While approximately half of all Asian people are born with an upper eyelid crease, that crease is different from an Occidental crease in important ways, most notably in height, shape, and depth. Some natural Asian creases are almost rudimentary and may be highly variable in their expression day to day.
Of those born without a crease or with a very low or weak crease who later seek double eyelid surgery, very few are trying to look Western. Rather, the vast majority desire the creation of a defined and stable platform of skin above the lashes that is harmonious with their other facial features and consistent with that occurring naturally in the Asian population. Some patients want only a "thinning" of excess skin or fat from fuller eyelids.
Interesting, the first medical description of an operation designed to establish a crease in the Asian single eyelid was published in Japan in the late 1800s, long before the intense intermingling of Eastern and Western cultures. Although the popularity of double eyelid surgery has grown rapidly in the last fifty years, the presence of a defined eyelid crease has long been valued because it is seen by many as allowing for a more accurate and intense expression of emotion.
While the ethical "baggage" associated with undergoing cosmetic eye plastic surgery has all but disappeared from contemporary thought, a few people still insist on investing the topic of Asian blepharoplasty with overtones of cultural rejection. Critics expressing such sentiments are far too narrowly focused, but so also are those who categorically reject the obvious influence of one culture upon another in today's highly interconnected world.
Electing to undergo any type of cosmetic surgery is an intensely personal decision, and each individual's motivations are different, multiple, and complex. For whatever reasons, double eyelid surgery has become the most requested cosmetic operation among those of Asian descent in both the United States and the Orient.
• "Asian" and "Occidental" defined
