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Asian Blepharoplasty - before and after female

Asian Blepharoplasty in London

Written by Dr Julian De Silva

In many parts of Asia double eyelid surgery, also known as Asian blepharoplasty, is the most common cosmetic procedure. As an exciting, multicultural city, London also has a high demand for Asian eyelifts.

The popularity of double eyelid surgery has grown rapidly in the last decade, as a defined eyelid crease has long been valued because it is seen as attractive and provides an expressive appearance.

The variability in the appearance of the Asian eyelid has underlying anatomical and cultural differences that need to be considered with Asian eyelifts. Dr De Silva believes that eyelid reshaping requires a balance between considering:

  • the natural shape of the eyelid
  • whether a crease is present
  • tapering of the natural crease
  • the presence of an epicanthic fold

Dr De Silva is a facial cosmetic surgeon specialising in the face only. He is renowned for producing natural-looking results and uses the most innovative and contemporary techniques from Beverley Hills and New York.

Asian eyelid reshaping is considered to be a technically difficult procedure, which is why some cosmetic and plastic surgeons do not perform it. It is a surgery of finesse detail with even a 1mm difference between the two eyelids readily noticeable.

Blepharoplasty is one of the most common cosmetic surgery procedures Dr De Silva performs, and as an expert in facial surgery, he has the necessary skills required to offer Asian eyelid lifts to patients from around the world.

Male face, Asian Blepharoplasty - front view

What is Asian blepharoplasty?

The anatomy of the Asian eyelid is unique and approximately 50% of Asians have no defined upper eyelid crease, as Western eyes do. Thus, the upper eyelid can be defined as a monolid.

The majority of Asian patients who seek cosmetic Asian eyelifts do not want to look “Westernised,” they would like to keep their ethnicity and have more open eyes and a natural-looking eyelid crease.

What is a double eyelid crease?

The eyelid crease is a naturally occurring fold in the upper eyelid skin that divides the upper eyelid into two parts. Although half of the Asian population has a crease, it is often poorly defined or positioned low down.

Asian blepharoplasty enables the reformation of a new, more defined and higher crease.

The Caucasian eyelid the anatomy of the muscle that lifts your eyelid (termed the levator muscle) this attachment forms the eyelid crease.

In the figure above of the Caucasian eyelid the anatomy of the muscle that lifts the eyelid (termed the levator muscle) is marked with green arrows and this attachment forms the eyelid crease.

Why have Asian blepharoplasty?

Common reasons for undergoing double eyelid crease surgery are to have more open and attractive-looking eyes. Motivations for surgery are specific to each person and include:

  • the ability to apply make-up without smudging
  • improve symmetry
  • reduce fullness of the upper eyelid
  • replace the need for eyelid taping
  • improve vision if the eyelid droops over the eye

Dr De Silva’s Technique

There is considerable variation in requests for Asian eyelifts and Dr De Silva advises patients with specific requirements to bring photographs of eyelids they like. He uses the most advanced techniques in his field to ensure a natural, long-lasting result.

Asian eyelid there is an absence of the levator muscle attachments resulting in an absence or faint crease, the Asian post-septal fat, this results in making the eyelid appear fuller and the eye look smaller.

In the figure above there is an absence of the levator muscle attachments in the Asian eyelid resulting in an absent, or faint crease. The blue arrow marks the Asian post-septal fat, which results in making the eyelid appear fuller and the eye look smaller.

What are the different types of Asian eyelid creases?

There are a variety of naturally occurring shapes to the upper eyelid crease in Asians. Dr De Silva tailors his surgery to the patient’s own anatomy and their preference.

The goal of the surgery is to achieve a patient’s expectations which commonly involves the creation of a natural Asian crease or a more open, Caucasian crease.

