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العربيةThe most important thing in double eyelid surgery:
deciding the surgical method
- Natural look
- Minimal loosening of the fold
- Satisfaction after surgery
- Achieving a defined eye shape
Eye Surgery
Double Eyelid Surgery (Suture and Incisional Methods)
The most important thing in double eyelid surgery is deciding on the surgical method
Double eyelid surgery creates a fold in the upper eyelid, and there are two methods: the suture method, which ties with thread, and the incisional method, which creates it with an incision.
- Method
- Suture method, incisional method
- Stitch removal
- Incisional method, day 7 (the suture method usually has no stitches to remove)
- Deciding on revision
- After at least 6 months have passed since the first operation
Table of contents for this page
- What is double eyelid surgery?
- How do the suture and incisional methods differ?
- For middle age, which is right: double eyelid surgery or upper blepharoplasty?
- How is double eyelid surgery performed?
- What kind of anesthesia is used for double eyelid surgery?
- How long does recovery from double eyelid surgery take?
- What are the side effects of double eyelid surgery?
- If the double eyelid loosens or I am not satisfied, can it be redone?
- Are there cases where double eyelid surgery should not be done or should be postponed?
- Face Plus Talk
- Frequently Asked Questions
- Related FacePlus TV Videos
- Related surgeries and procedures worth looking at together
- References
If you are looking into double eyelid surgery, we will show you the basic information at a glance first.
The criteria for choosing surgery according to eye shape and drooping are summarized in Causes of eyelid drooping and criteria for choosing surgery.
01
What is double eyelid surgery?
It is surgery that connects the skin to the tissue on the side of the eye-opening muscle so that the upper eyelid skin folds along a set line when the eye opens.
In a word, it is surgery that creates the place where the eyelid folds when the eye opens.
In eyes with a double eyelid, the eyelid skin folds inward along a single line when the eye opens. In eyes without a double eyelid, this folding place is absent or weak, so the skin comes down straight toward the eyelashes.
Double eyelid surgery creates this folding place. In medical terms, it is called double eyelid creation or Asian blepharoplasty.
Here is a more detailed explanation of why some eyes fold and others do not.
Mechanism
The supratarsal crease (the eyelid fold line) is described as forming where fibers of the aponeurosis (the broad tendon sheet at the end of the muscle) of the levator palpebrae superioris (the muscle that opens the eye) extend toward the skin near the upper edge of the tarsus[1][2]. In a study that dissected cadaver eyelids from Koreans and Westerners, in Asian eyelids without a double eyelid, the orbital septum (the membrane that encloses eyelid fat) joined the aponeurosis below the upper edge of the tarsus (the firm plate inside the eyelid). The fat in front of the septum extended down in front of the tarsus and the subcutaneous fat layer was also thick, so it was difficult for the aponeurosis fibers to extend toward the skin[1]. Double eyelid surgery creates a new fold line by attaching the skin to the aponeurosis or tarsus at a suitable height[3].
In plain terms — the double eyelid folds at the point where the muscle that opens the eye pulls the skin up with it. In an eye without a double eyelid, that connection is weak, and fat fills the space in between. Surgery creates this connection anew at a suitable height.
A Word from the Doctor
"What matters is getting the best possible result that suits your face as it is now and the condition of your eyes. Making them look exactly like a photo that simply looks pretty is neither possible nor good."
Double eyelid surgery is the most commonly performed of all plastic surgeries. Most cases are for cosmetic purposes, but double eyelid surgery, ptosis correction surgery, and similar procedures are also considered when opening the eyes is very difficult or forehead wrinkles are severe.
Face PlusBuried suture, incisional, in-line, out-line — considering double eyelid surgery?
A skilled plastic surgery specialist creates a result you can be satisfied with through an ideal design and delicate surgery. At Face Plus, double eyelid eye surgery is carried out more carefully and more effectively.
To decide the specific double eyelid surgery method, four points must be diagnosed carefully: whether the eyelid has a lot of flesh, whether the eyelid skin sags a lot, whether the eye-opening strength is adequate, and whether the epicanthal (Mongolian) fold is pronounced. Under the same or similar conditions, keeping surgery to a minimum where possible may lead to greater satisfaction after surgery.
