A double eyelid is one that is divided into an upper and lower portion by a defined crease. Roughly half of Asians are born with an eyelid crease, and the remaining are not. Eyelid surgery in patients of Asian and of Western descent (a/k/a Occidental) are extremely different in terms of goals, technique and procedure. The aim of eyelid surgery for Occidental patients is to restore what once looked fresh and young, usually accomplished by removing extra skin, stretched skin, and fat that is not in the optimal position as well as lifting sagging eyelid tissue. Additionally, eyelid surgery for Occidentals is performed on older patients anywhere from the 40’s and older. The aim of Asian patients seeking double eyelid surgery is not an anti-aging blepharoplasty procedure, but creation of an eyelid crease or enhancing a poorly defined crease, and symmetrical alignment of the eyelid structure. Unlike Occidental patients, many young Asians in their teens and early 20’s seek double eyelid surgery. Each patient’s desire for cosmetic surgery is very personal and the motivation is unique. Despite many people’s beliefs, double eyelid surgery is not sought after so that the patient can look more “Western.” Most patients revere their unique features and beauty. Some patients desire double eyelid surgery because they seek to have more expressive eyes or for their eyes to look bigger. For women, having a crease in the upper eyelid allows for more creative and dramatic application of eye-makeup. It is important to note that double eyelid surgery is challenging and technical in nature, and the patient should seek a cosmetic surgeon with significant experience performing this procedure such as Houston cosmetic surgeon Anthony Nikko, M.D.