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Asian Eyelid Surgery (Double Eyelid Surgery)

Dr. Zoumalan specializes in Asian eyelid surgery, also known as double eyelid surgery.   Asian eyelid surgery is a type of cosmetic eyelid surgery, which Dr. Zoumalan performs on people of different ethnicities but mainly those from Asian descent. Dr. Zoumalan has a practice which caters to patients from all over Southern California (including Los Angeles, Orange County, and San Diego) and those who fly in from various countries (i.e. China, Korea, Philippines, Japan) for the Asian eyelid procedure. He also teaches the specific techniques of Asian eyelid surgery to other surgeons in training as a Clinical Professor at the Keck School of Medicine of USC.

What is Double or Asian Eyelid Surgery?

Asian eyelid surgery is also referred to as double eyelid surgery. Double eyelid surgery (a type of Cosmetic eyelid surgery ) is a common plastic surgery procedure selected by patients of Asian descent. Asian eyelid surgery requires the skill set of a surgeon that is experienced in eyelid surgery. Dr. Zoumalan finds Asian eyelid surgery to be one of the most gratifying types of surgeries. It is a very delicate procedure that involves incredible attention to detail. Each patient has different desires, and Dr. Zoumalan goes over the whole entire process of Asian eyelid surgery and then formulates a surgical plan that is customized to each and every patient.   It is absolutely important to choose your plastic surgeon wisely when it comes to Asian or double eyelid surgery. There have been recent advances in better understanding the eyelid structure and anatomy in the Asian population, which has enabled plastic surgeons to apply this toward better and more predictable results.

Anatomic Structure Asian & Occidental Eyelids:

Although the Asian eyelid has the same anatomic structures as an Occidental (Caucasian or non Asian) lid, there are differences in the size and position of these particular eyelid structures. In general, the Asian upper eyelid crease forms closer to the eyelashes, is shaped differently, and is sometimes incomplete or broken into multiple folds. As a result, there are variations in Asian eyelids such that there is no true “one type of Asian eyelid.” Each patient is carefully evaluated and the surgical plan is designed based on what the patient desires.

It is important to state that most Asian patients without an eyelid crease who seek cosmetic Asian eyelid surgery do not want to look “westernized.” They rather want to have an eyelid crease similar to those Asian eyelids that do have an eyelid crease. Such patient wishes are carefully discussed so that the patient and Dr. Zoumalan are aware of the goals of the procedure. Photos of desired outcomes are always helpful to help clarify the patient’s wishes as well.

Variations of Eyelid Creases:

There are up to 8 or so various types of Asian eyelid configurations but the figures below illustrate three basic types of eyelid creases:

Asian Eyelid Surgery Crease Variation

a) No visible crease shows and this condition is seen in up to a half of the Asian population. The crease may be present but it is low and near the eyelashes.
b) Others have a crease set 2-4 mm above the eyelashes as seen above in the middle figure.
c) Some others have a higher set crease at 6-8mm.

Most Asian eyelid surgery patients that see Dr. Zoumalan for a consultation have an eyelid similar to Figure a) above and wish to either have a result somewhere between Figures b) and c) at a height from 4-7mm. As a result, lid crease enhancement in Asians is customized to the lid anatomy of each individual patient. A careful discussion with the patient allows for both Dr. Zoumalan and the patient to be as best informed and prepared for the surgical plan as possible.

Crease: Many (up to a half) of Asian patients have an upper eyelid with a low but defined upper eyelid crease. An eyelid crease allows the lid to be “broken up” into two visible parts which is referred to as a “double eyelid.” The other half who do not have a crease or show very little signs of a crease (termed “single eyelid”).

Occidental vs. Asian Upper Eyelids

The Asian upper eyelid also appears more full and “puffier” than the Occidental upper eyelid. The reasons include the following differences between Asian upper eyelids and Occidental upper eyelids:

1.Orbital fat is also located at a lower position in the upper eyelids which also herniates easier and as a result “bulges” easier.
2.Thicker brow fat which allows for a more prominent eyebrow.
3.Thicker subcutaneous fat layer of the skin which allows for a difficult crease to form.


Asian lids may have some element of an epicanthal fold. An epicanthal fold is a small crescent of skin that is usually present between the inner eyelid corner and the nose. Dr. Zoumalan can help in revising some of the epicanthal fold at the same as an eyelid surgery.   In cases of severe epicanthal folds, Dr. Zoumalan can perform epicanthoplasty to reduce the prominence of the epicanthal fold.

  • asian_eyelid_surgery_post_op

    Procedure performed:Asian eyelid (double eyelid) surgery.