Face PlusFace Plus Double Eyelid Eye Surgery: More Careful, More Effective
The most important thing in double eyelid surgery:
Face PlusPoints to consider when deciding on a double eyelid surgery method
To decide the specific double eyelid surgery method, the following four points must be diagnosed carefully. Under the same or similar conditions, keeping surgery to a minimum where possible may lead to greater satisfaction after surgery.
- 01Whether the eyelid has a lot of flesh
- 02Whether the eyelid skin sags a lot
- 03Whether the eye-opening strength is adequate
- 04Whether the epicanthal fold is pronounced
02
How do the buried suture method and the incisional method differ?
The buried suture method creates the line with thread without an incision, while the incisional method makes an incision along the line, trims excess skin and fat, and secures the line.
Since it can be hard to decide which to choose, we have set them side by side in a table.
| Type | Buried suture method | Incisional method |
|---|---|---|
| Method | Thread is passed through a few tiny needle holes to tie together the skin and the tissue on the inner side of the eyelid | The skin is incised along the desired line, excess skin, muscle, and fat are trimmed if needed, and then the line is secured |
| Whether skin is cut away | None is cut away | Skin is cut away as needed |
| Scar | Hardly any needle-hole marks remain | A thin scar remains along the double eyelid line. It lies on the inner side of the crease that forms when you open your eyes |
| Swelling | Tends to be less | More severe[4] |
| Loosening | As the thread loosens over time, the line may fade or come undone | Loosening tends to be less common than with the buried suture method, but it can occur[2][4] |
A Word from the Doctor
"…It is not that it never comes undone. Even with the incisional method, there is definitely a chance that the double eyelid will come undone."
Which method is suitable is decided by examining the amount of sagging skin and fat and the height of the desired line.
03
For middle-aged patients, which is more suitable: double eyelid surgery or upper blepharoplasty?
If the problem is sagging skin covering the double eyelid, upper blepharoplasty is considered first; if the problem is that the line is absent or weak to begin with, double eyelid surgery is considered first.
If you feel that your eyes look different in the mirror than before, you first need to sort out what has changed.
With age, the upper eyelid skin stretches and may cover the double eyelid you originally had. In this case, trimming the excess skin comes before creating a new line. This surgery is explained in Upper Blepharoplasty information.
There are also cases where the eye-opening strength is weak and the eyelid covers the pupil (blepharoptosis). In this case, creating a line alone leaves the problem of eyes that do not open fully. Surgery that corrects eye-opening strength together with double eyelid surgery is explained in Ptosis Correction (Blepharoptosis Correction) information.
Sometimes all three are present together. An examination sorts out which is the main cause.
Face PlusDouble Eyelid Surgery: Recommended in These Cases
- When you want defined, natural-looking eyes
- When your eyes are uneven or small
- When your eyes look sleepy and droopy
- When fat removal is needed along with eye surgery
- When you want eye surgery with quick recovery
04
How is double eyelid surgery performed?
The height and shape of the line are decided and marked while you sit upright; after anesthesia, the line is created with the buried suture or incisional method.
Since it may feel vague the first time, we have laid it out step by step.
| Step | Buried suture method | Incisional method |
|---|---|---|
| 1. Design | The height and shape of the line are decided and marked while you open and close your eyes | The same. The width of skin to be cut away is also decided |
| 2. Anesthesia | ||
| 3. Creating the line | Thread is passed through tiny needle holes and tied, and the knots are buried under the skin | An incision is made along the line and excess tissue is trimmed, then the skin is secured to the aponeurosis or tarsus |
| 4. Checking | You are asked to open your eyes, and we check the height of the line and the left-right balance | The same |
| 5. Finishing | The needle holes are usually not stitched | The skin is stitched with fine thread |
05
What kind of anesthesia is used for double eyelid surgery?
Anesthesia methods for double eyelid surgery at our clinic:
If you are worried about anesthesia, please feel free to ask at the consultation.
06
How long does recovery take after double eyelid surgery?
The incisional method causes more swelling than the buried suture method, and it takes several months for the swelling to go down and the line to settle[4][2].
If you have work or an important appointment coming up, this is probably what you most want to know. We have written it by time point.
| Time point | Status |
|---|---|
| Day of surgery to a few days | Swelling and bruising may occur. They are more severe with the incisional method[4] |
| Around day 7 | With the incisional method, the stitches are removed |
| 1–3 months | After incisional double eyelid surgery, dry eye symptoms were most common at around 1 month, and most had recovered by 3 months[5] |
| Several months | Swelling can linger, and the two sides may look different[2] |
At first the line looks higher and thicker than you want. This is because of swelling. As the swelling goes down, the line gradually becomes lower and thinner.
| Activity | Time point |
|---|---|
| Washing your face | |
| Going to work | |
| Eye makeup | |
| Contact lenses |
The speed of recovery differs from person to person. If you have an important event coming up, please tell us in advance at the consultation.
