It wasn’t until middle school that Eliza Houa Vang, a 23-year-old Hmong-American from Sacramento, California, became aware of her monolids.

Before leaving for school, Vang picked up her older sister’s black pencil eyeliner. She had watched her sister apply it a thousand times before, drawing a thin black line across her upper lash line. Today, Vang decided she’d try out the liner for herself. She slowly dragged the pencil across her closed left eyelid, but when she opened her eyes, the line disappeared. Frustrated, she began to thicken the line. Each time she opened her eyes, her eyelid seemed to swallow up the pigment altogether. After painting her entire eyelid with the liner, Vang finally saw the thin line she had hoped for— just like her sister’s.

From that day on, Vang religiously applied eyeliner everyday before school. Each day the line got thicker, and Vang thought her eyes looked better. But like most teenagers, as she entered high school, Vang became even more dissatisfied with her facial features, specifically her monolids.

“I started to question myself a lot after a while,” Vang recalls of her exhausting makeup routine. “Why wasn’t I born with a defined crease or double eyelids? Even my older siblings all had a small fold on their eyes, but why not me?”

Approximately 50 percent of East and Southeast Asian women are born with a minimal or absent supratarsal eyelid crease (“double eyelid”) like Vang. Monolids refer to the absence of this eyelid crease.

Katie Lemons, a Chinese 28-year-old raised in North Carolina, also confronted her monolids for the first time in middle school. After waking up one morning, Lemons looked in the mirror to discover one of her eyes looked a little different than it did when she went to sleep. Her mother immediately took notice of the new double eyelid that had temporarily transformed her left eye. She excitedly assured Lemons that “if [she] kept her eyes open very big, the double eyelid might stick around.”

“I thought it was strange that my own mother was making me self-conscious and unhappy about my appearance,” Lemons says of her mother’s advice, and her later suggestion about considering surgery to create a permanent double lid. Nevertheless, Lemons and Vang both deemed the permanence of surgery as too much of a risk to even consider it as a viable option.

For what many would deem a superficial procedure, Blepharoplasty, or eyelid surgery is the most common cosmetic request in Asia, and the third most common cosmetic procedure worldwide (after breast augmentation and liposuction). The procedure commonly referred to among Asian populations as “double-eyelid surgery” first gained popularity in South Korea and Japan before spreading west. As the number of cosmetic procedures continues to rise in the US, eyelid surgery is the surgical procedure seeing the most growth in 2017—up 26.3 percent, according to the American Society for Aesthetic Plastic Surgery.

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In 2013, Frankie*, a 27-year-old European transplant from China, who prefers not to use her actual name since her job requires a certain level of anonymity, decided she was done scrutinizing her appearance and fiddling around with makeup techniques that claimed to be catered to those with monolids like her. She wanted the surgery. “Monolid tutorials are still dominated by exaggerated looks with graphic liner or smoky eyes,” Frankie says about her frustration with how her lids folded; hiding the makeup she would spend hours applying.

“I’ve especially noticed how Asian characters in American television shows always sport purple smoky eyes even when other female characters barely wear eye makeup. I simply wanted to do normal everyday eye looks at ease like everyone else,” she says. She spent the next two years wearing eyelid tape to mimic the effects of a double lid.

Whether or not surgery is an option, many women with monolids choose to play around with temporary alternatives such as tape, glue, or fibers specifically designed to create the illusion of a double lid. As the eyelid sticks to the adhesive, these products create a new crease. After watching YouTube videos on alternative options, Vang purchased her first strip of eyelid tape online. Picking up the small linear tape with tweezers, she delicately placed it exactly where she had always dreamed a crease would be.

“But I started to realize something—I didn’t look like me,” Vang says. “I went back to applying my thick eyeliner, but I was happier this time around because at least these were my eyes and I was comfortable.” While Vang still occasionally uses eyelid tape to accessorize certain makeup looks, she boasts about the makeup skills that only her monolids could have helped her discover. “I’m quite proud of my eyeliner skills, if I say so myself,” she says.

For Lemons, it took the birth of her son for her to realize the appreciation she truly had for her unique eyes. “When I became pregnant with my son, everyone was curious about what he would look like, whether he would resemble me or his Caucasian father more,” Lemons recalls. “When my son was first born, he looked very Asian, mostly because of his eyes. As he’s gotten older, he started looking more like a mixture of white and Asian, but his eyes are still very much mine.”

Eventually, Frankie also came to love her eyes—after her surgery. Following months of research and recommendations, she checked in to the cosmetic surgery department of a reputable public hospital to undergo the minimally invasive surgery. She was out the door within 15 minutes. Four new holes on her eyelids and a small amount of extracted fat later, she finally had double lids.

“Having the surgery is the best thing I’ve ever done for myself,” she says. “I finally look like someone that I perceived myself to look like, as if I was born to have these round almond eyes.” But does opting for reconstructive surgery mean you don’t love or appreciate your heritage? Does a preference for double lids mean you’re victim to eurocentric standards of beauty?

These are the questions many Asian blepharoplasty patients like Frankie face when discussing their surgeries with others. But it’s not as simple as that. “There’s a misconception about what this procedure is. It’s not a westernization procedure,” says Brett Kotlus, a cosmetic oculoplastic surgeon who performs at least 25 double eyelid surgeries per year.

Nearly half of East and Southeast Asians are actually born with double eyelids, so wanting them doesn’t exactly equal whitewashing your appearance. (The first published description of this type of procedure was in the late 1800s, long before a strong Western presence in Asia.)

Before Frankie flew to China for her surgery, she told a few of her white friends about her decision. Her friends immediately warned against the procedure and wondered why she “would want to harm [herself] to look ‘more white.’” “I had to explain to them that double eyelids are a normal genetic trait that many Chinese are born to have,” she says.

A large percentage of double eyelid surgery recipients simply want the look of a crease to make the eyes appear more open, Kotlus says. “The motivation behind most people wanting to do this is wanting to look like an Asian that has a double eyelid, not to look like a different race or ethnicity,” Kotlus adds. “It’s just an illusion because the eyes aren’t more open; they are just framed in a way that makes them look more open.”

Even though some might see her decision to alter her appearance as controversial, Frankie is unapologetic. “The eyes I have now," she says, "are all mine, just slightly modified.”