Double Eyelid Surgery: Everything You Need to Know

Double eyelid surgery, known more formally as Asian blepharoplasty, is a procedure in which an upper-eyelid crease is created. This is often done for those of Asian descent who may not have a visible crease but who desire one.

The idea is usually not to Westernize their look. Many wish their eyes to have a less puffy appearance and to make applying eye makeup easier.

What Is Double Eyelid Surgery?

Double eyelid surgery is performed on an outpatient, scheduled basis. With this procedure, a sliver of tissue is removed and, as a result, a monolid is transformed into a double eyelid with a crease.

There are two types of techniques that may be used—the open method and the suture method. The less-invasive suture method can be used in those who have skin thin enough that there may intermittently be spontaneous eyelid folding.

Meanwhile, the open technique is for those cases with thicker skin or muscle, excess skin, or where the permanence of the result is important.

Contraindications

Even though many patients may wish to undergo double eyelid surgery, it is not right for everyone. Contraindications for undergoing this procedure include the following.

• Maturity level: Patients need to be old enough to cooperate and to understand the risks and potential complications of the procedure. Otherwise, they should wait and undergo the procedure at a later date.
• Thyroid disease
• Bulging eyes
• Dry eyes
• Clotting disorders

Potential Risks

All surgical procedures have some risks, and double eyelid surgery is no exception. Potential risks and complications you should be aware of before undergoing double eyelid surgery include:

• Asymmetry in the crease
• Bleeding after the procedure, ranging from slight bleeding underneath the eye, causing bruising, to hemorrhage
• Bleeding in the eye's orbit. leading to pressure on the optic nerve, which can result in a surgical emergency called a retrobulbar hematoma
• Drooping of the eyelid
• Excessively high crease
• Fading of the lid fold
• Allergic reaction to anesthesia
• Infection
• Temporary or permanent changes to vision

Be sure to discuss the possibility of one or more of these complications with your healthcare provider before agreeing to the procedure.

Purpose of Double Eyelid Surgery

This elective procedure is meant to create an upper-eyelid crease where there is none for those who desire this. Prior to eyelid surgery, you will meet with the plastic surgeon to discuss your expectations for the procedure and to determine if it is a good fit for you.

The surgeon will go over your medical history, considering things such as dry eye, thyroid problems, bleeding problems, and allergies.

In addition, be prepared for the following work-ups:

• Measuring vision with a thorough eye examination
• Measuring eyelids
• Testing tear production
• Photographing the eye from various angles

How to Prepare

In the days leading up to the double eyelid surgery, the plastic surgeon will instruct you to refrain from taking any medications that can increase bleeding. Examples include:

• Coumadin (warfarin)
• Aspirin
• Ibuprofen
• Naproxen
• Other medications or herbs known to pose a bleeding risk

Talk to your healthcare provider about exactly how far in advance you will need to stop taking these or any other medication, but do not stop using them unless you are expressly directed to. If you are taking warfarin or another medication for an existing medical condition, be sure to consult with your cardiologist or other applicable healthcare practitioner as well.

Location

This is a procedure that is performed in an outpatient setting. You do not need to prepare for an overnight stay.

What to Wear

On the day of the procedure, be sure to:

• Wear easy-to-change, loose-fitting clothing that either opens in the front or in the back. Don’t wear anything that must be slipped over the head.
• Avoid any makeup, particularly around the eyes.
• Don’t put in your contact lenses. Wear glasses instead.
• Leave any jewelry at home.
• Don’t wear nail polish.

Food and Drink

Avoid all food and drink, including water after midnight on the day before surgery. If you need to take any medications, a sip of water is allowable.

Medications

Be sure to tell the healthcare provider ahead of time about any medications you are currently taking to avoid complications.

What to Bring

On the day of the surgery, be sure to bring your ID, as well as your insurance card. (Note that this is generally considered cosmetic surgery, which insurance does not cover.) Also, you will need to have someone with you who can drive you home after the procedure and stay with you for the first 24 hours.

Pre-Op Lifestyle Changes

Avoid smoking for two weeks prior to the procedure, since this can interfere with your ability to heal and can cause scarring. Also, avoid any sun damage to your skin for at least two weeks before surgery. It is recommended to use a sunscreen with an SPF of 30 or higher during this period.

What to Expect on the Day of Surgery

This is what will happen when you go for your procedure.

Before the Surgery

About 30 to 45 minutes prior to the procedure, most patients will be given oral medication, including diazepam (Valium) and acetaminophen (Tylenol).

During the Surgery

To numb the upper eyelid during the surgical procedure, the area will be injected with a medication such as xylocaine or lidocaine, and topical tetracaine will be placed on the white part of the eye. This is done so that during the procedure patients can expect no pain.

If you are undergoing incisional double eyelid surgery:

• The upper eyelid will be measured and marked with a pen.
• An incision will be made in the marked area.
• Some fat and muscle will be removed to make room for the crease.
• The incision will be closed with the aid of stitches or sutures, which will be removed after about one week.

If the suture method is used:

• The upper eyelid is measured, and vertical lines are marked.
• Entry points between the vertical lines are marked.
• At each of the entry points, a small stab incision is made and a small amount of fat is removed if needed.
• Sutures are placed through the opening and tightened as needed. These are left in place.

After the Surgery

Postoperatively, your surgeon will instruct you to use eye drops and apply ointment they prescribe. Depending upon the procedure, you may also have to return to have sutures removed around three or four days after surgery.

Recovery

It is not uncommon for there to be mild swelling and some discoloration during the first couple of days. To help minimize this:

• Apply a cold compress (such as gauze pads dipped in ice water and wrung out).
• Keep your head propped up and elevated.
• Avoid strenuous activity and heavy lifting.
• Keep out of the sun.

After surgery, you will be able to shower and wash your hair, and can even wash your face.

Possible Future Surgeries

After the surgery, you should enjoy the result you expected. However, it is not unusual for some patients to need follow-up procedures to correct complications such as asymmetric folds, excessively high creases, fading folds, or a drooping eyelid.