Precautions after surgery
We will start by explaining why you should rest for a few days after surgery.
Factors reported as common among patients who developed bleeding behind the eye (in the orbit) after eyelid surgery included high blood pressure, taking aspirin before and after surgery, vomiting after surgery, and increased activity[6]. For this reason, avoid strenuous activity for the first few days after surgery.
Cold compresses, sleeping position, when to resume exercise, drinking, and saunas, and prescribed medication:
07
What side effects can double eyelid surgery have?
Left-right asymmetry, a line that loosens or fades, a line that is too high, scarring, dry eye, and irritation of the eye surface by thread can occur, and, rarely, there is bleeding that threatens vision.
This is information you must know before deciding on surgery, so we have written it out in full without shortening it.
- Left-right asymmetry (the height or shape of the line differs between the two sides). It is summarized as the most common complication in reviews[2]
- Loosening (the line fades or disappears). It is more common with the buried suture method[2][4]
- Overcorrection (the line looks too high or too thick)
- The line is lower than desired
- The line folds into multiple layers
- The scar becomes thick, or the areas above and below the line look sunken (incisional method)
- Thread knots show through, or a pulling sensation continues[7]
- The thread of the buried suture method is exposed on the inner side of the eyelid and irritates the black part of the eye (foreign-body sensation, stinging; rarely, the cornea is injured)[7][8]
- The eyelid feels as though it does not open as well (when tissue near the eye-opening muscle is affected)
- The eye does not close fully, or feels dry
- Hematoma (a collection of pooled blood), infection
- Rarely, reduced vision caused by bleeding behind the eye
The values summarized in a review that pooled several studies are below[2]. Because methods and subjects differ from study to study, they are given as ranges.
| Item | Values summarized in the review |
|---|---|
| Left-right asymmetry | Up to 35% |
| Line too high | 6~7% |
| Loosening | 0~3% |
Side Effects
A review (a paper that compiles and explains multiple publications) that organized the complications of eyelid plastic surgery by time period listed, within 1 week after surgery, corneal abrasion (scratching of the surface of the black part of the eye) and retrobulbar hemorrhage (blood collecting behind the eye), which can threaten vision; at 1–6 weeks, malposition of the upper and lower eyelids, strabismus (misalignment of the two eyes), corneal exposure (the eye not closing fully so that the surface of the black part is exposed), and epiphora (tearing); and, after 6 weeks, problems with eyelid height and contour, left-right differences, scarring, and prolonged swelling[9]. This review covers upper and lower eyelid surgery together and is not data on double eyelid surgery alone.
In simple terms — The problems we watch for differ depending on the time period.
- Right after surgery: scratching of the eye surface or blood collecting behind the eye may occur. Blood collecting behind the eye can threaten vision.
- After a few weeks: problems with eyelid height, left-right differences, and scarring may become apparent.
How often did patients need repeat surgery in the study?
In one study, about 11 of every 100 patients had additional surgery.
Do not wait in these cases
Bleeding behind the eye is reported to occur most often within 24 hours after surgery, especially within the first few hours, and in some cases several days later[6].
If something feels wrong after surgery, do not put up with it on your own.
Symptoms to have checked promptly
- When vision becomes blurred or you cannot see well
- When the eye or the area around the eye hurts unbearably
- When one eye suddenly swells firmly or feels as if it is bulging forward
- When you see double
- When bleeding continues and does not stop
- When the wound becomes red and swollen, or you have a fever or see pus
- When the eye stings severely, a foreign-body sensation persists, or there is glare or constant tearing
- When the incision opens
Outside clinic hours, do not wait: call 119 or go to the nearest emergency room.
Tell us at your next visit
- When the lines on the left and right look different
- When the line seems to be fading or coming undone
- When the line still looks too high or folded into multiple layers after the swelling has gone down
- When the eye seems to open less than it did before surgery
- When thread knots show through or a pulling sensation continues
- When the eye does not close fully or continues to feel gritty
- When the scar becomes more raised or itchy
During recovery, Dr. Park and the nursing team check your swelling, pain, and general condition together.
