance much as the open incisional approach does. However, it is less invasive and therefore requires even less recovery time. The drawback to this approach is that the supratarsal crease that created is static, meaning it doesn’t move fluidly as the person looks downward.

Discuss the best approach for a double eyelid surgery with your plastic surgeon. They will be able to determine which procedure will meet your goals with the least risk for side effects and expense.

DIY Double Eyelids

There are some products on the market that are geared toward creating the appearance of a double eyelid at home. While these products do not require a doctor and are reported to be safe for most users, they will create only temporary results. The two main product types are double eyelid glue and double-sided eyelid tape.

Glue for Double Eyelids Eyelid glue is an adhesive that is placed on the outside of the eyelid. The eyelid is then positioned to create a crease. The adhesive is held in position for a minute or so while it cures into place. Then, the eyelid crease is supported for 2-4 hours, depending on the amount of movement it receives.

Note that this product has to be reapplied every few hours. Due to the constant reapplication, some people develop eye irritation or irritation of the mucous membranes in and around the eyes.

Tape for Double Eyelids Double eyelid tape is a variant of eyelid glue. It comes as a fibrous plastic strip that is trimmed into shape, and then, applied to the surface of the eyelid. Like the glue, it requires regular reapplication and can cause irritation.

The Takeaway


The anatomy of the Asian upper eyelid is quite different than that of those of Western descent. Nearly half of those born in East or Southeast Asian countries are born with monolids or eyelids that lack supratarsal creases. This causes the eyelid to look tight and puffy. It also detracts from the appreciation of the eyelashes and other facial features.

Over the past decade and a half, the plastic surgery approaches to correcting Asian eyelids have evolved significantly. For many people of Korean, Japanese, Vietnamese, and Chinese cultures, getting a double eyelid blepharoplasty surgery is considered socially acceptable and normal. Many Asian people feel it is a common, everyday happening, like getting one’s nails manicured, or getting a haircut.

However, like all surgeries, this corrective cosmetic procedure has its risks of adverse side effects. Postoperative bleeding, bruising, scarring, double vision, dry eye, abnormal eye position, blindness, and the formation of multiple unwanted eyelid creases are all possible.

If you are interested in having a double eyelid procedure performed, then it is important to discuss your options with a skilled plastic surgeon who specializes in blepharoplasty.

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Source List


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  1. Dailey RA, Wobig JL. Eyelid Anatomy PubMed; 1982-12-01
  2. Bhupendra C. Patel; Michael J. Lopez; Zachary P. Joos. Anatomy, Head and Neck, Eyelash; 2020-07-27
  3. Harry S Hwang The effect of "single" vs "double" eyelids on the perceived attractiveness of Chinese women; 2014-03-03

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