Asian Blepharoplasty in New Jersey: What Double Eyelid Surgery Can and Cannot Change

Roughly half of people of East Asian descent are born without a visible upper eyelid crease, and a large share of the rest have a crease that is partial, uneven, or disappears by the end of the day. Creating or refining that crease — Asian blepharoplasty, or double eyelid surgery — is one of the most commonly performed aesthetic operations in the world, and one of the most commonly regretted when it is planned badly.

That is the right instinct, and it is the framing Dr. Farhad Rafizadeh uses in consultation with patients who come to Morristown from Bergen, Essex, Morris, and Union counties, and from across the Hudson. The useful conversation is not incisional or non-incisional. It is what should this crease look like on your face, and what does your anatomy allow? Technique follows from that answer, not the other way around.

Why the Asian Upper Eyelid Often Has No Crease

The upper eyelid crease is not a fold of skin. It is a tethering point. Fibers of the levator aponeurosis — the tendon that lifts the eyelid — reach forward and anchor into the skin, so that when the eye opens, the skin above that anchor folds over it. Where those fibers anchor determines where the crease sits, and whether there is one at all.

A cadaver, histology, and MRI study of Korean and Caucasian upper eyelids published in Archives of Ophthalmology identified three consistent structural reasons the crease is absent or low in the Asian eyelid: the orbital septum fuses with the levator aponeurosis below the top edge of the tarsal plate rather than above it; the preaponeurotic fat pad and a thicker subcutaneous fat layer sit in the way of levator fibers reaching the skin; and the levator’s primary insertion into the muscle and skin occurs closer to the lash margin. Asian eyelids that do have a natural crease showed an intermediate amount of fat — between the single-lid and Caucasian anatomy.

Two practical points follow from that. First, a monolid is a normal anatomical variant, not a deformity. Second, the fullness in the lid is structural, which is why a crease created in a full lid without addressing that fullness tends to fade — the tissue simply drapes back over the anchor.

The Goal Is a Crease That Belongs to Your Face

The single most common fear patients bring to this consultation is that surgery will erase something. It is a reasonable fear, because it has happened plenty of times: creases set far too high, epicanthal folds removed wholesale, a rounded eye opening that reads as obviously operated.

The features that make an eyelid look Asian — the crease height, the tapered shape at the inner corner, the way the fold sits close to the lashes — are the features you are trying to keep. The operation should make the eye look rested and defined, not borrowed.

In practice that means the design is drawn on your lid, with you sitting up, eyes open, in a mirror. Crease height, crease shape, and whether the inner corner is touched at all are decisions made before anything is numbed — and they matter far more to the outcome than which of the three technical approaches is used to hold the crease in place.

How the Crease Is Actually Made: Three Approaches

There are three broad families of technique. They differ in how the anchor is created, how much tissue can be addressed, and how durable the result is.

Non-incisional (buried suture) technique

• What it is: Sutures are passed through tiny punctures to create an adhesion between the skin and the deeper layer. No skin is removed.
• Best for: Thin eyelids, young patients, minimal excess skin, minimal fat.
• Advantages: Fastest recovery, least visible scarring, and the crease can sometimes be released early if a patient changes their mind.
• Trade-off: The highest rate of the crease loosening or disappearing over time, because nothing structural was changed — only tethered.

Small-incision or partial-incision technique

• What it is: One to four short incisions along the planned crease allow limited removal of pretarsal tissue or fat, with fixation to the deeper layer.
• Best for: Lids with moderate fullness but little excess skin.
• Evidence: A 2023 systematic review in Aesthetic Plastic Surgery pooled 13 studies and 4,177 patients across single-, two-, three-, and four-incision variations. It reported a pooled total complication rate of 5% and a fold-loss rate of 2%, with no significant difference between the single- and three-incision groups.
• Trade-off: Not appropriate when the eyelid skin is genuinely lax.

Full-incision technique

• What it is: A continuous incision along the planned crease, allowing skin, muscle, and fat to be addressed directly and the crease to be fixed to the levator or tarsus.
• Best for: Thick or full lids, real skin excess, revision cases, and patients who want the most durable crease.
• Trade-off: The most swelling and the longest settling period. The scar sits inside the crease and is typically inconspicuous once healed — but it is permanent.

For a patient in their forties or fifties whose complaint is heaviness rather than crease definition, the operation may look much more like a standard upper blepharoplasty with careful crease preservation than a classic double eyelid procedure. The two overlap constantly.

Where the Crease Should Sit — and Why Higher Is Not Better

This is where results are won and lost. A crease set too high produces a deep, hollow, permanently surprised look that never settles and is genuinely difficult to fix, because lowering an established crease means releasing an adhesion that the body has already healed.

An Asian crease is typically designed low — commonly in the range of six to eight millimetres above the lash line with the eye closed, rather than the nine to eleven millimetres more typical of a Western lid. Shape matters as much as height. A tapered crease merges into the inner corner and is the more common natural pattern; a parallel crease runs at even height across the lid and generally requires either a naturally shallow epicanthal fold or a procedure to modify it. Choosing a parallel crease in an eyelid built for a tapered one is one of the reliable ways to end up with a result that looks operated.

