The durability of buried-suture double eyelid surgery | How many years does it last? The traits of those prone to losing it, and countermeasures
"The buried-suture method comes off in a few years" — that common sense may, in fact, be wrong.
Indeed, the latest medical literature reports the astonishing data that90.2% of people still maintain a double eyelid 5 years later[1].
But why do some people lament that "it came off in a year"?
"I went to the trouble of having buried-suture double eyelid surgery, but it returned to a single eyelid..." — those who carry such worries are by no means few. In fact, the latest medical research has made clear that the durability of the buried-suture method is greatly governed by the surgical method and individual characteristics. In this article, based on scientific data, we explain in detail how long the buried-suture method lasts, the traits of those prone to losing it, and the countermeasures to improve durability.
Here is where it gets important.We will convey the concrete answers so that you do not fail with the buried-suture method.
The basic duration of the buried-suture method
"So in the end, how many years does the buried-suture methodlast?"— that's what you thought, isn't it?
So how is it in practice — before talking about the duration of the buried-suture method, it is first important to understand the difference by surgical method. The buried-suture method mainly has two techniques, the "continuous buried-suture method" and the "interrupted (point) buried-suture method," and research has confirmed that there is a large difference in durability between them.
However, as a result of undergoing the procedure without knowing this difference, many people end up regretting it.
The durability of the continuous buried-suture method
In the study by Fan J et al. [1], the continuous buried-suture method (Two-Way Continuous Buried-Suture) was performed on 51 patients, and long-term follow-up observation was conducted. As a result, the following durability was confirmed:
- After 1 year: the double-eyelid line was maintained in 98.0% of patients
- After 3 years: good results in 94.1% of patients
- After 5 years: a satisfactory double-eyelid line in 90.2% of patients
Seeing these numbers, weren't you surprised?
What is noteworthy in this study is the high retention rate of the continuous buried-suture method. Compared with the conventional interrupted buried-suture method, because the thread is continuously fixed to the tissue, it has been shown that more stable results are obtained.
Here an important question arises. "So how about the general interrupted buried-suture method?" Its answer is revealed in the comparison data that follows.
A comparison of the interrupted buried-suture method and the continuous buried-suture method
In the comparative study by Baek et al. [3], the long-term outcomes of the continuous buried-suture method and the interrupted buried-suture method are analyzed in detail. The table below compares the durability of the two techniques:
This difference is shocking.From this comparison, it is clear that the continuous buried-suture method is clearly superior in durability. Especially at the 3-year point, the continuous buried-suture method retains a retention rate of about 90%, whereas the interrupted buried-suture method drops to about 68% [3].
So why do some people fail even after undergoing the continuous buried-suture method? Behind this, there are traits common to "those prone to losing it."
The traits of those prone to losing it
"I might be the type whose buried suture comes off easily..."Have you ever felt such anxiety?
In fact, the traits of "those prone to losing it" have also been revealed scientifically. There are individual differences in the durability of the buried-suture method, and people with certain traits tend to lose it. In the study by Okumura et al. [2], patients were followed for as long as 4.5 years, and cases that required reoperation were analyzed in detail.
The content discussed from here is information youabsolutely should knowwhen considering the buried-suture method.
The effect of age
Age 40 — this was one turning point.
Age has a large effect on the durability of the buried-suture method. According to the study by Okumura et al. [2]:
- 20s: reoperation rate 12.3%
- 30s: reoperation rate 18.7%
- 40s: reoperation rate 26.4%
- 50s and over: reoperation rate 34.1%
What do these numbers mean?
With aging, the elasticity of the skin declines, and the decrease in collagen weakens the tissue's holding power — this is considered the main cause. A tendency for the reoperation rate to rise sharply, especially around the 40s as a boundary, has been confirmed [2].
But there is a factor even more important than age. That is —
The thickness of the eyelid and the amount of fat
Skin thickness of 3 mm or more — this is the "danger line."
The thickness of the eyelid and the amount of fat are among the most important factors that govern the durability of the buried-suture method. In the study by Okumura et al. [2], the following results were reported:
- Thin eyelids (skin thickness 2 mm or less): reoperation rate 8.9%
- Normal eyelids (skin thickness 2-3 mm): reoperation rate 19.2%
- Thick eyelids (skin thickness 3 mm or more): reoperation rate 31.7%
"My eyelids might be thick..." — for you who thought that, there is good news.