08
If the double eyelid comes undone or I am not satisfied, can it be redone?
In many cases it can be redone. Whether to proceed with revision surgery is decided at least 6 months after the first surgery.
We fully understand the wish to fix things as soon as possible when you are bothered by the result. Even so, we first watch how it heals.
As the swelling goes down, the height and shape of the line change over several months. Results are not judged by how things look right after surgery.
When a line made with the buried suture method comes undone, it may be redone with the buried suture method or secured by switching to the incisional method. Lowering a line is more difficult than raising it. Scarring from a previous incision and a shortage of excess skin have been reported as limits in correcting a high double eyelid[10].
What is checked in revision surgery, and the methods, are explained in Revision eye surgery information.
09
Are there cases where double eyelid surgery should not be done or should be postponed?
Yes. Typical cases are when weak eye-opening strength is the cause, and when the eyes are naturally dry. Criteria based on your health condition are confirmed at the consultation.
Surgery is not right for everyone right now.
Contraindications
If only a double eyelid line is created on an eye with blepharoptosis (a condition in which the eyelid margin droops because the eye-opening muscle is weak), the eyelid height problem remains and the left-right difference may become more noticeable. It has been reported that people who had dry eye symptoms before surgery may be at greater risk of dryness or conjunctival edema (swelling of the white of the eye) after eyelid surgery[11].
In plain terms
- If the eye-opening strength is weak, creating a line alone does not solve the problem.
- People whose eyes are naturally dry are prone to dry eye symptoms after surgery, so we plan carefully.
- If you have previously had double eyelid surgery, revision surgery is considered at least 6 months after the first surgery.
- If you take blood-thinning medication, consult the doctor who prescribed it. Do not stop it on your own.
- If you smoke, a period of quitting before surgery is needed.
Please tell us about all medications you take and any conditions you have at the consultation. Even things that seem minor are fine to mention.
10
Face Plus Talk
Double eyelid surgery is the most commonly performed of all plastic surgeries.
— Dr. Park Jung Keun, Plastic Surgery Specialist · Face Plus Talk
In practice, it draws the most consultations and the most operations. But the methods are also varied, so many patients are confused.
From the simplest buried suture method to the incisional method and ptosis correction surgery for blepharoptosis, the internet is well developed and there are many ways to get information, so many people come having already settled on a certain method.
However, after examination and consultation, there are often many differences from the method patients wanted or had in mind. There are also cases where people come having chosen wrongly because of various preconceptions.
The biggest misconception about double eyelid surgery is that the buried suture method is natural and the incisional method is unnatural. In particular, many people believe that incision means a much slower recovery and an awkward result. Another typical preconception is that the buried suture method comes undone easily, while an incisional double eyelid does not.
In fact, to decide on a surgical method, patients go from one clinic to another, agonizing over the choice. Plastic surgeons can have the same dilemma. Why? Because there is no fixed right answer.
The buried suture method is an option when the skin does not sag much, there is not much flesh in the eyelid, and the eye-opening strength is not poor. Only in such cases does the simple buried suture method give an attractive shape. If the skin sags and there is a lot of flesh, an incisional double eyelid is needed. The sagging skin must be removed, and fat or muscle removed along with it.
It is not the case that the buried suture method always comes undone and the incisional method never does. It may have been so in the past, but today the buried suture method does not come undone easily. The incisional method can also come undone in some cases.
In this way, the specific method is decided after a thorough examination. Only with an accurate diagnosis and a well-made plan can attractive eyes be created.
11
Frequently Asked Questions
Which is better, the buried suture method or the incisional method?
Rather than one being better, the suitable method differs depending on the condition of the eyes. For eyes with little sagging skin and fat, the buried suture method is often suitable; for eyes with a lot of sagging skin or fat, the incisional method is often suitable. The differences are summarized in the Buried Suture vs. Incisional Method comparison.
I hear the buried suture method comes undone. Is that true?
It can. Because the line is maintained by tying with thread, the line may become faint when the thread loosens over time. The incisional method can also loosen. If it loosens, revision surgery is considered only after at least 6 months have passed since the first operation.
Is the scar from double eyelid surgery noticeable?
The suture method leaves almost no needle-hole marks. The incisional method leaves a thin scar along the double eyelid line, placed inside the fold that forms when the eye is open. When the eyes are closed, the scar may be visible, and the redness fades over several months.
