ObjectiveThis study aimed to investigate preferences for elective double eyelid surgery and explore the psycho-social underpinnings influencing ocular aesthetics and attitudes towards aesthetic surgery. MethodThis nationwide online experiment was conducted throughout four tiers of cities in China using quota sampling, which included self-administered Likert scales for general self-efficacy and modified body image, and a set of discrete choice experiments (DCE) that measured the relative value and odds ratio of elective double eyelid surgery surgical options and marginal willingness to pay for procedure attributes. ResultsA total of 554 respondents were included in the final analysis (41.9% males, 57.9% females). Totally 47.1% of the respondents perceive double eyelid surgery as acceptable, with surgeon proficiency being the most important attribute (25.88%) followed by healthcare facilities (17.90%), maintenance time of double eyelid (18.62%), and others. Respondents held a Juste-milieu and moderate mind for ocular aesthetics. Those who accepted the surgery had higher ratings on all items of the modified body-image measures than their counterparts, with the sum of the 5-point Likert values being 27.5 (SD 11.2) versus 21.2 (SD 10.0) (P<0.001 for all), whereas there are no differences in the general self-efficacy scale. ConclusionChinese respondents prioritized improving their physical appearance and preferred undergoing aesthetic double eyelid surgery with a skilled surgeon at a higher-tier hospital. Understanding patients' stated preferences, training new surgeons, and improving Chinese medical system facilities are vital and urgent to better balance patient expectations and improve aesthetic surgical satisfaction.