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Many patients of Asian descent have an anatomically distinct upper lid appearance, commonly referred to as a ‘single fold’. Either a lack of a lid crease above the lid margin, or a very low-lying lid crease characterizes this appearance. Most Asians view a ‘single fold’ to be less attractive, when compared to the more westernized (Caucasian) appearance of a ‘double fold’ lid.

The Asian double fold procedure is a specialized form of upper lid Blepharoplasty referred to by many names including Asian Double Fold Procedure, Double Eyelid Procedure, And Asian Blepharoplasty. Dr. Lawrence Tong is very experienced in treating this specialized concern.

What does Asian Double Fold procedure accomplish?

Asian Blepharoplasty is a specialized form of Blepharoplasty. The same goals of standard upper lid Blepharoplasty often apply (removal of excess skin and fat), but with an important difference. The Asian double fold blepharoplasty creates a crease in the upper lid. This crease (called the supratarsal fold) is one element that distinguishes an Asian eyelid from a Caucasian eyelid. It is considered more attractive, and desirable for both men and women. Creating a supratasral fold can make the eye appear larger, more expressive, and improve overall attractiveness.

Issues to Consider With Asian Blepharoplasty

Dr. Tong’s Technique of Double Fold Surgery

Dr. Tong prefers to use the ‘partial incision’ technique for double fold surgery because it allows for a permanent crease creation, while minimizing the incision required. This technique places a short (1.5 cm or less) incision on the upper lid, at the level of fold creation.

An alternative technique is the ‘suture method’, which can be done without making an incision on the lid. The main drawback of the suture method is lack of permanence. The suture method generally achieves a result that lasts for a few years before gradually fading away.

Asian Blepharoplasty vs. Blepharoplasty in Asians

Not all Asian patients undergoing Blepharoplasty are necessarily having a double fold procedure. Some Asian patients may already have a natural double fold and are seeking lid rejuvenation in a similar fashion to a non-Asian patient. These patients should be considered as undergoing standard Blepharoplasty, with modifications geared towards the Asian patient population.

Two Types of Patients Seek Double Fold Surgery

Typically, patients undergoing the double fold procedure fall into two categories:

  • Younger patients that seek ONLY double fold creation
  • Older patients who seek double fold creation AND lid rejuvenation (removal of excess skin and/or fat to improve the youthfulness)

Obviously, the aims in these two patient populations are different and must be treated accordingly.

Attaining the Perfect Crease Height

It is critically important to have clear communication between surgeon and patient when planning for double fold creation. The crease height in Asians compared to Caucasians is different. A natural looking crease height for an Asian is typically much lower. Since the height can be created at any level, it is important for the surgeon to know the exact level desired by the patient.

Dr. Tong will simulate various crease levels during your consultation. By doing so, you and Dr. Tong will have a mutual understanding as to the desired crease height. On the day of the surgery, this is process is repeated and marked directly on the lid skin. This method ensures the most accurate way to obtain symmetry and desired crease height.

Incisions for Double Fold Surgery

Dr. Tong favours using the ‘partial incision technique’ for double fold creation. He makes the incision on the upper lid, measuring approximately 1.5 cm in length. The exact location of the incision for Asian double fold varies with the desired height of the crease. The exact markings are made just prior to surgery. Incisions in the eyelids typically heal to a point where they are almost imperceptible. This is due to the thinness of the skin. In addition, the incision will be well hidden by the new fold after all healing is complete.

Details about the Asian Blepharoplasty Procedure

Dr. Tong performs your Double Fold under IV sedation, in the CAAASF accredited surgical centre at 199 Avenue Road. During the procedure, you are sedated and largely unaware of your surroundings. Some patients may be able to have the procedure performed under local anesthetic only.

The Partial Incision Method

Dr. Tong makes the markings on your upper lid just prior to surgery. To create the double fold, he incises the short (1.5 cm or less) incision down to the muscle mechanism that opens the lid. Some fat in the area may need to be removed if the upper lid is ‘heavy’ due to fatty tissue. Dr. Tong then uses fine stitches to sew the skin down to the muscle layer, at the level of the desired fold. This creates the anatomy seen in Caucasian upper eyelids and Asian eyelids with natural double folds. The other eyelid is then completed. To check for symmetry, the patient is sat up and sedation is stopped. The patient is instructed to open their eyes. If symmetry is obtained, the procedure is complete, otherwise the patient is given more anesthetic and the lids are adjusted.

In a patient who also needs rejuvenation, Dr. Tong removes a strip of excess skin at the beginning of the procedure. The degree and fat removal may be more significant, as well.

Recovery after Double Fold Blepharoplasty in Toronto

Double Fold Blepharoplasty Recovery Immediately after Surgery

In the anesthesia recovery area, you awaken from sedation, while monitored by our nursing staff. Double Fold Blepharoplasty is an outpatient procedure. You will go home shortly after the effects of the anesthetic have worn off, accompanied by friends/family.

Double Fold Blepharoplasty Recovery at Home

At home, you should try to rest and relax as much as possible. You may do non-strenuous activities, but should avoid straining your eyes by watching television, or reading. To help decrease swelling and bruising around the eyes, sleep in a reclining chair, or use multiple pillows to keep your head elevated. Pain is typically mild, but your eyes may be sensitive to bright light over the first few days. Dr. Tong will prescribe medication that can be used during this time. You will have some bruising that lasts 5-7 days.

Follow Visits after Double Fold Blepharoplasty

Your first appointment with Dr. Tong occurs one week after surgery to have stitches removed. The majority of patients return work (non-strenuous) at 7-10 days, or sooner if you do not mind the bruising. Dr. Tong will likely allow you to start light exercise (e.g. walking) at 1 week after surgery. Avoid strenuous activity until 4-6 weeks after surgery.

Things to Expect as you Heal from Double Fold Surgery

The height of the folds will look slightly higher than expected initially. This occurs because there is swelling of the lids. The height settles to its natural position after a few weeks. After the initial post-op visit, you will follow up with Dr. Tong at 6 weeks, 6 months, and one year after surgery. Post-op photos will also be taken at these visits.

Like any procedure, the Asian Double fold procedure has risks and complications associated with it. The risks are low, but do exist. At your consultation, Dr. Tong will go over the pertinent potential risks and complications associated with Double Fold Surgery.

Become Educated about Toronto Asian Double Fold Surgery

It is important for every patient to learn about the procedure and his or her potential surgeon. During your consultation, you will have Dr. Tong’s undivided attention to talk, discuss, and ask questions. There is a great deal information to digest, and Dr. Tong will make sure that you are informed every step of the way. You will have the opportunity to view photographs of many examples of his Asian Blepharoplasty results. It is our goal to make you an educated patient. We have confidence that an educated patient will make better choices about their surgery and their surgeon.

To learn more about how Dr. Tong can help you with Asian Blepharoplasty, set up a Double fold Blepharoplasty consultation with Dr. Tong by giving us a call at (416) 972-0999. You can also let us give you a call; just fill out our contact form and we will call you on the same or the next business day. No doctor’s referral is needed.

See Dr. Tong’s work in our Asian Blepharoplasty before and after photos.

Double Fold/Double Eyelid Surgery at a Glance

What the procedure does
Creates a upper lid crease in patients that do not have one
Duration of the result
Length of time to perform the procedure
1 hours
Type of anesthetic most commonly used
IV sedation
Length of time off of work
7 days
Time to get back to exercise
2 weeks for light exercise, 4 weeks for heavy exercise
Pitfalls your Plastic Surgeon should avoid
  • Making the crease too high (ethnic incongruity)
  • asymmetry