General Information

Eyelid surgery is not the same for everyone. Each patient needs a special consideration according to their case. 

Asian blepharoplasty deserve a specific chapter among worldwide eyelid surgery due to important anatomical differences regarding caucasian anatomy, different approaches, surgical tricks and different expectations as well.

The term double eyelid is actually a misnomer and derives from colloquial references to an upper eyelid with a visible crease making a slight and natural division.

“Asian blepharoplasty” between physicians is commonly used  to more accurately refer to the surgical creation of an upper eyelid crease in asians and to distinguish it from traditional upper blepharoplasty for persons of western descent.

There are two principle techniques for the surgical creation of an upper eyelid crease usually known as: Non incision double eyelid surgery and the full incision double eyelid surgery. None of the above is better than the other… simply there is one specific technique for each one of our patients. In general is very important to determine if there is excess of skin and supratarsal fad pad in order to choose the best option for everyone.

Some features are remarkable to comment. In contrast to the commonly held perception that all asian eyelids lack an upper eyelid crease, there is, in fact important variation in the anatomical appearance  of the upper eyelids of asians, where 50% of individuals of Han origin (Chinese, Koreans and Japanese) with some kind or form of crease that when present, usually tends to be located 6.5 to 7.5mm from the upper eyelashes versus 9 to 11mm in Caucasians. The upper eyelids of asians without a crease often have more prominent subcutaneous and retro-orbicularis fat in the supratarsal region, a feature that is not shared in caucasian upper eyelids, where subcutaneous fat is essentially nonexistent and the retro-orbicularis fat pad is limited to the eyebrow region with some extension to the upper pre- septal area. More importantly, the orbital septum may some- times merge with the levator aponeurosis as low as 2 mm below the superior tarsal border in asians without a crease, whereas the septum joins the levator aponeurosis at a point 5 to 10 mm above the superior tarsal margin in Caucasians. The lower septal-aponeurosis confluence in Asians allows the preaponeurotic fat to extend more inferiorly relative to Caucasians. This intervening fat in the preaponeurotic area impedes crease formation. Asians with native upper eyelid creases have features intermediate to those of caucasians with creases and asians without creases. 


Most individuals who present for Asian blepharoplasty desire a permanent, natural, Asian-appearing upper eyelid crease. These individuals generally do not want to have eyes that look “Western”. Some other wants to change their Asian appearance to an occidental look. In this cases is very often to combine Asian blepharoplasty with epicanthoplasty.

Dark circles is a very common procedure combined with eyelid surgery. The top advanced procedure actually is called Nanofat, which is adipose derived stem cells applied to skin rejuvenation. It is new technique in regenerative medicine demonstrated more than 5 years ago published in the most importante facial and plastic journals around the world and Dr Pecorelli and Dr Guerra are top master in Europe working with fat grafting and nanofat for their patients in facial rejuvenation, also lecturing in national and international top meetings about facial plastic surgery.

Initial consultation with the patient should focus on ascertaining the patient’s specific goals and expectations and propose realistic results always regarding facial harmony.

Physical Exam

Examination must include assessment of the upper eyelid position and contour, any fullness of the pretarsal region, and the height and shape of any upper eyelid crease and fold if present. A straightened paper clip is used to temporarily create a crease by invaginating the pretarsal skin at the desired height. Demonstration of an upper eyelid crease in this manner facilitates counseling of the patient in regards to crease shape and height as the patient can see how his or her eyes appear with a crease set at various levels, and allows the surgeon and patient to arrive at a mutually agreed upon goal.

Evaluation of the eyelids is a dynamic process and requires observation with the patients’ eyes open and closed as well as with gentle manipulation of the eyelid and surrounding tissue. 

Surgical Technique 

Upper Eyelid: 

  • Non incision double eyelid surgery: creation of an upper eyelid crease trough a closed approach using sutures techniques.

Indications: no skin and subcutaneous fat resection.

  • Full incision double eyelid surgery: open approach to create an upper eyelid crease, combined with skin excess resection and fat subcutaneous and fat pad treatment regarding each case. 

 Indications: Skin excess, subcutaneous fat excess and septal fat pad treatment.


Mainly there are two kinds of variation regarding epicanthoplasty folds. The nasal tapered crease and parallel crease where epicanthoplasty is most   common to be performed in the first one in order to change the asian appearance.

Lower Eyelid: The most common procedure is trans-conjunctival approach with fat pad resection or transposition. However despite it’s important to avoid trans cutaneous approach in asian patients some cases with too much skin laxity need the open approach individualizing each patient.

Microfat grafting for tear trough, cheeks and zygomatic arches is a great option in combination with lower eyelid surgery according with each case. 

Surgery Duration: 1 to 2 hours.

Anesthesia: Local anesthesia and mild sedation in most of cases. Combined procedures or some specific medical conditions could need general anesthesia.

Regimen: Ambulatory procedure. 

Postoperative Management 

  • Ice pack, common pain relievers for 48 to 72 hours.
  • Special creams: Arnica Montana, Revitalizing Vit C Serum.
  • Facial Recovery Pack: mask, facial creams, microneedling (optional)  

Recovery Time: 5 to 8 days. Patients go home at the same day and can do normal activities without severe physical effort. Sutures will be removed after 5 to 7 days after surgery. Swelling and ecchymosis can appear depending each patient or combined procedure and usually last for 6 to 15 days. A special creams pack and facial recovery treatment is offered in our clinic for quick recovery.

FAQ: Please contact us to for more information. We can arrange a private consultation for your requires. If you are outside Barcelona, your time is very important to us. Online interview is offered for our patients using FaceTime, Skype or WhatsApp for specific days.

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