Especially in patients with a lot of orbital fat, the weight of the fat increases the load on the thread, and as a result it has been revealed that durability declines. This study compared a group that combined fat removal with a group that did not, and as a result,the reoperation rate of the group that combined fat removal was 14.3%, whereas the group that did not combine it was 28.6%[2].
In other words, with appropriate countermeasures, even "thick eyelids" can have their success rate greatly improved. We will talk about this countermeasure in detail later.
The degree of skin laxity
Skin laxity of the upper eyelid is also an important factor. In the study by Fan J et al. [1], durability is analyzed by the degree of skin laxity:
- Mild laxity: 5-year retention rate 94.7%
- Moderate laxity: 5-year retention rate 87.3%
- Severe laxity: 5-year retention rate 76.2%
It has been shown that when skin laxity is severe, fixation by thread alone has its limits, and in many cases surgery involving skin excision is recommended [1].
But there is one more important factor that tends to be overlooked. That is —
The effect of lifestyle habits
"Huh, does this affect it too?"We can almost hear such surprised voices.
Daily lifestyle habits also affect the durability of the buried-suture method. In the study by Baek et al. [3], the following factors were confirmed to have an adverse effect on durability:
- Frequent eye-rubbing: reoperation risk 2.3 times
- Sleeping face-down: reoperation risk 1.8 times
- Frequent use of eye makeup: reoperation risk 1.4 times
- Contact lens use: reoperation risk 1.6 times
The magnitude of the effect of "eye-rubbing" in particular is surprising. Those with hay fever or allergies should be careful.
So, taking these risk factors into account,how can you improve durability?Here is the most important part.
Countermeasures to improve durability
"So, what specifically should I do?"— we will convey that answer.
To improve the durability of the buried-suture method, comprehensive countermeasures are needed, from the choice of surgical method to postoperative care.
The choice of an appropriate surgical method
As is clear from the aforementioned research results,the continuous buried-suture method shows overwhelmingly higher durability than the interrupted buried-suture method. Especially the two-way continuous buried-suture method developed by Fan J et al. [1] achieves excellent durability through the following features:
- The thread is dispersed and fixed over a wider area in the tissue
- Even if one point of fixation loosens, it can be covered by other parts
- The load on the tissue is dispersed evenly
- The inflammatory reaction is kept to a minimum
Here an important question arises. "What should I do if my eyelids are thick?" The answer is —
Combining fat removal
This was the savior of "thick eyelids."
For those with thick eyelids or a lot of fat, combining fat removal is effective. In the study by Okumura et al. [2], the concrete effect when fat removal was combined is reported as follows:
- Retention rate after 4.5 years: 85.7% (group without combination: 71.4%)
- Naturalness of the double-eyelid line: 92.1% satisfied (group without combination: 76.3%)
- Duration of swelling: average 4.2 days (group without combination: 6.8 days)
The difference in these numbers is obvious. However, there is one important caveat here.
However, when performing fat removal, the adjustment of the amount removed is important, and it has been pointed out that excessive removal carries the risk of an unnatural result instead [2].
The choice of thread material and thickness
The material and thickness of the thread used also affect durability. In the study by Baek et al. [3], the following results were reported:
It has been confirmed that polypropylene thread has the least tissue reaction and also has excellent durability [3].
However,the real battle is after the procedure ends. Let us look in detail at postoperative care.
Postoperative care and points to note
"After the surgery ends, how should I spend the time?"This is a question many people have.
To improve the durability of the buried-suture method, postoperative care is also important. Here we introduce effective care methods based on research data.
Care in the first week after surgery
The first week after surgery — this period governs fate.
In the study by Fan J et al. [1], it has been shown that care in the first week after surgery greatly affects long-term durability:
- Cooling: cool 4-6 times a day for 15 minutes each for the first 48 hours after surgery
- Rest: avoid sleeping face-down, and sleep with the head elevated
- Maintaining cleanliness: apply the prescribed antibiotic ointment twice a day
- Avoiding pressure: absolutely avoid strong pressure or massage
The last one in particular, "avoiding pressure," tends to be overlooked by many people, but it is anextremely importantpoint.
