There are three main ways to create a double eyelid crease: temporary adhesive products, suture-based surgery, and incisional surgery. Which option makes sense depends on your eyelid anatomy, how permanent you want the result to be, and what you’re willing to spend. Each approach works differently and comes with distinct trade-offs worth understanding before you commit.
Why Some Eyelids Have a Crease and Others Don’t
The difference between a double eyelid and a monolid comes down to how the muscle that opens your eye connects to the skin. In a double eyelid, tiny fibers from the levator muscle (the muscle that lifts your upper lid) extend through the tissue and attach to the skin’s surface. When the muscle contracts to open your eye, it pulls the skin inward at the attachment point, creating a visible fold.
In a monolid, those connecting fibers are either absent or too weak to anchor the skin. Instead of folding inward, the skin simply slides over the rising eyelid like a curtain. Several factors contribute to this: the connective tissue may fuse at a different position, a thicker fat pad may block the fibers from reaching the skin, or the skin and muscle layers may be too thick for the pulling force to create a crease. Most people with monolids have some combination of these factors rather than a single cause, which is why creating a natural-looking crease requires addressing the specific anatomy of your eyelids.
Temporary Methods: Tape and Glue
Double eyelid tape and eyelid glue are the most accessible options. Both work by physically holding the skin in a folded position. Tape uses a thin adhesive strip placed along the eyelid to create a mechanical crease, while glue bonds two surfaces of skin together to form the fold. Neither changes your anatomy. The crease disappears when you remove the product.
These products are inexpensive and widely available, but daily use carries real downsides. A 2024 study on long-term double eyelid tape users found that 70% experienced discomfort, and prolonged use led to measurable eyelid laxity, meaning the skin stretched and lost its firmness over time. Tape users also showed structural changes in skin collagen and higher rates of complications like asymmetry and numbness compared to non-users. Perhaps most importantly, years of tape use can actually make future surgery more complicated, since the surgeon has to work with stretched, structurally altered skin.
If you use tape or glue occasionally for a specific event, the risks are minimal. But treating them as a long-term daily solution can create problems that are harder to fix later.
Suture-Based (Non-Incisional) Surgery
Suture-based double eyelid surgery creates a crease without a full incision. The surgeon makes a few tiny puncture holes along the eyelid and threads a fine suture through the skin, muscle, and the tissue lining the inside of the lid. When tied and buried beneath the surface, the suture mimics the natural fiber connection that creates a crease in double eyelids. The whole procedure typically takes under an hour.
The appeal is a faster recovery and no visible scar. Swelling is generally milder than with incisional surgery, and most people return to normal activities within a week or two. The trade-off is durability. Sutures can loosen over time, and some patients find the crease gradually weakens or becomes uneven on one side. This method works best if you have thin eyelid skin, minimal fat in the upper lid, and no significant skin drooping. If your eyelids are puffy or have excess skin, sutures alone usually can’t create a stable, lasting crease.
Incisional Surgery
Incisional double eyelid surgery is the most permanent option. The surgeon makes a cut along the planned crease line, removes excess skin and fat as needed, and creates a direct connection between the deeper lid structures and the skin. This replicates the anatomy of a naturally occurring double eyelid rather than relying on a suture to hold things in place.
Because the surgeon can remove tissue and reshape the lid’s internal structure, this approach works for a wider range of eyelid types, including lids with thicker skin, more fat, or mild drooping. The results are more predictable and longer-lasting than the suture method. The downside is a longer recovery and a fine scar along the crease line, though eyelid skin heals exceptionally well compared to skin elsewhere on the body. Over several months, the scar typically fades into the crease itself and becomes difficult to see.
How Crease Height Is Decided
One of the most important decisions in double eyelid surgery is where to place the crease. Height is measured in millimeters from the eyelash line to the fold, with the eyes looking downward so the lid is relaxed. For people of East Asian descent, the most common natural tarsal plate height (the firm tissue that gives the eyelid its shape) is around 7 mm, and surgeons often use this as a reference point when planning crease placement.
A crease set too high can look unnatural or cause the lid to feel heavy. One set too low may be barely visible. The ideal height depends on your individual anatomy, including how much skin you have, the position of your brow, and whether you have any asymmetry between your two eyes. Good surgical planning involves careful measurement and a conversation about the look you’re going for, whether that’s a subtle crease close to the lash line or a more defined fold.
Recovery Timeline
Swelling peaks during the first three to five days and is the most dramatic part of recovery. Your eyelids will look significantly more swollen than the final result, which can be alarming but is completely expected. Sutures are typically removed between days five and seven.
By the second week, swelling drops noticeably and most people feel comfortable returning to light daily activities. Over weeks three and four, the incision lines progressively fade. The crease will still look higher and more defined than the final result during this period because residual swelling props the fold up.
True final results emerge around months two to three. By then, minimal swelling remains (usually only noticeable to you), and incision lines continue blending into the natural crease. Some subtle settling can continue for up to six months. If you’re evaluating whether you’re happy with the outcome, give it at least three months before drawing conclusions.
Risks and Revision Rates
The most common issue patients notice after surgery is crease asymmetry, where one eyelid’s fold sits slightly higher or deeper than the other. This can result from differences in healing between the two sides, slight anatomical variation, or the crease being marked at a marginally different height during surgery. Minor asymmetry often improves as swelling resolves, but noticeable differences may require a revision.
Other possible complications include excessive bruising (which can lead to prolonged recovery and temporary skin discoloration), visible scarring if the wound doesn’t heal cleanly, and dry eye symptoms in the early healing period. Serious complications like infection or vision problems are rare.
Revision rates vary depending on the complexity of the procedure. In one study of upper blepharoplasty patients, about 7% of eyelids needed a revision for excess skin issues, and 15% of eyelids that also had a drooping-lid repair needed a second procedure to correct the lid’s contour. These numbers reflect combined procedures rather than straightforward crease creation alone, but they illustrate that touch-ups are not uncommon in eyelid surgery.
Cost
In the United States, the average surgeon’s fee for upper eyelid surgery is $3,359, according to the American Society of Plastic Surgeons. That figure covers only the surgeon’s time. When you add anesthesia, facility fees, medications, and any pre-operative tests, the total typically runs higher. Geographic location matters significantly: surgeons in major metropolitan areas and those with specialized experience in Asian blepharoplasty often charge more.
South Korea, where double eyelid surgery is one of the most commonly performed cosmetic procedures, generally offers lower pricing, with many clinics advertising packages that include all associated fees. If you’re considering traveling for surgery, factor in the cost of follow-up visits and the logistics of managing any complications from a distance.
Exercises and Massage
You’ll find videos and guides online claiming that specific eye exercises, lid massage, or repeated use of a blunt tool to press a crease into the skin can permanently create a double eyelid. There is no scientific evidence supporting any of these methods. The crease is determined by internal anatomical structures, specifically how muscle fibers connect to skin through layers of fat and connective tissue. No external pressure or muscle movement can replicate or create those connections. At best, pressing a temporary indent into the skin mimics the look for a few minutes. At worst, aggressive or repeated manipulation can irritate the delicate eyelid skin.