What Are Double Eyelids?

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One distinctive feature of the eye that varies from person to person is the number of creases on the eyelid. Eyelids that have no crease are called single eyelids, or monolids. Single eyelids are a genetic trait, but they are recessive, meaning these genes are expressed less often. On the other hand, double eyelid is the presence of a crease on the eyelid. While genetics determine whether someone has monolids or double eyelids, surgery is available to help people born with monolids get double eyelids if they want.

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What Is a Double Eyelid?

A double eyelid is simply an eyelid with a crease on the upper lid. It's a dominant gene, so it is expressed—or visible—more often than the recessive monolid gene. Double eyelids—particularly in Asian cultures—are often associated with beauty.

Surgery for Double Eyelids

Blepharoplasty is a surgery performed on the eyelid, and it can be used to treat a number of conditions, 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
  • Cosmetic reconstruction

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

Another procedure that is sometimes performed along with blepharoplasty is epicanthoplasty. 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. Epicanthoplasty is therefore commonly performed in conjunction with double eyelid surgery to eliminate some of the epicanthal fold, such that a crease can naturally take hold without tension and scarring.

Candidates for Surgery

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 blepharoplasty should know that going too far with the height of the crease added to the eyelid can look unnatural. Talk to your doctor about your eye shape, facial structure, and goals for your surgery.

Types of Procedures

Your doctor will help you decide which surgical technique is best for you based on your individual goals, face shape, other conditions, and recovery times. You may hear your doctor discuss different incision types like full incision, partial incision, and non-incision methods. In full incision surgeries, a cut is made along the eyelid, and extra tissue is removed. For partial incision procedures, small cuts are made, but no large areas are cut or removed. With non-incision techniques, small sutures are placed along the lash line to change the lid shape.

Several specific techniques are used for Asian blepharoplasty:

  • Incision method: 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 and can resolve wrinkles around the eyes as well. The upper eyelid skin is the thinnest in the body, and a barely perceptible scar, if any at all, may form after the procedure. However, even if a scar is present, it can be seen only with the eyes 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.
  • 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, but there is a chance that the double eyelids could disappear in time and the eyelids may return to their natural state.
  • Beads method: 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 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.

Recovery

Recovery from eyelid surgery will look different depending on the technique that was used. Incisional techniques may leave a scar, but people who received blepharoplasty that involves non-incisional methods may experience more and longer-lasting swelling and inflammation after the procedure.

Timelines for recovery from double eyelid surgery depend a lot on the type of surgery you have had performed. With incisional techniques, you will have sutures placed that may need to be removed after several days. The initial healing time is about two weeks, but full healing can take months. With partial incision and non-incisional techniques, you can expect to heal from surgery in about two weeks.

Your doctor will give you specific instructions on how to care for your eyelids after surgery, as well as how to manage the pain and discomfort, including:

  • Use a cold compress to reduce pain and swelling for the first two days—eyes can remain swollen for weeks to months after surgery.
  • Avoid heavy lifting or straining for three weeks after surgery—you can resume light exercise in about three days.
  • Keep your head elevated throughout the day and avoid sleeping flat—an extra pillow at bedtime is adequate.
  • Avoid the sun.
  • Do not use cosmetics (makeup can be resumed in 10 to 14 days after the procedure).
  • Don't use over-the-counter ointments.
  • Apply a thin coating of petroleum jelly to any external sutures twice a day.
  • If you wear contact lenses, leave them out for two to three weeks.

The most common complication after double eyelid surgery is an asymmetrical result, and can only be avoided with careful incision placement by your doctor. In some cases, eyelid surgeries have to be repeated. 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 Procedures

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, including:

  • Eyelid tape: A small piece of tape is applied to the upper eyelid, and you will use an instrument shaped like a stick that comes with the tape to push your eyelid up to 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. These pieces of tape are shaped like a crescent. 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. Similarly, you can 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.

A Word From Verywell

Double eyelids are a feature that is genetically programmed. While double eyelids are a dominant trait, recessive single eyelids are fairly common. Double eyelid surgery is very common in Asian cultures where double eyelids are common. The surgery is purely cosmetic and can come with complications like asymmetrical eyelids or even vision loss. Be sure to research the different methods for double eyelid surgery before deciding if it is right for you.

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