Is "trying buried sutures first" dangerous? The real probability that buried double eyelids will come undone
Approximately 20–30% of patients experience thinning or loss of the double eyelid line within 3 years after surgery.
There is data showing that the duration of results varies significantly depending on individual anatomical characteristics and lifestyle — such as eyelid thickness, presence or absence of eye-rubbing habits due to allergies, and daily friction from makeup removal.
Humans are said to blink approximately 20,000 times per day. The stress from this constant blinking movement places sustained strain on the suture used in buried suture techniques. As time passes, the tissue loses tension to the suture, and the double eyelid crease gradually becomes shallower — which can be understood as a natural physical reaction in a sense.
Double eyelid buried suture technique is a very popular method that uses ultrafine medical-grade sutures to form a double eyelid line. Because it does not use a scalpel, the psychological barrier is low and it is popular; however, it is necessary to accurately understand the risk that "buried sutures can come undone."
From a professional perspective, the buried suture method mainly has two approaches.Levator muscle method (a technique in which the suture is placed on the levator palpebrae superioris muscle that lifts the eyelid)andTarsal plate method (a technique in which the suture is placed on the tarsal plate, which is cartilaginous tissue on the back of the eyelid).
These approaches differ in terms of risk to the cornea, the strength of the double eyelid crease, and durability. Which is more appropriate cannot be determined without accurately diagnosing the structure of the eyelid.
While the buried suture method has the merit of "design changes being easily made," it tends to be unsuitable for those with thick subcutaneous tissue such as ROOF (pre-septal fat) or orbital fat. This is because the rebound force of the fat constantly places strong tension on the suture, which becomes a cause of early loosening.
Is the internet rumor that "incision double eyelids = terrible downtime" actually true?
Regarding downtime after incision double eyelid surgery, you may see pessimistic information on SNS and summary sites such as "swelling did not subside for over a month, and I couldn't go out at all."
While the internet tends to emphasize "incision has long downtime and is terrible," clinical practice using the latest medical technology reports different trends.
By minimizing tissue damage through appropriate surgical technique and performing proper cooling (ice application) after surgery,strong swelling typically peaks within approximately 1–2 weeks after surgeryit is known.
The true nature of post-operative swelling is the moisture and inflammatory substances that seep from blood vessels due to surgical stimulation. This acute inflammatory phase typically peaks at 48–72 hours after surgery and then gradually subsides. After that, excess moisture is absorbed through the function of lymph vessels and similar processes.
Suture removal is normally performed 5–7 days after surgery. At this point, there is approximately a 60–70% probability that swelling and subcutaneous hemorrhage (bruising) remain; however, in most cases, these settle to a level that can be covered by makeup or glasses.
While there are individual differences in healing ability, appropriate care such as sleeping with the head elevated can effectively shorten downtime. It is not necessary to give up on incision double eyelids simply because you "cannot take a long time off."
Buried sutures or incision — which is better? The truth when comparing duration and risks
For those seriously comparing and considering "Is buried suture or incision double eyelid surgery better?," we provide an objective comparison from a medical perspective.
When comparing double eyelid surgery, the following 3 points are important.
- Duration and strength of adhesion: The buried suture method relies only on suture tension and may come undone in several years. In contrast, the incision method creates direct adhesion between the skin and the levator aponeurosis, allowing semi-permanent duration to be expected.
- Ability to address eyelid thickness: The incision method can appropriately remove the orbicularis oculi muscle and excess fat, making it easier to create a clean line even for thick eyelids.
- Risk of revision and irreversibility: The buried suture method can easily be returned to its original state by removing sutures; however, the incision method is extremely difficult to return to completely because it involves removing tissue and creating adhesion.
Naturally occurring double eyelids have the anatomical characteristic that the tip of the muscle that lifts the eyelid branches and adheres to the back of the skin. The incision method is a surgical technique that externally reproduces this "adhesion structure that exists in naturally double-lidded people."
By creating strong adhesion, the incision method reduces the risk of loss of the double eyelid; however, the surgical skill of the operating surgeon and pre-operative simulation are directly reflected in the outcome. Regarding scarring from the incision method, it has been reported that the patient's skin quality (such as Fitzpatrick skin type) is related to how well the scar heals, making careful pre-operative examination important.
Compare double eyelid surgery by total future cost! Can you lose money by choosing based on price alone?
When comparing initial costs only, the buried suture method is often priced at approximately one-third to half that of the incision method. Because it is easy to start with, many people begin with the buried suture method.
This is the most common question asked during consultations. "Doctor, in my case, if my buried sutures come undone, can I redo them as many times as I want?" Actually, the answer to this question is "it is possible with conditions, but cannot be recommended."
If the buried sutures come undone and re-surgery is repeated 2 or 3 times,the total cumulative cost may end up being higher than receiving the incision method oncethere is sufficient supply. Additionally, beyond the financial cost alone, the "psychological burden" of downtime that occurs with each re-operation cannot be ignored.