I am middle-aged. Can I still have double eyelid surgery?
You can. However, in middle age, sagging skin or weak eye-opening strength often exists as well, so an examination first sorts out the cause. If sagging skin is the main problem, please also see the Upper Blepharoplasty information.
Can double eyelid surgery and canthoplasty be done together?
Sometimes they are done together. Whether to do them together is decided by looking at the distance between the eyes and the shape of the inner corner of the eye. Canthoplasty is explained in the Canthoplasty information.
Do you treat overseas patients?
Yes. Many patients come from countries with advanced medical care, such as the United States and Japan. Among overseas patients, about 60% are from Japan and about 30% are from the United States.
12
Related FacePlus TV videos
This links to a video on the Face Plus Plastic Surgery YouTube channel. View All FacePlus TV
13
Surgeries and procedures worth considering together
These are surgeries and procedures often discussed together with this surgery during consultations. Whether to have them together is decided after an examination.
Rhinoplasty
Canthoplasty
Refill (Lifting + Filler)14
References
- Jeong S, Lemke BN, Dortzbach RK, Park YG, Kang HK. The Asian upper eyelid: an anatomical study with comparison to the Caucasian eyelid. Arch Ophthalmol. 1999;117(7):907-912. PMID 10408455. doi:10.1001/archopht.117.7.907
- Nguyen MQ, Hsu PW, Dinh TA. Asian blepharoplasty. Semin Plast Surg. 2009;23(3):185-197. PMID 20676313. PMCID PMC2884917. doi:10.1055/s-0029-1224798
- Ma FY, Cheng MS. Mini-incision double eyelidplasty. Aesthet Surg J. 2010;30(3):329-334. PMID 20601556. doi:10.1177/1090820X10374094
- Yang E, Hengshu Z. Clinical Comparison of 3 Different Double Eyelid Surgeries. Ann Plast Surg. 2022;88(2):138-143. PMID 34510082. doi:10.1097/SAP.0000000000002991
- Yan Y, Zhou Y, Zhang S, Cui C, Song X, Zhu X, Fu Y. Impact of Full-Incision Double-Eyelid Blepharoplasty on Tear Film Dynamics and Dry Eye Symptoms in Young Asian Females. Aesthetic Plast Surg. 2020;44(6):2109-2116. PMID 32696159. doi:10.1007/s00266-020-01874-0
- Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. Ophthalmic Plast Reconstr Surg. 2004;20(6):426-432. PMID 15599241. doi:10.1097/01.iop.0000143711.48389.c5
- Mizuno T. Treatment of Suture-related Complications of Buried-suture Double-eyelid Blepharoplasty in Asians. Plast Reconstr Surg Glob Open. 2016;4(8):e839. PMID 27622107. doi:10.1097/GOX.0000000000000835
- Wang Y, Zhang Y, Tian N. Cause and Management of Suture-related Ocular Complications after Buried-suture Double-eyelid Blepharoplasty. J Plast Reconstr Aesthet Surg. 2021;74(12):3431-3436. PMID 34226132. doi:10.1016/j.bjps.2021.05.042
- Lelli GJ Jr, Lisman RD. Blepharoplasty complications. Plast Reconstr Surg. 2010;125(3):1007-1017. PMID 20195127. doi:10.1097/PRS.0b013e3181ce17e8
- Kim KK, Kim WS, Oh SK, Kim HS. High Double Eyelid Fold Correction Using Wide Dual-Plane Dissection. Ann Plast Surg. 2017;78(4):365-370. PMID 27740951. doi:10.1097/SAP.0000000000000905
- Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW. Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series. JAMA Facial Plast Surg. 2013;15(1):39-46. PMID 23329270. doi:10.1001/2013.jamafacial.1
- Wong J, Lam DP, Abrishami A, Chan MT, Chung F. Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth. 2012;59(3):268-279. PMID 22187226. doi:10.1007/s12630-011-9652-x
Dr. Park Jung Keun · Plastic Surgery Specialist, PhD in Medicine
He personally consults on and performs facial aging treatments such as facelift, droopy eyelid surgery, and thread lift. The doctor personally sees you from consultation through recovery.
About the DoctorOther pages in this menu
The content of this page is general medical information provided in accordance with the Medical Service Act, and the effects and recovery time of surgeries and procedures may vary by individual. All surgeries and procedures can cause side effects, so please make your decision only after a thorough consultation with a plastic surgery specialist.