  • Parallel crease—the eyelid crease is in parallel to the upper eyelid
  • Temporal flare crease—the eyelid crease has an increased height from the eyelid towards the ear
  • Nasal slant crease—the eyelid crease has increased height from the eyelid toward the nose
Different types of Asian eyelid creases

100s of experiences of Dr De Silva’s patients

Real Self. Top Doctor - Blepharoplasty 2020


4.98 from 592 reviews

By EL, Lower Blepharoplasty with fat transfer, laser and milia removal on May 19, 2020

I had lower eye blepharoplasty, with fat transfer, laser resurfacing and milia removal. I had researched and wanted the surgery for about 2 years before deciding to have some consultations I had two consultations with a well known surgery group but did not feel confident. I then met with Dr De Silva and knew as soon as the consultation was over that I felt confident enough to go ahead and am so glad that I did. My pre treatment appointments and advice were so thorough, and any questions that I had were answered so quickly by the clinics staff. The day of my surgery was seamless, and I felt in completely safe hands the entire time from the nurse Ellie, to the Dr performing sedation and Dr De Silva. The follow up appointments were really thorough and no question too small. I am really pleased with the results and am so glad I had the surgery with Dr De Silva. If you are considering surgery I would highly recommend visiting Dr De Silva. Thank you so much.
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By Upper & lower blepharoplasty Jan 1, 2020

I recently underwent an upper & lower Blepharoplasty with Dr DeSilva and the results are outstanding! From my very first consultation and after lots of research, I knew that I had made the right decision to go with Dr DeSilva. Naturally I was nervous but his amazing team were all very kind, extremely friendly and totally relaxed. The procedure was carried out under sedation and that too was fantastic. I can honestly say I felt no pain during and after the procedure and within 1 hour afterwards I was on my way home. I would 100% fully recommend Dr DeSilva to anybody considering a procedure such as mine. Thank you Dr DeSilva, you have instilled a new found confidence in me.
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Lower Blepharoplasty Dec 25, 2019

I had lower blepharoplasty surgery as I had a lot of wrinkles in my lower eyelids. I have big eyes so the wrinkles were very obvious and only being in my mid-thirty’s I felt it aged me. The surgery was only an hour long and Dr Julian and his team were all really nice and caring. I am extremely happy with the results and my eyes look so much better! The wrinkles are hardly there and I actually like how my eyes look in photos now! I definitely recommend Dr Julian and his team.
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Read More Reviews Here *Results May Vary

Dr De Silva and patient safety

Patient safety is of key importance for all facial plastic surgery. The intricate anatomy of the eyelids requires precision and care and so choosing a surgeon experienced in eyelid surgery is crucial.

Dr De Silva is a keen advocate of patient safety. On Sky News he has champion the need for patients to be given honest information about cosmetic procedures (both surgical and non-surgical), their benefits and risks so they can make an informed choice on whether a particular procedure is the right one for them.

What does Asian Blepharoplasty surgery involve?

There are over twenty differently reported techniques on Asian eyelid lifts, which can be divided into three principal methods: the suture method, the partial-incision method and the skin-incision method.

The Skin-incision Method (Trans-Cutaneous Approach)

This method of Asian Blepharoplasty is the most effective in the long term, as it involves making a skin incision in the natural crease of the skin, which is usually invisible in a few months.

Eyelid surgery can result in swelling and bruising that takes several weeks to settle. The benefit of the skin-incision methods is that it enables the creation of a natural-looking fold that is long-lasting.

The Suture Method

The suture or stitch method avoids any incisions in the skin, except for the passing of the stitches. The suture method is appealing as it avoids significant incisions in the skin. The stitches are buried underneath soft tissues and the recovery from surgery is fast.

Dr De Silva uses a customised suture method for Asian blepharoplasty where the recovery is usually only a few hours. The limitation with this method is that the sutures have a relatively short lifespan compared to the other methods because the effect is completely dependent on the stitches holding, and they can weaken with time.

The Partial-incision Method

The partial-incision method is a hybrid approach between the suture method and the full-incision method. Patients like this method as it has a relatively quick recovery of 1-2weeks with a small 1.5cm incision.

The main disadvantage is that there may be loss of the skin crease with time in some individuals, which may be a few months to a few years depending on the person. The long-term effects are better than the stitch technique alone.

The Partial-incision Method - eyelid schema: Skin, Orbicularis muscle, Levator Aponeurosis, Muller's muscle, Conjunctiva

What are epicanthic folds and magic epicanthoplasty?

The epicanthic fold is the name given to the fold of skin that is on the inner aspect of the upper eyelid that drops down to the lower eyelid. It conceals the inner aspect of the eye in many Asians.

Traditional surgery to open up this part of the eyelid resulted in the use of plastic surgery flaps that could result in visible scars.

When indicated, Dr De Silva uses a newer and innovative hidden incision technique that hides the incisions along the natural eyelid lines, termed “magic epicanthoplasty”. Epicanthus surgery in Asian blepharoplasty is intricate and just millimetres determine the final result.

