Many people of East Asian descent have what is known as a “monolid” – an upper eyelid without a natural crease. This is a completely normal anatomical variation and not a medical issue. However, some patients seek to create a visible eyelid fold to enhance the appearance of the eyes or to improve symmetry between the two lids. This is known as Asian blepharoplasty.
At the ELZA Institute, this procedure is performed by Dr. Dion Paridaens, a world-renowned oculoplastic surgeon with decades of experience in delicate eyelid surgeries, including extensive work on Asian eyelids. He has refined techniques that respect each individual’s anatomy and ethnic identity while enhancing eyelid contours in a natural-looking way.
The upper eyelid is a complex structure that primarily has the task of protecting the eye, but also has a great influence on the patient’s appearance (e.g. they look energetic, or tired). The tarsus gives firmness to the upper eyelid and has contains the Meibomian glands which provide the tear film on the ocular surface with an oily substance (sebum), which is important for lubrication. The levator and Müller muscles ensure that the eyelid can be lifted. The eyelashes protect against dust and debris and the skin gives general protection at the front of the eye. The sphincter muscle (M. Orbicularis) enables active eye closure and runs just below the skin. The orbital septum is an important barrier against infection, and also stops a bruise from going to the orbit.
Cross-section through Asian upper eyelid. Notice the purple line, which represents the connective tissue sheet (septum orbital), which continues towards the eyelash base; the fat behind this sheet extends downwards towards the eyelid lashes.
Cross-section through Caucasian upper eyelid. The purple line (connective tissue shot or septum orbital) inserts on the tendon of the eyelid lifter (levator muscle). At the level of this insertion, there are fibers between this tendon and the skin, resulting in a fold (crease), usually 8-10 mm above the lash line.
Asian blepharoplasty creates a defined eyelid crease that appears harmonious and natural. The procedure can:
A Natural Look
Photos from the past (around the age of 20–25 years) can give a good indication of the natural look of the eyelids and eyebrows – if too much tissue is removed, then it results in eyelids with an unnatural look.
After careful evaluation of the upper eyelids and the eyelid features on old photographs, combined with a comprehensive understanding the wishes of the patient, marks are made on the eyelids at the desired location. Careful attention is paid to achieving symmetry between the upper eyelids, with dimensions being measured at this point in the procedure. This is followed with several injections in the eyelids under monitored anaesthesia.
The eyes remain closed during the procedure. The skin surplus is surgically removed, and careful coagulation of the blood vessels is performed to prevent blue discoloration (bruising) of the skin after the procedure. If a skin fold needs to be accentuated or made, this is done with soluble sutures. The skin is then closed with a continuous suture which can be removed after 5–7 days.
Dr. Paridaens will determine the best technique based on your anatomy, age, and goals:
Ideal for patients with no excess skin or fat. A fold is created using buried sutures, without cutting the skin. This offers faster recovery and no visible scar.
Used when skin, fat, or muscle needs to be removed or reshaped. This method provides permanent, precise results and allows correction of asymmetry or heavier lids.
In selected cases, epicanthoplasty (reshaping of the inner eyelid corner) can be performed for further refinement.
Dr. Paridaens is internationally recognized for his expertise in aesthetic and reconstructive eyelid surgery. He has lectured and published extensively on eyelid techniques and brings the highest level of surgical precision to every case. Patients from around the world – including many from Asia – travel to Zurich for his care.
His approach combines:
Most patients return to work within 7–10 days. Swelling and bruising are typically mild and subside within two weeks. Final results become visible as the tissues settle over the following weeks.
If you are considering this form of eyelid surgery, we are happy to offer a personal consultation to explore your options with Dr. Paridaens.
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