Double Eyelid Surgery – All You Need To Know


Double eyelid surgery adds a crease to the upper eyelid to make the eyes appear larger. An incision is made along the eyelid and a piece of skin and sometimes some of the underlying muscle is removed. This skin is closed using stitches. The resulting scar forms a crease that creates a double eyelid. Double eyelid surgery is reportedly one of the most common form of cosmetic surgery procedures in Singapore.

Typical Result you Will Get – Before and After Photos

This is a comprehensive guide that provides important information about the surgery, including how to achieve natural results through your selection of crease, shape and height and what to expect from the recovery period.

Let’s start off with the review of eyelid terminology.

The type of eyelid features that we’re born with are passed to us from our parents. Roughly 50% of Asian people are born with what we refer to as a double island. This kind of island is characterized by small crease that separates the upper eyelid into two segments.

The crease is indicating in the photo on the left, run from the inside corner of the eye to the outside. With this kind of eyelid the muscle that elevates the eyelid called the levator is naturally attached to the overlying skin. This causes a crease deform when the muscle pulls the eyes open.

The other 50% of Asian people inherit a single eyelid. In the photo on the right you can see that there is no crease separating the upper island into two segments. In this case, the levator muscle is not attached to the overlying skin and does not form a crease as it pulls the lid open.

Both types of creases are variations of normal attractive and simply occur randomly. No one type of crease is better then the other. Since having a double or single eyelid occurs randomly. It’s quite common in the family for one sibling to have crease while the other does not. People with single eyelids often complained that their eyes look small or heavy. Many of our patients request double eyelid surgery so that their eyes can look more like one of their other family members.

So what are the objectives when it comes to double eyelid surgery?

They really are to create a natural looking upper eyelid crease, create more open and peering eyes. Create more exposed upper eyelashes and reduce upper eyelid puffiness in some patients.

Are you a candidate for the surgery?

You may be if you were born with single eyelid creases and desire a more open eyed appearance. In this case your cosmetic surgeon can create a tolling crease the desired height and shape. You’re also a candidate if you have no creases and your eyes look puffy and heavy.

Some patients have extra skin and fat in the upper eyelids and they wish they have this removed during the double eyelid procedure. If this is the case, your plastic surgeon can remove skin and fat to create a more sculpted and less puffy appearance and create a new double eyelid crease.

You’re also a candidate if you already have creases, but they’re hard to see or they disappear when you’re tired. In this case your surgeon can make the creases more prominent or remove skin and fat to create more open eyed and less puffy parents.

Watch the animation of this procedure:


Let’s take a look at to commonly perform double eyelid surgery techniques.

These are the incisional, which is permanent technique and the non incisional a.k.a the suture technique.

What is the difference between these two techniques?

With the incisional technique the crease is permanent. The crease is created by permanently attaching the eyelid to the muscle underneath. The crease behaves naturally and I’ll explain this in a moment. With the suture technique the crease may be temporary. The creases created by sutures that stay in the eyelids. The crease does not behave naturally. This is what I mean by natural crease behavior.

Image above: Non incision method

In people who are born with upper eyelid crease. The crease should be visible when the eyelid is open. The creases should disappear however, when the eyelids are closed. And you can see this here. These pictures are an example of a naturally behaving crease. With the incisional technique the creases behave naturally because the underlying muscle is attached directly to the skin as it occurs naturally.

image above: incision method

With the suture technique the creases formed by attaching the skin through stitches that remain within the skin. These creases are still visible when the eyelid is closed. So while there are pros and cons to both. The incisional technique produces the most natural results.

While achieving national results is often the main objective. It is important to understand that there are pros and cons to each technique.

Let’s look at these pros and cons when it comes to the incisional technique.

