Despite common use of the term "Asian blepharoplasty," double eyelid surgery is not a blepharoplasty. Both operations are indeed performed on the upper eyelid. Beyond that, their differences are so fundamental that they are best thought of as unique rather than closely related procedures.

Nomenclature aside, why might this matter to a potential patient?

"Blepharoplasty" is an older operation developed on and for patients of European and Occidental descent, while "double eyelid surgery" is a more recent operation developed on and for patients of Asian lineage. Many cosmetic surgeons who can perform a blepharoplasty with skill have little or almost no experience with double eyelid surgery.

The most prominent differences between the two operations relate to intended goals, ages of the patient population, and surgical techniques.

• Most Occidental patients requesting blepharoplasty are in their forties, fifties, and sixties, while the vast majority of Asian patients requesting surgery are in their teens, twenties, and thirties.

• In the Occidental eyelid, the primary goal of surgery is rejuvenation of the aging upper lid. For the most part, the operation is subtractive (that is, removal of stretched, weakened, or poorly positioned skin and fat). Typically, minimal attention is devoted to reshaping the already-present crease.

• In the Asian eyelid, the primary goal of surgery is creation of a new crease or enhancement of an inadequately defined, asymmetrical, or unstable crease. Skin and fat removal are minimal, and, in many cases, no fat is removed at all. Instead, the procedure is focused on the realignment of youthful internal eyelid structure.

• Trying to compare minimal-incision "suture techniques" for crease creation with blepharoplasty becomes even more tenuous. The two operations share no common features.

• If a young Asian patient is approached surgically in a manner similar to that used in an aging Occidental patient, the result can appear unnatural and surgical.