--- title: "Indian Double Eyelid Plastic Surgery: Suture vs Incision" description: "Double eyelid plastic surgery for Indian eyes: suture vs incision, natural crease height, healing by week, and why a crease set too high is hard to undo." url: https://drshikhabansal.com/blog/double-eyelid-surgery-india-asian-blepharoplasty/ date: 2026-10-06 author: "Dr. Shikha Bansal" --- # Double Eyelid Plastic Surgery for Indian and Asian Eyes "Can a crease be made in my eyelid without my eyes looking like someone else's?" That is the question behind most enquiries about plastic surgery for a double eyelid. The lid may have no visible fold at all (a monolid), a fold so low it disappears when the eyes are open, or a crease on one side only, so the two eyes do not match. Double eyelid surgery, also called Asian blepharoplasty, creates or refines that crease. It is a different operation from the eyelid lift done for age-related hooding: the aim is to build a fold where little or none exists, not to cut away loose skin. This post covers how Indian and South Asian lids differ, the suture and incisional methods, how a natural crease height is chosen, what can be done about uneven creases, and what recovery and risks look like. This is general information only and not a substitute for medical advice from a qualified plastic surgeon who has examined your eyes. ## Who this article is for - Adults with a monolid or only a faint crease who want a defined, stable fold - People with one creased and one uncreased lid who want the two to look closer - Anyone who wants a crease that suits an Indian face rather than a Westernised look - Those comparing the suture and incisional methods before a consultation - People researching [eyelid surgery in Gurgaon](/procedures/blepharoplasty/) who want to understand crease creation specifically If the concern is loose, overhanging skin that has developed with age, that is standard upper blepharoplasty, explained in the [blepharoplasty guide](/blog/blepharoplasty-eyelid-surgery-india-guide/). ## How Indian and South Asian eyelids differ The upper eyelid crease forms where fine fibres from the lid-lifting muscle (the levator aponeurosis) attach to the skin. In many Asian lids these attachments are sparse, low or absent, and the fat behind the lid tends to sit lower and further forward, so the lid looks full and the fold is faint or missing. Indian and South Asian lids vary widely: many do have a crease, though it can be low, uneven or partly hidden, with more fullness than textbook lid shapes. The same anatomy-first logic applies elsewhere on the face, as covered in [Indian nose anatomy and ethnic rhinoplasty](/blog/indian-nose-anatomy-ethnic-rhinoplasty-considerations/). ### Pretarsal fullness The strip of lid just above the lashes (the pretarsal area) may hold extra soft tissue and fat. This padding can push a fold down or hide it. For a new crease to hold, some of this tissue often needs careful thinning, which is one reason the incisional method is usually favoured for fuller lids. ### Crease height and shape Crease height is measured from the lash line. Western lids tend to have a higher crease, commonly around 8 to 11 mm in women; Asian creases, where present, typically sit lower. Shape matters as much as height. A tapered crease narrows towards the nose and merges near the inner corner, while a parallel crease runs alongside the lash line across the whole lid. Tapered creases tend to look natural on many Indian faces; parallel creases read as more pronounced. ### The epicanthal fold Some people have a small fold of skin covering the inner corner of the eye, the epicanthal fold. A strong fold makes a parallel crease difficult without also altering the inner corner (epicanthoplasty), a separate procedure with its own scarring risk that most patients do not need. ### Monolid vs double eyelid A monolid is a normal anatomical variant, not a defect. Crease surgery for appearance is a personal choice, not a medical necessity; only rarely, for example when lashes turn in against the eye, is crease formation part of a functional repair. ## Suture vs incisional: which double eyelid method suits you? Double eyelid plastic surgery is done in two main ways. The suture (non-incisional) method uses fine buried stitches through tiny punctures to anchor the skin to deeper tissue; it suits thin lids with little fat or excess skin and tends to recover faster, but the crease can loosen or fade over time. The incisional method uses a cut along the planned crease, thins tissue where needed and fixes the skin to the deeper layer; it typically gives a more durable fold and suits fuller or asymmetric lids, with longer swelling and a fine scar hidden in the crease. ### The suture method Small punctures are made along the marked line and permanent fine sutures are passed beneath the skin to create adhesion. No skin or fat is removed, swelling is usually modest, and the procedure is typically done under local anaesthesia. The trade-off is durability: in fuller lids especially, the sutures may loosen and the crease may become shallower or disappear, sometimes needing a repeat procedure. ### The incisional method An incision is made along the planned crease, a narrow strip of skin, muscle or pretarsal tissue is removed where needed, fat is reduced conservatively, and the skin edge is fixed to the levator or the firm plate of the lid (the tarsus). This method is generally preferred for thick lids, excess skin, marked asymmetry and revisions. The scar sits within the fold and tends to fade. A partial-incision variant, using a short cut of about 1 to 2 cm, suits lids that fall between the two categories. ### Checking for ptosis first Mild ptosis (a lid margin that sits lower than it should because the lifting muscle is weak) can