Double Eyelids

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What are Double Eyelids? 

A double eyelid has a visible eyelid crease. It is the opposite of a single or monolid that has no crease. Both double and single eyelids are normal and require no medical intervention.

Despite being normal, some people have cosmetic reasons for undergoing double eyelid surgery. They opt for surgery when their:

  • Eyelid interferes with vision
  • Eyelids don’t match
  • Eyes don’t look as large as they’d like
  • Makeup is difficult to apply

Are Double Eyelids Rare?

No. This is the most common type of eyelid for people not of Asian descent and about half of people who are of Asian descent have a double upper eyelid.

What Causes Double Eyelids? 

For most people, their genetics are the reason they have double eyelids. Double eyelids might also be caused by:

  • Aging
  • Ptosis
  • Fat accumulation
  • Underdevelopment or weakening of the eyelid muscles 

What Does a Double Eyelid Look Like?

Double eyelids feature a crease on the upper lid. For some, it’s a well-defined crease and very noticeable. For others, it’s slight and invisible without a close examination. 

As someone’s face ages over time, the delicate skin surrounding their eyes loses its elasticity and relaxes. This causes their large eyes with well-defined creases to develop hooded lids or partial creases

Can a Double Eyelid Cause Health Issues? 

Usually, double eyelids cause no health issues for people. However, if their upper lids droop or sag, it can affect their peripheral vision. 

Drooping double eyelids cause:

  • Problems reading
  • Eye pain
  • The need to tilt the head back to see
  • The inability to drive safely
  • Tension headaches
  • Excessively dry or water eyes

The shape of your eyelids changes over time as you age. Problems also occur due to certain cosmetic procedures and diseases. 

Common health and vision problems related to changing eyelids include:

  • Blepharitis: Inflammation of the eyelids caused by a problem with the oil glands near the base of the eyelids, a bacterial infection, or skin conditions. It usually doesn't affect vision. However, it can make eyelids red, itchy, and swollen and leave eyes red and watery.
  • Ptosis: Occurs when, over time, the upper eyelids may start to sag. It’s caused by the muscles that support them losing their strength. It can also be caused by eye injuries, neurological problems, and diseases.
  • Blepharochalasis: Occurs due to the loosening of eyelid skin caused by loss of elasticity. This creates new folds that droop over the lashes and block the upper field of sight by covering the pupil.
  • Ectropion: Occurs when the muscles of the lower lid weaken, making the lid sag and turn outward, away from the eyeball. This causes the upper and lower lids to no longer meet when the eye is closed. Eyes might tear excessively and become red and irritated. Cases range from mild to severe.
  • Entropion: Occurs when the lower lid rolls inward toward the eye causing the lashes to constantly rub against the cornea. People with entropion feel as if there is something in their eye, and experience tearing and blurred vision.

In some cases, doctors recommend double eyelid surgery (a type of blepharoplasty) to deal with these problems.

What is Double Eyelid Surgery? Is it Permanent? 

Knowing what to expect before undergoing cosmetic eyelid surgery helps you decide if the procedure is right for you. 

Before committing to surgery, ask your doctor:

  • What result should I expect from the procedure?
  • Will the procedure help repair any problems I’m having with vision?
  • Are any of my existing medical issues cause for concern if I have the procedure?
  • Should I opt for the incisional or non-incisional surgical technique?
  • What are the specific steps of the procedure?
  • What type of anesthesia is used?
  • What are the risks?
  • What is the recovery time?