  • Asian eyelid surgery beverly hills

    Preoperative diagnosis:Upper lid dermatochalasia (extra skin) resulting in lid hooding and ptosis.

    Procedure performed:Bilateral upper lid blepharoplasty.

  • double eyelid surgery los angeles

    Preoperative diagnosis:Upper eyelid blepharoptosis (dermatochalasia), no visible upper lid creases.

    Procedure performed:Upper eyelid blepharoptosis repair/blepharoplasty while preserving no visible creases and avoiding a double lid formation after surgery.

  • before and after asian eyelid surgery

    Preoperative diagnosis:Upper lid and brow ptosis resulting in difficulty seeing well and a tired appearance.

    Procedure performed: Bilateral upper lid blepharoplasty, upper lid ptosis repair, and upper lid internal browpexy (upper lid brow ptosis repair done through an internal suture technique).

  • before and after upper eyelid surgery

    Preoperative diagnosis: Bilateral upper lid ptosis and excess skin

    Procedure performed: Bilateral upper lid ptosis repair, upper lid blepharoplasty


*Individual results may vary

All before and after pictures displayed are real patients who have consented to having their pictures published on our site. Individual results will vary with each patient and Dr. Christopher Zoumalan does not guarantee any outcomes of procedures shown. All pictures are meant for reference and illustrative purposes only.

What type of Asian Eyelid do you prefer?

Each patient desires a different look, and Dr. Zoumalan does not provide just one type of Asian eyelid surgery to all his patients. There are variations of an eyelid that females may desire more so than males, and there are subtle enhancements that some may like while others may not.

Questions that Dr. Zoumalan will ask you are:

What is your desired lid crease height?
Some desire a lower crease height than others such as at 4mm in comparison to the average which is 6-7mm.  Others want a slightly higher lid crease set at 7-8mm.    Dr. Zoumalan will go over examples with you in person and help you determining your desired lid crease height.

Asian-Eyelid-1Example 1: Low lid crease, set at about 4mm in height

Asian-Eyelid-2Example 2: Medium lid crease, set at about 6mm in height


Example 3: High lid crease, set at about 8mm in height

Do you wish for a nasally tapered crease or a nasally parallel crease? The way the lid crease ends closer to your nose can be designed as either parallel or tapered. A nasally tapered crease tends to be more popular among my patients, such that the lid crease ends in a tapered fashion toward the epicanthal fold or medial canthus. The epicanthal fold can often be revised and improved at the same time as well if a nasally tapered crease is created. A parallel crease is more often desired in men than in women, and the lid crease shape follows the shape of the eyelid, hence being parallel. Dr. Zoumalan will discuss both options and help guide you through your decision-making process.

Asian-Eyelid-4Example 1. Parallel eyelid crease

Asian-Eyelid-5Example 2. Nasally tapered crease. Not how the crease
tapers as it nears the nose.

Do you wish for a slight lateral flare in your crease or a parallel lateral crease? Some people wish to have a parallel lateral crease while others want to have some of the corner of their eyelid appear more “lifted.” The difference between the two is usually very subtle, but both at the end offer natural looking results. Dr. Zoumalan will help discuss these options with you and help guide you through the exciting process of getting you ready for your eyelid surgery.

Asian-Eyelid-6Example 1. Parallel lateral crease.

Asian-Eyelid-7Example 2. Lateral crease flare


Example 3. Shows the differences in a lateral flare versus a lateral parallel crease.

These are some of the questions that Dr. Zoumalan will be asking you during your consultation, so it would be beneficial to you to prepare ahead and to have a better idea which type of lid crease you best prefer. But if you feel that you are not quite sure at this time but wish to undergo Asian eyelid surgery, meeting with Dr. Zoumalan will better help you in this decision-making process.

Dr. Zoumalan and his office will be there to assist patients throughout the entire process as they undergo Asian eyelid surgery.

Where is the incision in the upper eyelids performed for upper eyelid blepharoplasty?

Dr. Zoumalan will carefully identify your natural fold and make an incision over the natural fold. Most of us are born with a natural fold; If the fold is too high or non-existent (as in some Asian eyelids), Dr. Zoumalan will discuss with you the options to change the fold of the eyelid. Dr. Zoumalan uses a modified technique to remove the excess lateral hood of the skin by curving side marks upwards that help in removing the lateral hood but also opening the eyelid while holding the forehead elevated. The incision of the hair cures well inside the crow's feet. Curving down can often result in a more visible incision and can leave the residual skin and also bring the eyebrow down. Dr. Zoumalan pays close attention to wound closure using very fine, non-absorbable sutures, which are usually removed in 5-6 days.

Common Question and Answers