The main Pro is that the new crease is permanent because as surgeons we create the crease through an incision. There’s more control and precision with creating the crease height and shape, and this allows access to the other eyelid structures to better address upper eyelid fat deposits, excess muscle and extra upper eyelids skin. The main cons to the technique is that it is quite complex and require special expertise and skill. Healing time is slightly longer than that of the suture technique.


As mentioned, it’s very important to achieve natural looking results. And this is largely determined by crease height and shape that the patient and the surgeon agree upon. During the consultation the patient and your surgeon discuss various options for crease height and shape.

These decisions determine how dramatic or subtle the change to the eyes will be. First of all, the patient chooses their new crease shape. They can choose between an inside fold or an outside fold. With an inside fold the crease runs parallel to the lash line and tapers inside the epicanthic fold on the inside corner of the eye.

As you can see with the drawing of the eyelid on the left. The crease appears to start at the inside corner of the eye. Among Asians who are born with creases the inside fold is the most commonly occurring shape because of this, the inside fold is the most popular choice among patients who want the most natural looking results.

With an outside fold, the crease runs parallel to the lash line and ends above the epicanthal fold at the inside corner of the eye. As you can see with the drawing of eyelid on the left. The crease appears to start above the inside corner of the eye, because this type of fold occurs less often in Asian people it is less natural looking. Having said this, patients do sometimes select this fold shape, since it can create a more open eyed appearance.

Once the patient has selected a crease shape, it’s time to select the height. There are three crease heights to choose from. With the small crease height, the crease is created roughly 6 to 8 millimeters above the eyelash line and a minimal amount of skin above this line is removed.

With the medium crease, the crease is created roughly 7 to 9 millimeters above the eyelash line and a moderate amount of skin above is removed. With the high crease. The crease is created 8 to 10 millimeters above the eyelash line, and a significant amount skin above is removed.

The small crease is the most naturally occurring crease among Asian people are born with creases and is therefore the most natural looking when created surgically.

The small crease high is the most popular crease height selected. The medium crease height occurs less commonly among Asian people and therefore this crease looks less natural when created surgically. Having said that, this crease height does result in a more open eyed appearance with a prominent obvious crease and is sometimes requested. High creases do not occur naturally in Asians, and is therefore a very uncommon request.

What to Expect

When it comes to the surgery itself, you can plan to go home the same day of surgery. It takes roughly 1.5 to 2 hours to perform and many patients relax or even doze off during the procedure. After it’s complete, the patient rest for about thirty minutes and then can return home.

Your surgeon will typically begin the procedure by injecting local aesthetic into the outlets so that no discomfort is felt. Patients have the option of taking a mouth oral sedative so that they are relaxed during the procedure.

The surgeon then make an incision in the eyelid. He/she has to careful to hide the incision in a new crease so that the scar will be very difficult to see. Some patients have extra skin and fat in the upper eyelids and they wish to have this removed during the procedure.

Finally, your surgeon will create the new permanent increase by using a special suturing technique to permanently attach the skin to the underlying muscle that creates the fold. The sutures are removed one week after surgery. Most people take one week off work and feel comfortable being seen in public one to two weeks following surgery.

Recovery time

How soon you are ready to make your debut really depends on the degree of swelling and bruising that you experience. Everyone heals differently.

You’ll be find to be back to household activities the day after surgery, light exercise after one week and vigorous exercise two weeks later. While you’ll see the results of surgery in the first week.

The complete result can take up to six months. Most patients experience little to no discomfort during the recovery period. They are sometimes bothered by itchy eyes where the incisions were placed.

The majority of bruising and swelling is typically gone in one to two weeks. However, some residual swelling can last for three months. Your new creases will appear too high in the beginning because of swelling. This will then settle to it’s final position over a period of several months.

Your surgeon has to keep in touch and see you on a regular basis to monitor your progress. A typical follow-up schedule consists of aftercare appointments, 7 days, 3 months, 6 months in a year after surgery.


The price of this procedure ranges from SGD 1000-3000 (Ask your surgeon first; different clinic may have different pricing)