Buried suture method

The buried suture method, commonly known as the ‘double-fold surgery,’ or also referred to as the ‘non-incision method,’ is a technique where sutures are passed through small needle holes without making a skin incision to create a double eyelid. This method involves creating about 3-4 holes with a diameter of approximately 1 mm each, passing the sutures through them, and tying knots so that the muscle and skin are attached from the skin to the conjunctiva through the suturing site.

Candidates of the Buried Suture Method

1. When there is no fat and the eyelids are thin and elastic.
2. When the eyelid skin is not sagging.
3. When a faint double line appears on the original double line.
4. When desiring a thin inner double eyelid.

Advantages and Disadvantages of the Buried Suture Technique

■Advantages

  1. There is minimal swelling and no scarring since the skin is not incised.
  2. The surgery is simple and typically takes 20 to 30 minutes.
  3. It creates a natural double eyelid line, and the surgical scars are not visible.
  4. Partial revisions are easy, allowing for straightforward corrections in case of reoperation.
  5. Washing the face and applying makeup are possible from the 3rd to 4th day after surgery, enabling a quick return to daily activities.

■Disadvantages

  1. It is not possible to address issues such as double eyelid loss, sagging skin, or removal of excess skin, muscles, or fat.
  2. Since no skin incision is made, there is a risk of skin sagging, leading to a narrower double eyelid width.
  3. In cases of thin skin, there is a possibility of the knots of the thread being felt or visible.
  4. Surgery can be challenging for eyes with excessive fat or muscles, or sagging skin.

Incisional method

■Partial incision

The partial incision method combines the advantages of the incision method and the buried suture method to create a natural and refreshed eye appearance.
This method, which combines the strengths of the incision method and the buried suture method, actively induces adhesion artificially rather than simply suturing with thread, reducing the chances of the double eyelid becoming undone. For eyes with severe eyelid sagging or significant scarring, it is possible to resolve the sagging skin and minimize scarring through minimal incisions during a revision surgery.

■Full incision

The incision method is traditionally the most common approach, involving the removal of sagging eyelids, muscles, and fat layers through skin incisions to reliably create double eyelids. Therefore, it is suitable for those with sagging eyelids, or those requiring muscle or fat removal, or correction of ptosis. The surgery takes about 30 minutes to 1 hour, and stitches are removed on the 4th to 5th day after surgery.
Although the time it takes for swelling to subside may vary from person to person, approximately 70% of swelling subsides within about 1 to 2 weeks after surgery, with the remaining minor swelling gradually decreasing over 2 to 3 months.

Candidates of the Incision Method

1. When there is sagging skin and excess skin on the eyelids
2. When the skin is thick and the muscles and fat layers are thick
3. When removal of sagging skin and fat is necessary simultaneously
4. When there is ptosis of the eyelids and the eyes appear sleepy
5. In cases of revision surgery, when the double eyelid line is too high and scar removal is required

Dark circles (similar to the incision method)

  1. When there is sagging skin and excess skin on the eyelids.
  2. When the skin is thick and the muscles and fat layers are thick.
  3. When removal of sagging skin and fat is needed at the same time.
  4. When there is eyelid ptosis and the eyes appear sleepy.
  5. In the case of a revision surgery, when the double eyelid line is high and scar removal is necessary.

Merits and Demerits of Incision Method

■Merits

  1. Eyes with excess fat and thick fat layers require surgery using the incisional method.
  2. Even in cases of sagging skin, surgery can be performed while removing the excess skin.
  3. It allows for creating a clearer double eyelid compared to the non-incisional method.
  4. Surgery can be performed on all types of eyes.

■Demerits

  1. Swelling takes longer to subside compared to the non-incisional method.
  2. It is less conspicuous, but surgical scars remain.
  3. The procedure is performed under local anesthesia, and the surgery typically takes about an hour.

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