The double eyelid, the common name for a crease on the upper eyelid, is arguably one of the most defining features of a human face. This feature only appears in some people and can make the eyes appear larger, making it an attractive feature in many cultures. Hence, it is common for people without them to turn to surgical methods to create a pair of well-defined double eyelids.
However, double eyelid surgery is a lifetime commitment. To help you make a more informed decision, the following are 4 important things you should know before going under the knife.
- The different types of upper eyelids
First and foremost, let us learn about the different type of upper eyelids and their defining features
This is what is commonly known as the single eyelid where there is no visible crease on the upper eyelid. This is rather common in people of East-Asian descent. Celebrities with monolids include South Korean Singer Kang Seul-Gi and actress Park So-dam from Oscar-winning film Parasite.
- Partial eyelid crease
In this case, the eyelid crease is visible, but not well-defined. The crease may become more defined with age as the skin on the upper eyelid loosens. In most cases however, this can be considered as a monolid. South Korean singer-actress Bang Min-ah is a good example of this case.
- Hidden double eyelids/Hooded eyelids
On first sight, these may seem like monolids. However, as the name suggests, hidden double eyelids have their crease partially or fully hidden by a “hood” of skin drooping over the crease, the creases only become visible at certain angles, or when blinking/squinting. This can be congenital, or may have evolved from regular double eyelids when the skin sags due to aging. Celebrities examples include South Korean singer-actress Bae Su-Ji (Suzy), Japanese actress Yuriko Yoshitaka and American actress Jennifer Lawrence
- Tapered double eyelids
Tapered double eyelids are well-defined eyelid creases which runs along the length of the entire eye, and tapers off into the medial corners of the eye. This is more common in people of Asian descent. Celebrities with tapered double eyelids include Japanese actress Yui Aragaki, South Korean singer Lee Ji-eun (IU) and American singer Hailee Steinfeld.
- Parallel double eyelids
Parallel double eyelids, like tapered ones, are well-defined creases running along the length of the entire eye. These however, “float” above the eyes and do not taper into the medial corners. Parallel double eyelids are more common in people of western descent. Celebrity examples include American actresses Scarlett Johansson and Zoe Saldana, and Chinese actress Fan Bing Bing
- The anatomy of double eyelids
Why do some people have double eyelids but not others?
The main reason behind lies in the levator aponeurosis, which is part of the muscle responsible for lifting your upper eyelids. In people with double eyelids, the muscle attaches to the skin surface at different vertical levels. This causes some parts of the eyelid to be pulled inwards when the muscles contracts, creating that signature crease. However, for those with monolids, the muscle only attaches itself at one uniform level. Hence only the edge of the eyelid is pulled up when the muscle contracts, and no crease is formed.
- Types of surgery to create/enhance double eyelids
As explained earlier, double eyelids are caused by additional attachment points in the levator muscle. Through surgery, it is possible to manually to form that signature crease without these tethers.
There are several approaches to double eyelid surgery:
- Incisional upper blepharoplasty
Incisional Upper Blepharplasty is the traditional approach to double eyelid surgery. In this case, the plastic surgeon will make a horizontal incision along the upper eyelid. From this incision, fat and excess tissue may be removed, some muscles may be reattached and some excess skin may be excised, depending on what is necessary. The incision is then closed with sutures. The modifications, together with the internal scar tissue “anchors” the eyelid down to form the crease, creating the double eyelids. Scars, if any will be hidden in the crease itself an is not usually noticeable.
Incisional upper blepharoplasty is also performed to correct ptosis, a medical condition where the upper eyelids droop down due do a defect in the levator muscle
- Double Suture and Twist (DST) eyelid surgery
For DST eyelid surgery, the surgeon will make 3 punctures at strategic points on the upper eyelid. A pair of sutures is then passed through these 3 punctures and twisted using a special technique. This pulls the eyelids inwards, forming the crease and creating double eyelids. This approach is faster and less invasive than the incisional approach.
However, DST is not suitable for those with a lot of fatty tissue around their eyelids, or those with eyelid ailments like ptosis.
- Infrabrow lift
The infrabrow lift is technically not considered a true double eyelid surgery. It is however, suitable for people with existing hidden double eyelids or hooded eyelids who which to make their ceases more prominent. In this case, the surgeon makes an incision along the lower brow line. Excess fat and skin are excised from this incision before closing it with sutures. This tightens the skin between the brows and the eyes, effectively lifting any skin off the eyelid creases and exposing them. Any scars will be well-concealed along the lower brow line and hardly visible.
On the other hand, those with hidden double eyelids may also want to undergo surgery to make their creases more prominent.
Below is a summary of the 3 procedures:
|Procedure||Incisional upper blepharoplasty||DST double eyelid surgery||Infrabrow lift|
|Suitable for||Creating double eyelids in most patients||Creating double eyelids in patients without much fatty tissue around the eyes
|Exposing existing double eyelids which are concealed. Unable to create new double eyelids.|
|Length of surgery
|45 to 60 min||15 to 40 min||45 to 60 min|
|Downtime||2 to 4 weeks
|1 to 2 weeks||2 to 4 weeks|
|Swelling and bruising
|Mild to moderate||Mild||Mild|
|Best effects seen after
|2 to 3 months||4 to 6 weeks||4 to 6 weeks or less|
|May be noticeable, but usually concealed||Usually unnoticeable||Usually unnoticeable|
|Longevity||Long-lasting/permanent, usually non-reversible||Sutures may degrade over time, and creases can deform or fade away||Long-lasting/permanent, usually non-reversible|
- Which type of double eyelids are more suitable for you.
Everyone has different facial features, and also different opinions. Hence, it is difficult to say for sure which is the more suitable double eyelid for you. What is appealing to others may not appeal to you.
Still, there are some general guidelines which you can look to:
- Tapered or parallel?
As mentioned, tapered eyelids are more common amongst Asians. Hence, they tend to fit better on an Asian face and may look more natural than parallel eyelids. Tapered eyelids also generally look better on those with smaller eyes. Finally, they can look great without makeup, and are suitable for those who want to be confident in their own skin.
Parallel eyelids on the other hand, usually give the bearer a more Western look, and are more suitable for those with similarly western features. They are generally more suitable for people with larger eyes. Also, parallel eyelids will often look much better with makeup as compared to tapered eyelids. Therefore, if you are going for a more western look, or frequently put on makeup, you may want to opt for the parallel eyelids
- Low, medium or high?
Unlike tapered or parallel eyelids, there is no hard and fast rule as to which eyelid height is most suitable. Generally, the lower the crease, the more natural it looks. On the other hand, lower creases can be very subtle and not easily visible, which defeats the purpose of the double eyelid surgery. Ultimately, height of eyelids really depends on individual facial features and preferences.
Nevertheless, the above are just general guidelines for those who are unsure. An individual with Asian features can look fantastic with parallel eyelids and vice versa. What is important is that you are satisfied with the results.
If you are still unable to make a decision, our doctors can provide you with professional advice. They are experienced with good eyes for aesthetics and you can trust them to tell you which is the most suitable.
In most, if not all cases, double eyelid surgery is a lifetime commitment. Hence, it is important for you know understand as much as possible before doing so. If you do decide to go under the knife, we will do our best to meet your needs, and you can look forward to having attractive, larger eyes.