The Origins of Blepharoplasty
Before U.S. Commodore Matthew Perry breached Japanese borders in 1853, the nation had remained in a 250-year period of isolation under Tokugawa sovereign rule. Prohibiting any exchange of people or ideas between Japan and the outside world, the shogun and samurai ruled Japanese society.
But when Commodore Perry and his colonial fleets arrived, ready to import western values and form commercial ties, Japan quickly absorbed all that western culture had to offer – including western notions of beauty.
In 1896, Japanese physician M. Mikamo was the first to publish a technique for "westerniz[ing] the Asian eyelid." His procedure was instantly extremely popular; according to a 2002 article in the Archives of Facial Plastic Surgery, this was because "Japanese women became enamored of Western beauty and ached to emulate their western counterparts."
Mikamo is said to have "worked squarely within Japanese physical characteristics to achieve his objective without wholesale import of European ideals." In fact, his original work cites that the double eyelid was more common among Japanese people than the epicanthal fold (single eyelid); Mikamo estimated that 80% of the Japanese population had the double eyelid naturally.
As for the aesthetic implications, Mikamo's observations from over 100 years ago are in line with what surgeons and patients seeking the surgery say today: "He contended that the single lid contributed to a 'monotonous and impassive' countenance and ran counter to what 'writers and painters have regarded as an indicator of beauty.'" Also mentioning that single eyelids could result in "narrowed vision," Mikamo apparently regarded the single eyelid as a "true defect."
Adapted from another Japanese surgeon's work, a correction of improper eyelid functioning that resulted in a double eyelid appearance, Mikamo's procedure was distinctly created for aesthetic purposes:
Figure 1. Illustration of Mikamo's procedure in which 3 sutures of 4-0 silk spaced 3 mm apart are placed on the proposed crease set at 6 to 8 mm above the ciliary margin and passed through the palpebral conjunctiva. The sutures were removed 4 to 6 days after surgery.
With no reference to western appearance or standards, Mikamo's conclusion stated that his goal was to create "natural looking" eyes.
Figure 2. Illustration of a woman from Mikamo's original article. She had a natural double eyelid on her left eye (B), and Mikamo successfully operated on the right eyelid to match it. Note that the figure is presented unconventionally here, as in the original, with the preoperative view (B) on the right and the 3-week postoperative view (A) on the left.
Source: Lam, Samuel M.
"Mikamo's Double Eyelid Blepharoplasty and the Westernization of
Japan." Archives of Facial and Plastic Surgery, Vol. 4. July-Sept