Epicanthoplasty: The Add-On That Deserves the Most Caution

The medial epicanthal fold is the small web of skin at the inner corner. Reducing it lengthens the visible eye opening and is what makes a parallel crease possible in many lids. It is also the part of this operation with the least forgiving scar, because the medial canthal skin is thin, mobile, and sits in a concavity where hypertrophic scars and webbing are conspicuous. Noticeable scarring is the complaint most often associated with epicanthoplasty, more so than with a primary double eyelid operation.

Two conservative principles are worth insisting on. Do not add an epicanthoplasty simply because it is offered as part of a package — it should be driven by your anatomy and your crease design. And when it is done, under-correction is far easier to live with than over-correction: an inner corner opened too aggressively produces a rounded, exposed look that cannot be undone.

What Double Eyelid Surgery Cannot Change

Clear expectations prevent most disappointment. Creating a crease does not:

• Lift a droopy eyelid margin. If the lid edge itself sits low, that is ptosis — a levator muscle problem — and it needs to be diagnosed and treated as such. A crease built over an unrecognised ptosis produces asymmetry that shows up the moment the swelling settles. See functional eyelid surgery for how that is evaluated.
• Raise a low or heavy brow. Brow position and eyelid crease are separate problems that imitate each other. Operating on the lid when the brow is the cause removes skin the brow still needs. A brow lift is the different answer.
• Fix dark circles or under-eye hollowing. Those belong to the lower lid and the tear trough, and are a separate discussion entirely.
• Guarantee perfect symmetry. Almost no one has symmetric eyelids to begin with, and pre-existing asymmetry — in brow height, lid margin, or orbital shape — carries through surgery. It can be improved. It is not erased.

Recovery: What the First Three Months Look Like

The visible timeline is longer than most patients expect, and the crease looks wrong before it looks right.

• Days 1–7: Swelling and bruising peak in the first 48 to 72 hours. Cold compresses, head elevated, sleeping on your back. Non-permanent sutures typically come out around day five to seven.
• Weeks 2–4: Most people are presentable for work by two weeks, though the crease still sits noticeably high and deep. Makeup is generally cleared once incisions are fully sealed and your surgeon says so.
• Months 2–3: The crease drops and softens as swelling in the pretarsal tissue resolves. This is the stage where patients who were quietly worried stop being worried.
• Months 6–12: Final crease height, final scar maturation, final symmetry. No decision about revision should be made before this point.

Non-incisional recovery compresses the early part of that timeline considerably. It does not shorten the last part — a suture-created crease still needs months to look natural.

Revision and Reversal: Be Honest With Yourself Up Front

Reversibility is often oversold. A buried-suture crease can sometimes be released in the early weeks if the sutures are accessible, and it may fade on its own — which is a feature if you disliked the result and a defect if you liked it. A full-incision crease is not reversible. Revision is possible, and creases can be raised, deepened, or reshaped with reasonable predictability, but lowering an existing crease is among the harder problems in eyelid surgery.

The practical conclusion: decide the crease height carefully the first time, with a surgeon willing to talk you out of something. Revision surgery is a real option, not a safety net.

Choosing a Surgeon in North Jersey

North Jersey has one of the largest Asian-American populations on the East Coast, concentrated in Bergen County and spreading through Essex, Morris, and Union — which means patients here have real options and no reason to travel for this. What to look for is unglamorous: board certification by the American Board of Plastic Surgery, verifiable before-and-after photographs of eyelids that look like yours, and a surgeon who spends more of the consultation on crease design than on technique names.

A useful test question: what would you advise against in my case, and why? A surgeon who has an answer is planning your eyelids. One who does not is selling a procedure.

Dr. Rafizadeh sees eyelid patients at the Morristown office from Chatham, Madison, Summit, Short Hills, Livingston, Montclair, Fort Lee, Palisades Park, and throughout North Jersey and the greater New York area. Patients travelling from further out can find logistics information on the out-of-town patients page.

People Also Ask

Common Questions About Double Eyelid Surgery

What is the difference between incisional and non-incisional double eyelid surgery?

Non-incisional surgery creates the crease with buried sutures passed through small punctures, without removing skin or fat. It heals fastest and leaves the least visible scarring, but the crease is the most likely to loosen or fade over time because nothing structural was changed. Incisional surgery uses a continuous incision along the planned crease so that skin, muscle, and fat can be addressed directly and the crease fixed to the deeper layer. It swells more and takes longer to settle, but it is the more durable result and the only option when there is genuine excess skin or significant eyelid fullness. Small-incision techniques sit between the two.

Will Asian blepharoplasty make my eyes look Western?

It should not, and a well-planned operation is specifically designed not to. The features that give an Asian eyelid its character — a lower crease height, a tapered shape at the inner corner, a fold that sits close to the lashes — are preserved rather than removed. Results that look Westernized generally come from a crease set too high, an epicanthal fold reduced too aggressively, or both. Ask your surgeon to draw the proposed crease on your lid and show you in a mirror before surgery, and ask to see photographs of their patients with eyelid anatomy similar to yours.