The steps of incisional double eyelid surgery include:

  • Measuring and marking the eye with a pen, based on the desired outcome
  • Administration of IV sedation or general anesthesia and a local anesthetic
  • Cutting several incisions along the eyelid line
  • Removal of the marked excess skin
  • Removal of muscle and fat tissue
  • Closure of incision with glue or stitches

Incisional double eyelid surgery is recommended for anyone who has:

  • Thick skin
  • Need for extra skin or fat removal
  • A desire for permanent results

Risks of incision double eyelid surgery include:

  • Allergic reaction to anesthesia
  • Infection
  • Visible scarring
  • Temporary or permanent vision changes

The steps of non-incisional upper eyelid surgery include:

  • Measuring and marking the eye with a pen based on desired outcome
  • Administration of IV sedation or general anesthesia and a local anesthetic
  • Insertion of tiny punctures along the line on the eyelid
  • Placement of sutures through the puncture holes to tighten the crease above the upper lash line

The sutures dissolve, so there’s no need to return to the doctor to have them removed. Non-incisional surgery causes less scarring than incisional procedures. It is also reversible. It’s ideal for people who do not need fat or extra skin removed.

Risks of non-incisional double eyelid surgery include:

  • Asymmetrical result
  • Loosening of the double fold
  • Infection
  • Irritation from sutures
  • Visible puncture marks
  • Inclusion cyst if a stitch is buried

Who is a Candidate for Double Eyelid Surgery? 

Anyone with a monolid can consider undergoing double eyelid surgery for cosmetic purposes. There are also health reasons for opting to have the procedure. 

Reasons for undergoing double eyelid surgery include:

  • Vision problems
  • Establishing symmetry
  • Enlarging eyes
  • Making makeup application easier
  • Fatty deposits or puffiness in the upper lids
  • Loose or sagging skin that causes folding that impairs vision
  • Having excess skin and/or fine wrinkles

People who are in good health who do not smoke and have realistic expectations for the results of their procedure are good candidates for eyelid surgery.

Eyelid surgery is not a good option for people who:

  • Want to improve uneven eyes
  • Want to lessen the appearance of crow’s feet
  • Have dry eye symptoms
  • Have drooping eyebrows
  • Smoke
  • Have an eye infection or disease
  • Have other severe illnesses or infections

Recovery & Healing Time

Basic healing occurs within approximately two weeks after incisional surgery. It can take several months to heal completely. Many people experience the following during the recovery period:

  • Bruising
  • Bleeding
  • Pain
  • Dry eyes
  • Light sensitivity
  • Swelling
  • Changes in skin sensation

People who undergo non-incisional surgery heal faster and are usually fully recovered within two weeks

Other Treatment Options for Fixing Double Eyelids

Eyelid tapes and glues are alternatives to double eyelid surgery. These products are available without prescription and create a crease in the eyelid. Eyelid tape and glue:

  • Temporarily provide a crease in the lid
  • Are removable
  • Allow you to avoid the risks of surgery
  • Give you an idea of what double lids look like before committing to surgery
  • Need to be reapplied every day
  • Can shift or fall off while wearing
  • Can cause an allergic reaction
  • Put vision at risk

People with single eyelids can make their eyes look larger and create the illusion of double eyelids with makeup. This is an easy way to see how you’d look with double eyelids without making a permanent commitment. Makeup tips include:

  • Shaping your eyebrows to enhance the shape and size of your eyes
  • Applying shadow in a horizontal gradient
  • Avoiding dark eyeshadow over the whole lid
  • Applying light shadow along the lower lash line
  • Avoiding application of eyeliner in the inner corner of the eye
  • Lining your lash line only halfway with a smudge-proof liner
  • Highlighting the inner corner with a light shade of shadow
  • Applying false eyelashes
Resources
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(1) “Eyelid Disorders.” Medlineplus.gov.

(2) “Eyelids.” Wexnermedical.osu.edu.

(3) Harvard Health Publishing. “Drooping Eyelid (Ptosis).” Harvard Health.

(4) “Eyelid Surgery.” American Academy of Ophthalmology, 19 Apr. 2021.

(5) “American Society of Plastic Surgeons.” American Society of Plastic Surgeons, 2019.

(6) “Eyelid Surgery (Blepharoplasty).” Cleveland Clinic.

(7) “The Aging Eye: When to Worry about Eyelid Problems.” Harvard Health, 10 Oct. 2019.

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