We'll tell you honestly — here's what the latest research says about Double-eyelid suture method duration.
Among Double-eyelid surgeries, the "Double-eyelid suture method" is the most popular and easy to undergo. This technique creates Double-eyelids using thread without a scalpel, and has gained much support due to its short downtime. However, many people worry, "Won't it eventually come loose?"
How long does the Double-eyelid suture method actually last? In fact, a large-scale recent study shows that the re-surgery rate for standard 2-point Double-eyelid suture method is "22.3% (Okumura et al. 2025)" overall. However, there's no need to worry. With surgical refinements and individual eyelid characteristics, this re-surgery rate can be dramatically reduced.
This article thoroughly analyzes cutting-edge cosmetic surgery research data from around the world, explaining the differences between people whose Double-eyelid suture method easily comes loose and those whose lasts longer, as well as science-based approaches to maximizing the duration.
Duration of Double-eyelid suture method — Latest research data
The reality of re-surgery in 2-point Double-eyelid suture method
In a large-scale retrospective cohort study published in 2025, data from 52,281 people who underwent 2-point Double-eyelid suture method at 105 clinics nationwide in Japan were analyzed, with 600 people's outcomes tracked (maximum follow-up period 4.5 years). As a result, the rate of re-surgery due to thread loosening was22.3% (Okumura et al. 2025)(134 out of 600 people). The re-surgery rate for all causes reached26.8%(161 out of 600 people).
Re-surgery rates vary significantly by age group
Re-surgery rates due to thread loosening by age group:
The highest re-surgery rate is in "those under 20 years old (41.0%) (Okumura et al. 2025)", with the best longevity in "those aged 30-39 (12.0%)". Additionally, in another cohort study (873 Asian patients, maximum 7-year follow-up (Shi et al. 2022)), there is long-term durability data showing that with specific suturing techniques, Double-eyelid line disappearance occurred in 0 cases.
Characteristics of people whose Double-eyelids easily come loose — Do any apply to you?
Effects of eyelid fat (orbital fat, ROOF) and skin thickness
People with thick, puffy eyelids tend to have Double-eyelid suture method come loose more easily. Inside the eyelid, there is a layer of fat called ROOF (post-orbicularis oculi fat) or orbital fat, and when the volume of these fats is large, they act as a physical barrier that inhibits the formation of strong scarring (tissue adhesion) around the thread.
Changes in skin and tissue with age
- Young people (under 20): The skin's elasticity is very high and the orbicularis oculi muscle is soft, so the thread experiences strong rebound force, causing tissue to bounce back from the thread.
- Older people (60 and above): With decreased collagen and elastin, connective tissue weakens, and the anchor strength of the "foundation" that fixes the thread decreases.
Does the type of thread change duration? — Double vs Single comparison
Difference between point-fixation vs tunnel method (continuous method)
In a comparative study of 852 people (Yang et al. 2022), the recurrence rate within 2 years post-surgery was as follows:
While standard point-fixation is relatively prone to coming loose, using a technique that creates a tunnel in the subcutaneous tissue to connect tissues more firmly has been shown to keep the recurrence rate lower than open surgery.
Thread fixation direction and strength (resistance to blinking force)
Traditional Double-eyelid suture method often places thread "horizontally", which is weak to blinking movements and easily loosens. In contrast, when using an improved suturing technique that vertically fixes the 3 layers of the levator aponeurosis, pre-tarsal orbicularis oculi muscle, and pre-tarsal fascia, in 563 people followed for 6 months or more, Double-eyelid line disappearance due to thread loosening was "0 cases" (Shi et al. 2022).
Why lifespan extends when simultaneously performing fat removal (defatting)
Why does lifespan extend?
ROOF and orbital fat are "physical barriers" that prevent strong scarring from forming at the site where thread is placed. By removing this fat, strong connections form between tissues, providing structural stability that doesn't rely solely on thread strength.
Signs and how to respond when you think "it might have come loose"
Signs that thread is beginning to loosen
- The Double-eyelid line becomes thinner, shallower:The once-crisp definition of the crease begins to blur.
- Appearance of asymmetry between eyes:One eye only experiences narrowing of the line width or shape changes. Patients with pre-operative asymmetry of 1 mm or more have an extremely high reoperation rate of 42.7% (Chen et al. 2023).
Countermeasures
- Addition of fat removal (defatting): If the eyelid thickness caused loosening, fat removal can be added during reoperation to extend the duration of the next result
- Change in fixation points or surgical method: Switching to multi-point fixation or continuous suturing, or transitioning to partial incision or full incision methods
Daily lifestyle precautions for longer-lasting results
Caution against prolonged hard contact lens wear
Long-term hard contact lens wearers experience eyelid tissue damage from repeated strong pulling of the eyelid when removing the contact lens and chronic physical irritation from the lens edge, which weakens the fixation base of the suture in the buried suture method.
Blinking and eye rubbing movements
Actions such as "rubbing eyes strongly due to hay fever" and "vigorously rubbing the eyelid when removing eye makeup" are equivalent to directly destroying the suture fixation, so they must be avoided as much as possible.
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Summary of this article
- Reoperation probability varies significantly by age:The overall reoperation rate for two-point fixation is 22.3%, but under age 20 (41.0%) is particularly prone to loosening, while ages 30–39 (12.0%) show the longest durability.
- Eyelid fat is the biggest barrier:Simultaneous fat removal can reduce the reoperation rate from 33.5% to 17.0%, cutting it approximately in half.
- Suture placement method can extend longevity:Point fixation (recurrence rate 5.88%) shows shorter duration compared to the subdermal tunnel method or vertical multi-layer fixation method (recurrence rate 0–0.58%).
- Asymmetry and fading lines are SOS signals:Avoid strongly rubbing your eyes and pulling hard contact lenses off; if asymmetry in the line appears, consult your doctor early.
If you have any questions about the buried suture Double eyelids procedure, please feel free to contact us.
References
- Okumura et al. 2025. Age-Related Variations in Reoperation Risk from Suture Loosening in Two-Point Buried Suture Double Eyelid Surgery. Aesth Plast Surg. 2025 DOI
- Okumura et al. 2025. Effect of Upper Eyelid Fat Removal on Reoperation Rate and Long-Term Stability in Buried Suture Double Eyelid Surgery. Aesth Plast Surg. 2025 DOI
- Jung et al. 2018. The Double Thread Buried Nonincisional Blepharoplasty Technique. J Craniofac Surg. 2018 DOI
- 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 DOI
Author of this article
Hiromitsu Nakamura Physician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
Has experience presenting research at domestic and international academic conferences, and is also involved in technical guidance and education for Zetith Beauty Clinic as a whole. Specializes in precision aesthetic medicine based on anatomical evidence, pursuing natural results tailored to each individual's skeletal structure and tissue characteristics.