Eyelid surgery is not one operation performed the same way on every face. A Western or traditional upper blepharoplasty is designed around the anatomy most often seen in Caucasian eyelids. An Asian blepharoplasty has to respect a different set of anatomical features, and a different idea of what a natural result looks like. Understanding those differences helps patients ask better questions and recognize when a surgeon is planning the operation for their eyes rather than applying a template.

Why the goal is different
Historically, both patients and surgeons often defined the goal of Asian eyelid surgery as a Caucasian look. Reviews of the anatomy note that, over time, people realized that Caucasian-like eyelids make Asian patients look quite unnatural (Kiranantawat and colleagues, 2015). Today the aim is to preserve ethnic identity while improving the eyelid, which means choosing the operation and the crease design to suit the patient’s own anatomy.
How the Asian upper eyelid differs
The same anatomical review lists several characteristics that distinguish the Asian upper eyelid:
- The upper eyelid crease is less apparent than in a Caucasian eyelid.
- The upper lid tends to look puffier and to have more fullness.
- The palpebral fissure (the eye opening) is narrower, which can give a slit-like look.
- Mild ptosis (a lower position of the upper lid) is commonly seen.
- The outer corner of the eye tilts upward.
- An epicanthal fold (skin covering the inner corner of the eye) is common.
- The soft tissue distance between the inner corners of the eyes is wider, by roughly 5 to 7 mm compared with Caucasians.
The review also reports that the average Asian eyelid crease sits about 2 mm lower than a Caucasian crease, and that the upper lid crease is lower in men (4 to 6 mm) than in women (6 to 8 mm). This matters in the operating room, because a crease placed at a Western height can look unnatural on an Asian eyelid.
The anatomy behind the crease and the fullness
In Caucasian eyelids, the orbital septum (a thin membrane that holds fat in the orbit) normally fuses to the levator aponeurosis (the tendon of the muscle that lifts the lid) about 3.7 mm above the top of the tarsal plate. According to the same review, this prevents preaponeurotic fat from descending and interfering with crease formation when the eye opens. How these layers relate in the Asian eyelid is one reason crease formation and eyelid fullness behave differently, and it is the reason a one-size operation does not fit every patient.
What a Western or traditional blepharoplasty usually addresses
A Western or traditional upper blepharoplasty is most often performed to remove excess skin, and sometimes a small amount of muscle or fat, from an eyelid that already has a defined crease. The crease is largely preserved. For many patients with Asian eyelids the question is different: the crease may be low, faint or absent, so the operation may need to create or reconstruct a crease as well as manage fullness.
What an Asian blepharoplasty plans for
Published reviews of Asian blepharoplasty emphasize maintaining ethnic integrity and recognizing the need for appropriate adjunctive procedures (Flowers, 2002). One common adjunct is medial epicanthoplasty, a procedure that modifies the epicanthal fold at the inner corner of the eye. It is a common method for correcting epicanthal folds in Asians but sometimes causes unsatisfactory results, which is one reason careful planning matters (Ha and colleagues, 2022).
Your surgeon’s technique, whether incisional or suture-based, is a separate question, which we discuss in Double Eyelid Surgery: Incisional vs. Suture Technique.

What about the lower eyelid?
The anatomical review notes that there is not much difference in the anatomy of the lower eyelid between Asians and Caucasians. Lower eyelid surgery is therefore planned mostly around the individual’s fat, skin and support rather than ethnicity. For details, see Transconjunctival vs. Subciliary Lower Blepharoplasty and Lower Blepharoplasty Recovery.
Questions to ask your surgeon
- How do you decide where my eyelid crease should sit, and how high will it be?
- Will my result keep a natural look that fits my face?
- Do I have an epicanthal fold or mild ptosis that should be part of the plan?
- How many Asian blepharoplasty patients do you treat, and can I see before and after photos of eyelids like mine?
- What are the risks, and how are revisions handled?
Every patient’s anatomy and goals are different. If you are considering eyelid surgery, schedule a consultation so your eyelids can be examined in person. This article is for general education and is not medical advice.
References
- Kiranantawat K, Suhk JH, Nguyen AH. The Asian eyelid: relevant anatomy. Seminars in Plastic Surgery. 2015;29(3):158-164. PubMed.
- Flowers RS. Asian blepharoplasty. Aesthetic Surgery Journal. 2002;22(6):558-568. PubMed.
- Ha JH, Park YO, Jin US, et al. Revisional medial epicanthoplasty using reverse Z-plasty technique. Aesthetic Surgery Journal. 2022;42(1):10-15. PubMed.











Contact Us