What Are Double Eyelids? (2024)

One distinctive feature of the eye that varies from person to person is the number of creases on the eyelid. Double eyelids are those with a visible outfold crease. This is in contrast to single eyelids, or monolids, which have no crease. Genetics determine whether you have double eyelids or not. Most people do.

Surgery to form double eyelids is available. It may be done for cosmetic reasons or because an eyelid that doesn't have a crease is interfering with your vision.

This article covers what double eyelids are and how they can be achieved with surgery. It also covers the types of surgical procedures available along with several non-surgical options.

What Is a Double Eyelid?

A double eyelid is simply an eyelid with a crease on the upper lid. Some people, particularly in Asian cultures, associate double eyelids with beauty.

The gene behind this feature is dominant, meaning only one parent needs to pass it down to their child for it to appear. The gene behind monolids, on the other hand, is recessive; both parents need to pass it down for a child to have no eyelid crease.

Approximately 50% the Asian population has a minimal double eyelid or a monolid.

Double eyelid surgery has become a popular cosmetic surgery among people in China, Korea, Vietnam, and Singapore, as well as Asian Americans.

When Double Eyelid Surgery Is Considered

Double eyelid surgery may be done for cosmetic or functional reasons.

On the cosmetic side, one may opt for eyelid surgery because they like the look of double eyelids as opposed to monolids.

Or, they may opt for the surgery because their eyelid skin has drooped due to the natural loss of collagen and elastin in the skin that occurs with aging.

In some cases, the eyelid may droop so low that it interferes with vision. Eyelid surgery may therefore be used to correct the drooping eyelid(s) and prevent issues with vision.

Eligibility

Eyelid surgery isn't for everyone, and there are some considerations when it comes to who makes a good candidate:

• You should be in good health, with no major health issues.
• You should not have any conditions that may impair or delay healing.
• You should be a nonsmoker.
• You must have realistic goals for the end result.
• You should not have any serious eye conditions.

People who want to undergo surgery to form a double eyelid should know that going too far with the height of the crease added to the eyelid can look unnatural.

Talk to your healthcare provider about your eye shape, facial structure, and goals for your surgery.

Surgery to Form a Double Eyelid

Blepharoplasty is a type of eyelid surgery that can be used to create double eyelids. During the procedure, a surgeon makes a small incision in the natural crease of the eyelid. They then remove excess skin and/or fat as needed.

Blepharoplasty can be used to fix a number of concerns, including:

• Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision
• Fatty deposits that appear as puffiness in the eyelids
• Bags under the eyes
• Drooping lower eyelids that reveal white below the iris
• Excess skin and fine wrinkles of the lower eyelid

Eyelid surgery was one of the top five cosmetic surgeries in the United States in 2019. It is also the top cosmetic procedure in eastern Asia.

In fact, cosmetic surgery that is performed to create double eyelids is sometimes referred to as Asian blepharoplasty. Typically done as an outpatient procedure, this surgery creates a fold, or an upper eyelid crease, in people who don't have it.

Epicanthoplasty is another procedure that is sometimes performed along with blepharoplasty. During epicanthoplasty, some of the excess skin at the inner corner of the eye, known as the epicanthal fold, is removed.

A heavy epicanthal fold hinders the natural formation of an outfold crease. Thus, by removing some of the epicanthal fold, a crease can naturally take hold without tension or scarring.

Surgical Techniques

When discussing your options for eyelid surgery, you may hear your healthcare provider mention different incision types:

• Full incision: A cut is made along the eyelid and extra tissue is removed.
• Partial incision: Small cuts are made, but no large areas are cut or removed.
• Non-incision: Small sutures (stitches) are placed along the lash line to change the lid shape.

These different incision types are used in the various Asian blepharoplasty techniques described below.

Incision Bethod

An incision is made in the upper eyelid and tissue may be removed. This method is virtually pain-free and allows for more customization of the final result. It can also resolve wrinkles around the eyes.

The upper eyelid skin is the thinnest in the body, so there is a chance you will have a very small and light scar, if any at all. However, even if a scar is present, it can only be seen when the eyes are fully closed.

Plastic surgeons performing this procedure may use very fine sutures that fall out in about six to seven days and do not require removal. The incision method is widely considered to be the most reliable and durable of the options. Results can last at least seven to 10 years, depending on how quickly your skin naturally ages.

Buried Suture Method

Your surgeon will make small holes and create an eyelid crease with three buried sutures. This method is good for people who want a shorter recovery and no scar.

The main disadvantage of the buried suture method is that there is a high possibility that the monolid will recur within a few years. One small study found that double eyelids lasted an average of five years when this method was used.