How long does double eyelid surgery take to heal?

Swelling and bruising peak in the first two to three days and most patients are presentable for work at about two weeks, though the crease will still look high and deep at that stage. Sutures typically come out around day five to seven. The crease drops and softens noticeably between months two and three, and the final crease height, scar appearance, and symmetry are not settled until somewhere between six and twelve months. Non-incisional technique shortens the early swelling phase considerably but does not shorten the final settling period.

Can Asian blepharoplasty be reversed?

Only partially, and only for some techniques. A crease created with buried sutures can sometimes be released in the early postoperative weeks while the sutures are still accessible, and such creases may also fade on their own over years. A crease created with a full incision is not reversible — the adhesion is permanent. Revision surgery can raise, deepen, or reshape an existing crease with reasonable predictability, but lowering a crease that is set too high is one of the more difficult problems in eyelid surgery. That is the argument for being conservative with crease height the first time.

What is epicanthoplasty and do I need it?

Epicanthoplasty reduces the small fold of skin at the inner corner of the eye, lengthening the visible eye opening and making a parallel crease shape possible in eyelids that would otherwise only support a tapered crease. Many patients do not need it. It carries the least forgiving scar in this area of surgery, because the skin at the inner corner is thin and mobile, and noticeable scarring is the complaint most associated with the procedure. If it is recommended, ask specifically why your crease design requires it, and understand that under-correction is far easier to live with than an inner corner opened too aggressively.

Am I a candidate for double eyelid surgery if I already have a partial crease?

Yes, and this is one of the most common presentations. Partial creases, creases that appear on one side only, and creases that fade by the end of the day are all situations where the levator fibers reach the skin inconsistently. The goal in these cases is usually to make an existing crease continuous, symmetric, and stable rather than to build one from nothing, and the surgical plan is often more conservative as a result. An in-person examination with the eyes open and closed is necessary, because a partial crease can also be the visible sign of a mild ptosis that needs to be addressed separately.

How high should the double eyelid crease be set?

Lower than most patients expect. An Asian crease is commonly designed in the range of about six to eight millimetres above the lash line with the eye closed, compared with roughly nine to eleven millimetres in a typical Western eyelid, and the right number for any individual depends on their tarsal plate height, eyelid fullness, and brow position. Shape is as important as height: a tapered crease merging into the inner corner is the more common natural pattern, while a parallel crease usually requires a shallow epicanthal fold or a procedure to modify it. A crease set too high is the single most common cause of an obviously operated result.

Does Asian blepharoplasty remove fat?

Sometimes, and conservatively when it does. Anatomical studies have shown that Asian eyelids without a natural crease contain more subcutaneous and suborbicularis fat, including a pretarsal fat component that sits directly where the crease is meant to form. Removing a measured amount of that tissue lets the crease anchor reliably instead of fading as the fullness drapes back over it. Aggressive fat removal, however, produces a hollow, aged upper lid that is very difficult to correct later, so the modern approach is to remove only what prevents the crease from forming and to preserve the rest.

Sources & References

1. Jeong S, Lemke BN, Dortzbach RK, Park YG, Kang HK. “The Asian upper eyelid: an anatomical study with comparison to the Caucasian eyelid.” Archives of Ophthalmology. 1999;117(7):907–912. PubMed
2. Yu P, Chen S, Gu T, Zhao M, Teng L, Lu J. “Small-Incisional Techniques for Double-Eyelid Blepharoplasty: A Systematic Review.” Aesthetic Plastic Surgery. 2023;47(3):1067–1075. PubMed
3. American Academy of Ophthalmology — EyeWiki. “Asian Blepharoplasty (Double Eyelid Procedure).” eyewiki.org
4. American Society of Plastic Surgeons. “Eyelid Surgery (Blepharoplasty).” plasticsurgery.org
5. American Board of Plastic Surgery. “Verify a Surgeon’s Certification.” abplasticsurgery.org
6. Farhad Rafizadeh, MD, FACS — RealSelf Q&A profile. realself.com

Related Reading From Dr. Rafizadeh’s Blog

Other articles on eyelid surgery for North Jersey patients:

• Blepharoplasty & Eyelid Surgery in Morristown: An Overview
• Ptosis vs. Blepharoplasty: Is It Skin or Muscle?
• Are You a Candidate? Upper vs. Lower Blepharoplasty
• Blepharoplasty vs. Brow Lift: Which Do I Need?

Bottom Line

Double eyelid surgery is a design operation with a technical component, not the reverse. Crease height and crease shape decide whether the result looks like a rested version of you or like an operation; technique decides how durable that crease is and how long the swelling lasts. Set the crease low, be conservative at the inner corner, rule out ptosis and brow descent before anything is cut, and give the result six to twelve months before judging it.

If you are considering Asian blepharoplasty or any form of eyelid surgery in Morristown or anywhere across North Jersey, Dr. Rafizadeh’s office can arrange a consultation to examine your eyelid anatomy and walk through what your crease design would realistically involve.