Furthermore, repeatedly passing a thread through the same area of the eyelid and securing it is seen to slightly increase the risk of chronic inflammation from foreign-body reaction and the risk of the thread becoming exposed on the back of the eyelid and scratching the cornea of the eyeball.
Additionally, repeated surgery can cause subcutaneous tissue to adhere and harden, and it has been reported that when finally attempting to switch to the incision method, the surgical difficulty increases and achieving the ideal result becomes less likely. Rather than focusing solely on immediate cost savings, it is important to compare Double eyelids surgery from a "long-term cost-effectiveness" perspective that considers yourself 5 and 10 years from now.
"Which one is right for me?" 3 conditions to check when you're unsure
Ultimately, when choosing between the buried-suture method and incision method for Double eyelids surgery, please consider the following conditions in light of your own situation.
- Eyelid anatomical characteristics: Those with thin skin who easily develop a crease when pushing up the eyelid with a finger are suited for the buried-suture method. Those with thick skin and pronounced puffiness are better suited for the incision method.
- Desired Double eyelids design: A natural divergent type can be sufficiently achieved with the buried-suture method. However, when hoping for a wide parallel Double eyelids that overcomes the epicanthus, the incision method (in some cases combined withMedial canthoplastyis often necessary.
- Tolerable downtime: If you absolutely cannot secure more than one week of downtime, the buried-suture method becomes a strong option.
When East Asian-specific epicanthus is strongly pronounced, the skin is pulled down strongly from the inner-eye side, so attempting to create wide parallel Double eyelids with the buried-suture method places excessive strain on the thread. This is what causes the thread to come loose early or results in an unnatural hamster-eye appearance.
The element we deferred earlier—the one that most influences "long-term satisfaction"—is:"Choosing a surgical method that is completely adapted to your eyelid's anatomical characteristics".
Forcing selection of a surgical method that doesn't match skeletal structure or fat volume is reportedly most likely to lead to design collapse and future regret.
If you're thinking "what about my case?"
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Summary of this article
Let's review the important points to keep in mind regarding the differences between the buried-suture method and incision method in Double eyelids surgery.
- The buried-suture method is convenient but carries the risk of coming loose in several years; it is suitable for those with thin eyelids
- The downtime for incision Double eyelids varies by individual, but strong swelling typically lasts 1–2 weeks as a guideline
- Considering lifetime re-operation risk and tissue burden, the incision method may offer better cost-effectiveness in some cases
- Double eyelids surgery should not be selected based solely on cost or convenience; comparing surgical methods according to eyelid thickness and desired design is of paramount importance
If you have any concerns, please feel free to consult with us. At Zetith Beauty Clinic, we provide careful counseling based on medical evidence.
References
- Rohrich R, Savetsky I, Suszynski T, et al. Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty. Plastic & Reconstructive Surgery. 2020 DOI
Author of this article
Hiromitsu Nakamura Physician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
With a track record of research presentations at domestic and international academic conferences, he is involved in technical instruction and education across Zetith Beauty Clinic. He specializes in precise nose surgery based on anatomical evidence and pursues natural results tailored to each individual's skeletal structure and tissues.
Author of this article
Hiromitsu Nakamura Ginza Clinic Physician
Zetith Beauty Clinic Ginza, Osaka Shinsaibashi, Fukuoka
With a track record of research presentations at domestic and international academic conferences, he is involved in technical instruction and education across Zetith Beauty Clinic. He specializes in precise aesthetic medicine based on anatomical evidence and pursues natural results tailored to each individual's skeletal structure and tissues.
Summary of this articleLet's review the important points to keep in mind regarding the differences between the buried-suture method and incision method in Double eyelids surgery.The buried-suture method is convenient but carries the risk of coming loose in several years; it is suitable for those with thin eyelidsThe downtime for incision Double eyelids varies by individual, but strong swelling typically lasts 1–2 weeks as a guidelineConsidering lifetime re-operation risk and tissue burden, the incision method may offer better cost-effectiveness in some casesDouble eyelids surgery should not be selected based solely on cost or convenience; comparing surgical methods according to eyelid thickness and desired design is of paramount importanceIf you have any concerns, please feel free to consult with us. At Zetith Beauty Clinic, we provide careful counseling based on medical evidence.ReferencesRohrich R, Savetsky I, Suszynski T, et al. Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty. Plastic & Reconstructive Surgery. 2020 DOIAuthor of this articleHiromitsu Nakamura PhysicianZetith Beauty Clinic Ginza, Osaka, FukuokaWith a track record of research presentations at domestic and international academic conferences, he is involved in technical instruction and education across Zetith Beauty Clinic. He specializes in precise nose surgery based on anatomical evidence and pursues natural results tailored to each individual's skeletal structure and tissues.