This 31-year-old Asian woman presented with very heavy monolids and eyelid ptosis which made her eyes appear very small. She desired a natural, a very low Asian crease, tapered medially into epicathal folds (infold) to preserve her ethnic eyelids, while opening her “small” eyes. Dr. Amadi discussed that her best option was incision approach double eyelid surgery with external ptosis repair, as she would require fat excision to decrease the “heavy burden” appearance of the eyelids. The patient was very pleased her combined double eyelid surgery with ptosis repair.