An 83 year-old woman came to see me 5 weeks ago because she was not keen to travel to Kuching for cataract operation as suggested by her private doctor. From the examination, her cataracts were not so dense and the main problem was her excess eyelid skin (dematochalasis) that cover her vision. Her visual acuities were 6/36 but when the eyelids were lifted the vision improved to 6/18. If I were to perform just cataract surgery, the droopy eyelids will still block the vision so I recommended to her and the grand-daughter who accompanied her that the eyelids should first be lifted and only if the vision still bothered her would I perform cataract operation. It must be the way I explained to the grand-daughter that made me received a phone call from the old woman's son asking for clarification. "Doctor do you seriously think that my mum need a double eyelid surgery? She is not concerned about her look you know?" Well, I had to explain at length over the phone that the main purpose of the operation is to remove the excess skin that cover her vision and creation of the double eyelid (skin crease) was not to make her attractive (which is an added bonus if it does at not extra cost) but to create a barrier to prevent the remainin skin from coming down to block the vision. Now I must be more careful about using the term "double eyelid" when counselling the elderly with droopy eyelids as the term appear to be associated with vanity or seduction in the mind of some patients. Anyway, post-operativelythe patient was happy with her vision and her grand-daughter thought she looks younger and less tired (the added bonus without extra cost)!