Not all double eyelid surgery (Asian blepharoplasty) are done for aesthetic purposes. This 5-year-old boy had a long history of eye irritation and blurred vision. Examination showed ingrowing eyelashes exacerbated by his puffy eyelids and lack of skin creases (double eyelids). I created low skin creases (for boys double eyelids should be made low and girls higher) and everted the eyelashes. The creation of skin creases (double eyelids) not only made the eyes appear bigger but also prevent the upper eyelid skin from coming over the eyes and push the eyelashes inwards. The operation was done under general anaesthesia and the lower pictures were taken 6 months later.