Asian double eyelid surgery, also known as Asian cosmetic blepharoplasty, is an operation designed to create or enhance a crease in the upper eyelid. While there are two main approaches for achieving this goal, there are many variations within each group depending upon a surgeon's experience and skill.

The suture technique, sometimes mislabeled as a non-incisional approach, is an operation first described in the late 1800s and modified countless times since right up to the present day. The operation requires placement of permanent sutures knotted internally to compress the eyelid's anatomy. A crease is always present (static crease) whether the eyes are opened or closed. Because skin is not removed, the technique allows for minimal customization of the double eyelid and is not the most appropriate approach in other than some very young patients. Sooner or later, the buried sutures break or untie. Once internal compression is lost, the crease either weakens, disappears, or is lost in an irregular or spotty fashion on either one side or both.

While still popular in some parts of Japan because of quick execution, short recovery times, and reduced cost, suture techniques are not the favored approach in most Asian or Western countries. Despite modifications said to increase durability, there are too many limitations.

The incisional technique for double eyelid surgery is a more modern approach that incorporates both some advances in non-Asian "European" blepharoplasty with a vastly improved understanding of the normal anatomic mechanism of natural crease formation in the Asian eyelid. In contrast to the static crease created by the suture technique, the new crease forms only when the eyes are opened (dynamic crease). Because skin and sometimes fat and muscle may be removed as indicated, the technique allows for a high level of customization. The crease is permanent because it depends on internal anatomic rearrangement rather than retained suture knots.

Incisional double eyelid surgery is a difficult operation that requires a high level of surgical expertise, experience, and precision; it shares almost nothing in common with older suture techniques. Incisional surgery is not well-suited for the casual eyelid surgeon or in a setting where surgery is performed without an in-depth preoperative analysis and consultation with the surgeon.

A partial incision technique for double eyelid crease surgery spanning only the middle third of the lid has been said to incorporate the best features of each of the two basic methods described previously. Unfortunately, some Asian cosmetic surgeons have experienced just the opposite: the hybrid technique combines the least desirable features and limitations of both, most notably inadequate skin removal, uneven or excessive fat removal, compromised structural rearrangement, minimal customization options, retained sutures, and impermanence.

While serious complications such as infection and vision loss are rare, all double eyelid surgery procedures, can, as is true for any type of facial plastic surgery, create aesthetic issues such as an unnatural appearance, too high a crease, ethnic imbalance, or "Westernization."