This operation is often requested by patients of Asian ancestry who lack a supratarsal fold, the naturally occurring crease of the upper eyelid. This occurs because the eye lifting muscle, the levator, has either lost its attachments to the skin or the attachments are lower on the eyelid over the tarsus, the stiff portion of the lower aspect of the upper eyelid, thus not allowing for the naturally occurring crease to occur, or do not have the fold bilaterally; When the fold then is present, this creates two aesthetically pleasing segments to the upper eyelid referred to as the double eyelid. which is considered aesthetically normal. The double eyelid operation uses standard upper eyelid surgery techniques with the addition of re-establishing the levator connection to the upper eyelid skin.