The magic epicanthoplasty technique also speeds up recovery and reduces the risk of scarring. Dr De Silva uses this technique for specific patients to open up their eyes, minimise scars and achieve the double eyelid result while maintaining a natural enhancement.

Different types of epicanthic folds and magic epicanthoplasty

What type of anaesthesia is used?

Dr De Silva uses sedative anaesthesia, also known as “twilight anaesthesia,” which is combination of local and sedative medications. At the Centre we have developed our own specialised form of twilight anaesthesia, based on practices in the USA.

This sophisticated sedation uses tiny amounts of four to five sedation medications that cumulatively give a relaxing and safe experience, avoiding the risks and side-effects of general anaesthesia. There is a much shorter recovery period than general anaesthesia, with most patients able to leave 30 to 60 minutes after the procedure.

These are the most advanced sedation techniques available, and the optimal option for patients considering Asian eyelid surgery. For more information on sedation anaesthesia please click here.

Woman's face, Asian eyelid surgery photo, oblique view

What is the ideal height of your eyelid crease?

The height of the eyelid crease is determined by your eyelid anatomy, for example, the height of the rigid plate in your upper eyelid that gives it its tensile strength, termed the tarsal plate. The tarsal plate has an important function in enabling the eyelid to blink and protect the eye.

The height of the tarsal plate varies (on average is between 6.0 and 7.5 millimetres) and is unique to each person. Dr De Silva measures the height of your eyelid tarsal plate during the procedure, and the final height of your eyelid crease is determined by the tarsal plate and your specific requirements.

The Key is not too low or too high to preserve a natural-looking enhancement.

When can I return to social activities and work?

The recovery is dependent on the method used for surgery. Most patients take one to two weeks off work and social activities.

By this time, approximately 80-90% of the swelling has resolved. As a result of normal swelling the upper eyelid may look too high immediately after the surgery, as the swelling reduced the skin crease height comes down.

There are surgical techniques that Dr De Silva takes to minimise swelling and bruising, and there are steps that patients can take to improve the recovery period, including applying cold presses frequently in the days following surgery and avoiding certain medications and foods that encourage swelling.

Residual bruising can be covered with cosmetics and mascara after ten days.

Woman's face, Before and After Asian blepharoplasty Treatment, female patient front view

What are the risks?

The risks are similar to upper blepharoplasty, described in previous pages. The key to a good outcome is always meticulous attention to detail with crease position and volume of fat reduction in the eyelids delivering relative symmetry.

A conservative amount of fat is reshaped in the upper Asian eyelid to reduce eyelid fullness. Essential to a natural-looking result is the avoidance of over-removal of fat, which will result in a hollower appearance of the upper eyelid.

Asian blepharoplasty is technically more demanding than Caucasian blepharoplasty, and revision rates have been reported between 5 and 20%.

Will I have a visible scar after surgery?

Dr De Silva uses his own customised technique to achieve Asian blepharoplasty. The advantage over other methods includes a rapid recovery with minimal swelling less than one week after surgery.

The shape, contour and design of the eyelid crease are of paramount importance in hiding the scar from Asian blepharoplasty. The customised technique utilises the newly formed crease to hide the scar, although no scar is invisible as it is hidden in the natural crease line.

Any scar in the skin may be slightly red and elevated immediately after surgery, but with normal healing, the scar remodels to become flat and difficult to see.

View Before and After Asian blepharoplasty Treatment photos

*Results May Vary

Can Asian blepharoplasty be combined with other procedures?

Dr De Silva frequently combines Asian upper eyelid surgery with other facial procedures:

  • Lower eyelid surgery for puffiness (eye bags)
  • Asian Rhinoplasty (enhance bridge and narrow features of nose, more definition to nasal tip)
  • Chin augmentation and facial balance
  • Facelift (deep plane, natural facelift)

Revision Asian Blepharoplasty

Asian blepharoplasty is regarded as a challenging aspect of eyelid surgery. The degree of detail is fine and aspects such as asymmetry are often present.

Over 30% of all Dr De Silva’s patients have undergone previous surgery and are termed revision procedures. Although more challenging than primary surgery, often with Dr De Silva’s advanced techniques the overall appearance and symmetry of the eyelids can be improved.

Revision Asian Blepharoplasty - line surgery around eyelid

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