Monolids, hidden double eyelids

What is the difference between single eyelids and hidden double eyelids?

A double eyelid crease is formed when fibrous attachments connect the levator muscle to the overlying upper eyelid skin; when the eyes open, this muscle pulls the skin inward to create a fold. In single eyelids (monolids), these attachments are either absent or very weak, leaving the eyelid skin smooth and flat. In hidden double eyelids, a crease is present, but it sits low or is hooded by excess skin and fat from above when the eyes are open, making the fold visible only when closing the eyes or looking down. Many single eyelids are also accompanied by thick eyelid fat, making the lids appear heavy and the eyes smaller than they actually are.

Why is this distinction important before choosing a procedure?

Non-surgical double eyelid creation (suture blepharoplasty) creates a crease by anchoring the skin to the levator muscle using a few sutures; it does not remove excess skin or fat. Therefore, for hidden double eyelids caused by excess skin and thick fat, suture blepharoplasty often yields an indistinct fold or loosens over time as the overlying skin continues to press down on the crease. Conversely, for young individuals with thin skin and minimal fat, a full incisional blepharoplasty would be a more invasive intervention than necessary.

What determines an aesthetic and long-lasting eyelid crease?

The amount of excess skin, the thickness of upper eyelid fat, the strength of the levator muscle, the distance from the eyelid margin to the eyebrow, and bilateral symmetry. The doctor also evaluates whether there is mild concomitant ptosis (drooping eyelids) — if present, creating a crease without correcting the levator muscle will make the eyes appear tired and sad.

Realistic expectations

The goal is to achieve an eyelid crease that harmonizes with your eye shape and facial features, maintains bilateral balance, and allows for easier eye-opening — rather than creating an overly wide crease like a photo model. Creases created via suture blepharoplasty may gradually fade over the years in individuals with thicker fat; creases from incisional blepharoplasty are more permanent, but they leave a scar hidden within the fold and require a longer recovery period.

How does BonBoz approach single and hidden double eyelids?

A plastic surgery specialist directly conducts your consultation: measuring excess skin, assessing fat thickness through palpation, checking levator muscle function, and simulating the crease position with a specialized probe so you can preview the result. Based on these findings, the doctor recommends suture blepharoplasty (for minimal excess skin and fat) or a mini/full incisional blepharoplasty (for excess skin, thick fat, and hooded eyelids). The examining doctor is the one who performs the procedure; the incision technique, recovery timeline, and potential risks are thoroughly explained in advance.