Bead Stitch Method (Non-Incision)

Six sutures are placed through the eyelid and stabilized with beads so that the sutures don't cut into the skin. The sutures are removed several days later after the double eyelid has been created by scarring.

This is the least surgical approach, but it does cause quite a bit of inflammation, which is required to create the scar that forms the double eyelid. While this doesn't involve cutting, it does have the longest recovery time due to postoperative swelling.

The bead stitch method is more durable than the buried suture method. Still, it is less likely to produce as long-lasting results as the incision method.

Double Eyelid Surgery Recovery

Recovery from eyelid surgery will be different depending on the technique that was used.

With partial incision and non-incisional techniques, you can expect to heal from surgery in about two weeks.

With incisional techniques, your sutures may need to be removed after several days. The initial healing time is about two weeks, but full healing can take months.

Your healthcare provider will give you specific instructions on how to care for your eyelids after surgery, as well as how to manage pain and discomfort. These may include:

• Using a cold compress to reduce pain and swelling for the first two days.
• Using eyedrops to keep your eyes from getting dry.
• Avoiding heavy lifting or straining for three weeks after surgery. You should be able to resume light exercise in about three days.
• Keeping your head elevated throughout the day and avoid sleeping flat (an extra pillow at bedtime is adequate).
• Avoiding the sun.
• Not using cosmetics (makeup use can be resumed in 10 to 14 days after the procedure).
  
• Applying a thin coat of petroleum jelly to any external sutures twice a day.
• Not using any other over-the-counter ointments.
• Leaving your contact lenses out for two to three weeks, if you wear them.

If an incision is done, there may be a scar. People who have a blepharoplasty done with non-incisional methods may experience more and longer-lasting swelling after the procedure.

When to See Your Doctor

Like any other surgical procedure, there is a chance that complications will arise during your recovery. Be sure to monitor your health closely, and don't hesitate to call your healthcare provider if you have any questions.

• Your stitches come loose or your incision comes open
• You are bleeding from the incision
• You have any changes in your vision
• Your scar is raised or seems excessive
• Your scar is still red after four weeks
• It hurts or feels uncomfortable to blink or close your eyes
• Your feel any pain in your eye

You should also seek immediate medical care if you have signs of infection, such as:

• Swelling, pain, warmth, or redness on your eyelid or nearby
• Red streaks leading from the incision
• Pus draining from the incision
• Fever

Possible Surgical Complications

The most common complication after eyelid surgery is an asymmetrical result. This can only be avoided with careful incision placement by your healthcare provider.

Blepharoplasty is also known to worsen or trigger dry eye syndrome in some people. Dry eye syndrome occurs when your eyes don't make enough tears to lubricate the eyes. One study found that approximately 13% of people who have upper eyelid blepharoplasty develop dry eye syndrome.

Redness and swelling are an expected side effect of surgery that should resolve after a few weeks.

Other less frequent complications may include:

• Infection
• Bleeding
• Vision loss
• Overcorrection

Nonsurgical Ways to Get a Double Eyelid

If you aren't ready to consider surgical methods for creating a double eyelid, there are cosmetic solutions that allow you to transform your monolids into double eyelids temporarily, if you so desire.

Eyelid Tape

This is special tape that typically comes in crescent-shaped strips. You apply a piece to the upper eyelid and use an instrument shaped like a stick (included) to push your eyelid up and create a fold.

You will want to keep pushing for about a minute to make sure a part of your eyelid is securely stuck to the tape.

You can put on makeup as usual afterward. The tape can be cleaned off with a makeup remover.

Eyelid Glue

Eyelid glue is applied to the top of the eyelid with a brush that comes with the bottle.

Similar to the process used for eyelid tape, you use a stick-like instrument to push the eyelid and create a fold after letting the glue dry for about 30 seconds. You will also want to keep pushing it for about 60 seconds.

It can be cleaned off with a makeup-removing solution.

Summary

Surgery to create double eyelids is called blepharoplasty. Excess fat and skin is trimmed from the eyelid and a crease is formed. Blepharoplasty is sometimes done alongside epicanthoplasty, in which excess skin is removed from the inner corner of the eye.

Blepharoplasty can yield long-term results, depending on the method your surgeon uses. The results of blepharoplasty are not permanent, however. There is a chance that you will need a touch-up surgery several years down the line.

Eyelid tape and eyelid glue are good, non-permanent options to consider if you want to avoid surgery.

A Word From Verywell

Finding the right surgeon is critical to ensuring your surgery goes smoothly and without complications. Start your research by seeking out oculoplastic surgeons—plastic surgeons who specialize in eyelids.

Prospective surgeons should be board certified by the American Board of Ophthalmology. You can verify a practitioner's certification on the organization's website. They should also be able to show you before and after images of their blepharoplasty results, along with many positive testimonials from their past patients.