Removal of orbital fat is a common maneuver during double eyelid surgery, and most textbooks list it as an integral step. In our experience, however, excising fat does not serve to "beautify" the Asian upper eyelid and is seldom indicated.
In general, patients seeking double eyelid surgery to create or enhance a weak crease are not just young but often very young. Aging tendencies have not yet made an appearance.
Treating young lids in a "subtractive" manner (as is done in European "blepharoplasty" performed on older Occidental patients) makes little sense.
Incisional double eyelid surgery requires only a structural rearrangement of internal tissues to create a permanent crease. A tiny amount of closing muscle and orbital septum do need to be trimmed.
Fat removal, however, is not necessary.
Why Prevailing Wisdom Regarding the Lid Crease Seems Incomplete (video - Premium Edition only)