A monolid is an upper eyelid with little or no visible crease, so the lid appears as a single smooth surface from lashes to brow. It is a completely normal eyelid shape, especially common in people of East and South-East Asian heritage, and needs no treatment. Some adults choose surgery to create a crease, while others seek help only when the lid becomes heavy or hooded with age.
What creates, or doesn’t create, an eyelid crease
The upper eyelid crease forms where fine fibres from the muscle that lifts the lid (the levator) attach to the skin. When the lid opens, these attachments pull the skin inwards and a fold appears.
In a monolid, those attachments are fewer, lower or absent. There is often a little more fat in front of the lid structures and a fold of skin at the inner corner, called an epicanthal fold. The result is a smooth lid without a defined crease. None of this affects eyesight or eye health.
Monolids, hooded eyes and ageing: not the same thing
- Monolid: a lid shape you are born with, with little or no crease at any age.
- Low or hidden crease: a crease exists but sits low or is partly covered by skin; many people described as having monolids actually have this.
- Hooded eyelid: a crease is present but covered by a fold of skin from the brow area.
- Age-related heaviness: any lid, including a monolid, can gather excess skin over time and begin to feel heavy or restrict vision at the outer edge.
Knowing which of these applies is the first step, because the treatment options differ.
Accepting and enhancing the natural shape
Many people love their monolid eyes and have no wish to change them. Make-up artists use gradient eyeshadow, tightlining and carefully placed eyeliner to add definition without altering the lid. Eyelid tapes and glues create a temporary crease, although frequent use can irritate the skin.
It is worth saying clearly: a monolid is not a flaw. Any decision about surgery should come from a personal preference, made without pressure, rather than a sense that the eye is abnormal.
Surgical crease creation
Upper eyelid surgery to create a crease is often called double eyelid surgery. It is a form of upper blepharoplasty and aims to form a natural fold by attaching the skin to the deeper structures at the chosen height. Depending on the lid, a small amount of skin or fat may also be removed.
The most important decision is the crease height. A low, gently tapered crease usually looks most natural and harmonious with the face; a crease set too high can look surprised or unnatural and may be hard to correct later. Mr Nassab takes time to discuss your preferences and how different crease shapes would suit your features.
Risks specific to crease surgery
Alongside general risks such as bleeding, infection and bruising, crease surgery carries its own considerations. The crease may be uneven between the two eyes, may fade or become shallower over time, or may be higher than expected while swelling persists. Removing too much skin or fat can leave a hollow look, and the scar in the crease can remain visible for some months.
Most of these risks are reduced by conservative planning, careful technique and patience while healing settles, which can take several months.
When a monolid becomes heavy with age
Later in life, excess skin can fold down over the lashes of a monolid, making the eye feel tired or heavy and sometimes narrowing the field of vision. Here the aim of surgery is usually to remove that excess skin while respecting the natural shape of the eye rather than adding a dramatic crease. Some patients prefer to keep a low, subtle crease; others want no crease at all. Both are reasonable approaches that Mr Nassab can discuss at consultation.
Frequently Asked Questions
Is having monolid eyes a medical problem?
No. A monolid is a normal eyelid shape and does not affect vision or eye health.
Can monolids develop a crease naturally?
Some people find a faint crease appears or changes with age, weight change or swelling, but a true monolid usually stays the same.
How long does crease surgery take to settle?
Initial swelling improves over two to three weeks, but the crease can take several months to settle to its final height and softness.
Will crease surgery change who you look like?
The aim is a subtle crease in keeping with your features. A conservative approach helps keep your natural character.
How much does upper eyelid surgery cost?
Upper blepharoplasty is priced from £5,000 under local anaesthetic or from £6,500 under general anaesthetic. The £150 consultation fee is separate.
