Background <p>Upper eyelid tumors threaten ocular function and facial aesthetics, while traditional reconstruction for large or complex defects often causes complications like ectropion, scarring, and unnatural contours. This study assesses a modified Burow orbicularis oculi myocutaneous flap with double eyelid formation to enhance functional and aesthetic results, especially in Asian patients.</p> Methods <p>In this retrospective study, 32 Asian patients (mean age 60 ± 8.5 years) with upper eyelid margin tumors (20 benign, 12 malignant; defect ≤ 2 cm in length and ≤ 1.5 cm in width) underwent tumor excision and immediate reconstruction using the modified flap technique. Malignancies received wider excision with intraoperative frozen section analysis. The flap, advanced with 1-mm overlap and Burow triangle excision, reconstructed the eyelid margin and created a double eyelid crease. Outcomes included flap survival, eyelid function, aesthetics, satisfaction, and complications over 12 months.</p> Results <p>All 32 patients had negative margins and 100% flap survival. At 1 week, mean residual eyelid gap was 0.27 ± 0.32 mm; full motility returned in 30 patients, with minor restriction in 2. No ectropion, trichiasis, scarring, or flap failure occurred. Aesthetic results showed excellent color, contour, and scar concealment. Patient satisfaction was high (mean 4.8 ± 0.37), with no difference between benign and malignant cases. No recurrences were noted during follow-up.</p> Conclusion <p>The modified Burow orbicularis oculi myocutaneous flap with double eyelid formation provides a reliable, single-stage solution for upper eyelid reconstruction, achieving safe oncologic margins and superior functional and cosmetic results, especially for Asian patients with distinct eyelid anatomy.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a></p>