Double eyelid surgery is popular worldwide, especially in East Asia. Although double eyelid surgery seems simple, it comes with numerous complications. These complications can be divided into disordered complications and esthetic complications. Plastic surgeons pay more attention to the esthetic aspect. In our long-term clinical work, we have repeatedly observed that many patients with overactive facial muscles (frontalis muscle or corrugator supercilii muscle) often develop esthetic complications after surgery. These patients present with an appearance of a double eyelid fold that is either too high, too low, or absent. However, some plastic surgeons have not realized this, and most of them believe that esthetic complications are caused by improper techniques during surgery. Therefore, it is necessary for us to share our experience in this field with our peers.