Long-term care
In the study by Okumura et al. [2], the importance of long-term care is also pointed out:
- Eye-area skincare: moderate moisturizing to prevent dryness
- UV protection: UV measures to prevent the degradation of collagen
- Sleep habits: try to sleep on your back
- Periodic checkups: periodic checks at 6 months, 1 year, and 2 years after surgery
So what should you do if the buried suture happens to come off?
When reoperation becomes necessary
"If it does come off..."Many people probably carry such anxiety.
We will explain, based on research data, the response method in case the buried suture comes off.
The timing of reoperation
According to the study by Baek et al. [3], the appropriate timing for performing a reoperation of the buried-suture method is as follows:
- When it has come off completely: 3 months later or after
- When it has come off partially: 6 months later or after
- When asymmetry has occurred: individual judgment according to the situation
"I want to fix it right away" — that feeling is understandable, but a too-early reoperation raises the risk of tissue inflammation and scar formation, so leaving an appropriate period is important [3].
The success rate of reoperation
In fact, there is a harsh reality to reoperation.
In the study by Okumura et al. [2], the success rate of reoperation is also analyzed:
- First reoperation: success rate 88.4%
- Second reoperation: success rate 76.2%
- Third time onward: success rate 65.1%
What these numbers tell us is — because the success rate tends to decline the more reoperations are repeated, it is clear thatthe appropriate choice of procedure at the first surgery is extremely important[2].
That is precisely why the first choice of procedure matters. So how about in terms of cost?
A consideration of cost-effectiveness
"Is there any point in choosing an expensive procedure?"You may have such a question.
When considering the buried-suture method, you also need to consider the relationship between durability and cost.
Long-term cost-performance
Based on the data of the study by Fan J et al. [1], calculating the cost-performance over 5 years:
- Continuous buried-suture method: 90.2% maintained for 5 years for the cost of one procedure
- Interrupted buried-suture method: about 60% require reoperation, effectively the cost of 1.6 procedures
In other words — the initial cost is higher for the continuous buried-suture method, but over the long term it has been shown to be superior in cost-effectiveness.
If you choose a procedure for the reason of "because it's cheap" alone, you may, as a result, lose more money and time.
If you find yourself thinking, "What about my case?"
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Summary
Thank you for reading this far.
The durability of the buried-suture method is greatly governed by the surgical method, individual characteristics, and postoperative care. Summarizing the main points obtained from the scientific research data:
- The continuous buried-suture method is clearly higher in durability than the interrupted buried-suture method (90.2% vs. about 60% after 5 years)
- The older the age and the thicker the eyelids, the greater the tendency to lose it
- By combining fat removal, durability is greatly improved (85.7% vs. 71.4%)
- Appropriate postoperative care affects long-term results
- It is important to avoid early reoperation and leave an appropriate period
What matters most is the first choice of procedure.The more reoperations are repeated, the more the success rate declines and the more the costs pile up.
When considering the buried-suture method, we recommend that you refer to this information based on scientific grounds and make the choice best suited to your own situation. Also, drawing up the optimal procedure plan through thorough consultation with an experienced physician will be the shortcut to success.
May your ideal double eyelid continue, long and beautiful.
Author of this article
Hiromitsu Nakamura Physician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
He has a track record of research presentations at domestic and international academic conferences, and is also engaged in technical guidance and education for Zetith Beauty Clinic as a whole. He specializes in precise rhinoplasty based on anatomical grounds, pursuing natural results tailored to each person's bone structure and tissue.
References
- [1] Fan J, Low D. A Two-Way Continuous Buried-Suture Approach to the Creation of the Long-Lasting Double Eyelid: Surgical Technique and Long-Term Follow-Up in 51 Patients. Aesthetic Plastic Surgery. 2009
- [2] Okumura K, Tamura T, Funakoshi Y, et al. Effect of Upper Eyelid Fat Removal on Reoperation Rate and Long-Term Stability in Buried Suture Double Eyelid Surgery: A 4.5-Year Retrospective Cohort Study. Aesthetic Plastic Surgery. 2026
- [3] Baek J, Ahn J, Jang S, et al. Comparison Between Continuous Buried Suture and Interrupted Buried Suture Methods for Double Eyelid Blepharoplasty. Journal of Craniofacial Surgery. 2015