Although Asian double eyelid surgery is the most common cosmetic operation in the world, rates of aesthetic dissatisfaction and functional complications are surprisingly high. In several East Asian studies, for instance, the incidence of disappointing asymmetry has been reported to range from between 13 and 35 percent.

Typical problems encountered by the revision surgeon include:

Less severe:

• crease that is too low
• objectionable crease asymmetry
• incomplete or broken crease
• bad skin scarring
• loss or weakening of the crease over time

More severe:

• crease that is too high, deep, or arched
• multiple or accordion like mini-creases
• inability to fully open the eye (ptosis)
• inability to fully close the eye
• hollowness from excessive fat removal

Multiple mini-creases and ptosis in hollowed lids after Asian eyelid surgery

Successful Asian eyelid revision surgery requires a highly customized approach. While a number of procedures are available for treating less severe problems, most standard operations provide disappointing results in the more severe group due in large part to their failure to reestablish natural fat relationships between the eyelid and the deeper orbit.

Once delicate tissues around the eye have been scarred or removed, efforts to restore are challenging and not always successful. Patients who treat first-time double eyelid surgery as a "commodity" and chase only the lowest price are often shocked to learn how difficult, stressful, and expensive it can be to improve on poor results.