A basic cosmetic surgery has become so popular that one part of the world calls it routine. But most Americans have never heard its name.

Asian blepharoplasty, or fold creation, is the process by which a crease is surgically created in the eyelid. Today, the surgery is common among Asian girls between the ages of 16 and 25. This trend is raising questions about cultural and personal perceptions of beauty.

Edmund Kwan, a medical director and plastic surgeon in Manhattan, N.Y., said Asian people tend to have a thicker upper eyelid, shallower bone structure surrounding the eye and a lack of muscle extension into the eyelid.

During surgery, which lasts about 45 minutes, the doctor removes some of the extra tissue of the upper eyelid, advances the levator muscle and stitches it to the skin where the fold is desired, about 7 to 8 millimeters from the eyelashes. The extra skin that forms from opening the eye will gather and fall into place to form the crease. Blepharoplasty was one of the top five surgical procedures done in the United States in 2011, with 196,286 patients receiving the surgery, according to the American Society of Plastic Surgeons.

Olivia*, a sophomore at Ithaca College, said her eyes used to be so small it was difficult to apply makeup.

Olivia had the surgery during winter break when she went home to Kunming, China. The doctors and nurses encouraged her to have her nose done at the same time, but she did not want to change her face drastically. The small light red scars are barely visible above her eyelids, buried in the new creases. She said her eyes should be totally healed with no marks left in a few months.

“It’s just such a small surgery,” Olivia said. “You know how people here have braces? That’s how common it is.”

The surgery gave her more confidence and saved her time in her daily routine. Olivia said standards surrounding beauty are more trivial in China. She noticed this the most her first time home after going to school in the United States.

“I realized the standard of beauty is totally different,” she said, “I feel like it is a lot more work back home to be considered pretty.”

Karen*, a sophomore who is an American of Chinese descent, had the surgery about two years ago.

I’m still me. I’m just a little bit happier. Every time I look in the mirror I feel a little more confident about myself. – Olivia*

“It’s really hard for people to understand when I tell them this because it sounds really silly, but you don’t understand it unless you go through it,” Karen said. “When you don’t have eyelids, you can’t wear makeup.”

Kwan was Karen’s plastic surgeon. Karen, like Olivia, opted for the most natural-looking crease possible. Karen said she disagrees with the idea Asians receive the eyelid crease surgery to look Caucasian. This assumption is a false generalization, Kwan said.

“It was to enhance my beauty,” Karen said. “It wasn’t to look like someone else or to look less Asian. I love looking Asian. I know getting cosmetic surgery wouldn’t change that at all.”

Kwan said the assumption that blepharoplasty is done in pursuit of Western beauty is a common misconception. While the trend of bigger eyes may have been affected by the influx of Western culture portrayed in Asian media, most people who receive the surgery want to look more attractive, not necessarily Caucasian. Olivia and Karen agree. Both said they did not seek to alter their Asian identity by having the surgery.

“I’m still me,” Olivia said. “I’m just a little bit happier. Every time I look in the mirror I feel a little more confident about myself.”

Olivia said the change in her eyes was so subtle that many of her friends and even some extended family did not notice. Her parents and her Asian friends loved the result and complimented her, she said. Karen told only family and one friend she was going to have the surgery.

“My Caucasian friends didn’t notice, but all my Asian friends were like, ‘Oh my God, your eyes look so great,’” Karen said. “And my family thought it was really great too.”

Freshman Esther Kim, an American of Korean descent, considered the surgery once in the past, but changed her mind as she grew older. Kim experimented with eyelid tape, a double-sided tape used to create false double eyelids.

“In eighth grade a bunch of my friends were into the double eyelids so I actually tried the tape because I wasn’t going to go under the knife and make it permanent,” Kim said. “I just wanted to see what it was like and when I had it on I definitely felt a little bit more confident.”

Kim said she changed her mind because she realized the perception of beauty that was being projected to her came from the media. Kim said she came to the conclusion that she would rather not alter her physical appearance based on what she saw on TV.

“I kind of felt like I was being manipulated,” Kim said. “I’m more comfortable with my eyes the way they are now.”

Kim visited extended family in South Korea a couple of times and noticed how prevalent plastic surgery is there. In the capital, Seoul, Kim said it is easy to find a plastic surgery clinic on some blocks. She understands the cultural pressures and expectations in Asia, but feels confident in the way she looks. As for Asian people who have had blepharoplasty, Kim said she thinks of it like she would any other surgery.

“I feel like they could’ve gone without it,” Kim said. “You were fine the way you were, but if you’re happier now, then so be it.”

While it may be difficult for some Americans to conceptualize, Kim said, plastic surgery in some Asian countries is the norm right now.

“Kids here want cars, kids over there want plastic surgery,” Kim said. “It’s a very different culture.”

*Students’ names have been changed to protect their identities.