be a hidden cause of an uneven crease or unequal lid show between the two eyes. Lid height and muscle function are measured before surgery. If ptosis is present, it can often be corrected in the same sitting, depending on its degree and cause; creating a crease over unrecognised ptosis tends to make asymmetry worse. ## What crease height looks natural on Indian eyes? A natural result usually means a crease that is low to moderate in height, often tapered, and in proportion to the brow and eye opening, rather than a high, wide fold borrowed from Western faces. A crease set too high can give a surprised or "operated" look and is much harder to correct than one set slightly low. Planning is done sitting upright with the eyes open. In consultation we typically simulate the fold with a fine instrument while you look in a mirror, so the height is agreed together before anything is marked. Several factors guide the final height: - **Lid show**: how much lid is visible between lashes and fold with the eyes open - **Brow position**: a low or heavy brow makes a high crease look unnatural - **Gender and preference**: men usually suit a lower, subtler crease - **Existing partial crease**: where present, it is usually the best guide ## Can uneven or asymmetric eyelid creases be corrected? Uneven creases are very common: one eye has a fold and the other does not, or the folds sit at different heights. Surgery can usually bring the two sides much closer, sometimes by operating on one side only to match the other, but an exact match cannot be promised. Underlying causes, such as mild ptosis on one side or a difference in brow height, need to be identified first, because they decide whether crease surgery alone will help. ## Recovery and risks Most double eyelid procedures are done as day care under local anaesthesia, sometimes with sedation. After the suture method, swelling tends to settle over one to two weeks. After the incisional method, stitches are typically removed around day five to seven, visible swelling eases over two to three weeks, and the crease often looks higher and deeper than planned at first. The final shape usually settles over three to six months, and after the incisional method subtle softening can continue for up to a year. Aftercare generally includes cold compresses and sleeping with the head raised; eye makeup and contact lenses are avoided, as is strenuous exercise, for the period your surgeon specifies. Risks include: - Asymmetry between the two creases - Fading or loss of the crease, more often after the suture method - A crease that sits too high, or extra folds above the intended one - A hollow look if too much fat is removed - Prolonged swelling, a visible scar, infection or bleeding - Temporary dryness or difficulty closing the eye fully - A buried suture showing through, a small cyst at a stitch, or a slight droop of the lid after surgery - Rarely, bleeding behind the eye that threatens vision and needs emergency treatment Revision is possible but harder than the first operation, which is why a conservative plan is usually the safer one. ## Choosing a surgeon for double eyelid surgery in Gurgaon For a crease measured in millimetres, the surgeon's training and planning matter more than the method's name. Look for a qualified plastic surgeon who examines for ptosis and dry eye and simulates the crease with you. They should explain which method suits your lid and why, and who handles follow-up and any revision. Ask to see results on Indian or South Asian lids, not only on lids that already had a crease. Dr. Shikha Bansal holds an MBBS (Gold Medalist), MS General Surgery and MCh in Plastic & Reconstructive Surgery from SMS Medical College, Jaipur, and is registered with the Haryana Medical Council (Reg. No. 24859). Consultations take place at the clinic in Sushant Lok 1, Gurgaon. Fees depend on the method and on whether ptosis correction is added; the [eyelid surgery cost guide](/blog/blepharoplasty-cost-india-gurgaon/) explains what drives a quote. ## Frequently asked questions ### Is double eyelid surgery permanent? The incisional method tends to give a long-lasting crease because the skin is fixed to deeper tissue. The suture method is less durable, and the crease may loosen or fade over months or years, particularly in fuller lids. Ageing can still change how any crease looks. ### Can a monolid be turned into a double eyelid? In most cases, yes, with either method, depending on how thick and full the lid is. The aim is a fold that suits your face, not a change of ethnic appearance. ### How long does double eyelid surgery take to heal? Many people return to desk work within about a week after the suture method and one to two weeks after the incisional method. Visible swelling typically fades within two to three weeks, while the crease keeps softening for three to six months, or up to a year after the incisional method. ### Can double eyelid surgery be reversed? A suture crease can sometimes be released if the sutures are removed early, though some fold may persist. An incisional crease is much harder to undo, and lowering a crease set too high is a complex revision. ### What does double eyelid surgery cost in India? The fee depends mainly on the method, whether one or both lids are treated, and whether ptosis correction is needed. The [eyelid surgery cost guide](/blog/blepharoplasty-cost-india-gurgaon/) breaks down these drivers; an exact quote follows an examination. ## Next steps A double eyelid crease works best when it is planned around your own lid, brow and eye shape rather than a photograph of someone else's. If you are weighing the suture or incisional method, or hoping to even out an uneven pair of creases, an examination is the right next step. [Book a consultation](/contact/)