Why do some people regret Double eyelids surgery?
Double eyelids surgery (blepharoplasty) is one of the most frequently performed procedures in cosmetic surgery. There are two methods: the suture method (a method using threads to hold the eyelid) and the incision method (a method that creates Double eyelids by incising the skin). Each has its merits and risks. To prevent regrets such as "it disappeared," "the width was different from what I imagined," or "the swelling won't go down," accurate pre-operative information is essential.
5 Common "Failure" Patterns
① Double eyelids disappeared (suture method)
The suture method fixes the eyelid with threads, so the Double eyelids may become thinner or disappear due to factors such as rubbing the eyes, thick eyelids, or weak thread placement. Re-operation (re-stitching) or a transition to the incision method is considered.
② The width is broader or narrower than expected
The gap between the desired Double eyelids width and the actual result is the biggest cause of regret. It is essential to carefully confirm the width during pre-operative simulation. Depending on the thickness of the eyelid and the amount of orbital fat, the appearance can differ even with the same width.
③ Asymmetry between left and right
Pre-existing left-right differences may become apparent after surgery, or asymmetry may occur due to variation during the procedure. It is important to check left-right differences in advance and share adjustment plans within the feasible range.
④ Swelling persists / Hamstring state
Especially with the incision method, post-operative swelling can last 1 to 3 months. If the unnatural puffiness called "ham eyes" persists, correction may be necessary.
⑤ Scarring / line irregularities (incision method)
With the incision method, a permanent line is created, so the way the scar heals and the shape of the line depend on the surgeon's skill. Skilled suturing technique is necessary to achieve thin, clean scarring.
Suture method vs. incision method: Which is right for you?
- Double eyelids (non-incisional method) is suitable for: thin eyelids, desire for natural results, want to minimize downtime
- Double eyelids (incisional method) is suitable for: thick eyelids, excess orbital fat, prioritizing longevity, previous experience with non-incisional method not holding
Checklist for a trustworthy clinic
- Whether they evaluate eyelid thickness, fat volume, and skin sagging (skin laxity) in advance
- Whether they perform simulation with your desired width before surgery
- Whether they explain your original left-right asymmetry and present how it will look after surgery
- Whether there is a guarantee system for the non-incision method (re-treatment if it comes off)
- Whether there are natural-looking before-after cases with the incision method
Zetics Clinic's Approach
Individual diagnosis: evaluate eyelid thickness and fat volume
Eyelid structure varies greatly from person to person, and we individually design the surgical method, number of anchoring points, and whether fat removal is necessary to match each patient's needs.
Pre-operative simulation: align width and shape
Using tape and digital tools, we confirm the desired width and share an image of "Double eyelids suited to your eye area" before surgery.
Careful suturing and post-operative care
Especially with the incision method, the scarring outcome is crucial. Fine suturing and post-operative aftercare minimize scarring.
We can also consult about revision from other clinics
Whether "the width from my previous Double eyelids surgery doesn't suit me," "my sutures came loose," or "an unnatural line remains after the incision," we welcome consultations about concerns following procedures at other clinics.
Dissatisfaction and deformity breakdown after Double eyelids surgery (Analysis of revision consultation patients)
Source: Multiple studies (2018–2025) revision consultation patient data
Patient Satisfaction After Corrective Double Eyelids Surgery
Source: Secondary blepharoplasty for unsatisfactory double eyelid folds (2022), Average follow-up 12 months
Burial Method vs Incision Method — Which Should You Choose?
Research Data on Double Eyelid Surgery Complications and Revision Rates
When considering Double eyelids surgery, understanding "how many patients are satisfied" and "what complications may occur" accurately is the first step toward making a choice you won't regret. Below, we present the reality of Double eyelids surgery honestly, based on data from peer-reviewed medical literature.
① Satisfaction and Breakdown of Dissatisfaction with Double Eyelid Incision Surgery
In a 2018 study published in the International Journal of Ophthalmology (DOI: 10.18240/ijo.2018.12.07), 132 of 180 patients (response rate 73.3%) who underwent modified Z-method medial epicanthoplasty and Double eyelids incision surgery simultaneously were followed up for an average of 26 months (7–49 months).
- Satisfaction rate for both function and appearance: 80.3%
- Proportion rated "good or better" on patient-reported outcomes (PROM): 81.8% (average score 96/120 points)
- Proportion answering "highly satisfied or higher": 82.6% (average satisfaction score 104/120 points)
- Proportion of surgical scars rated as "minimal or not visible": 85.6%
However, negative data were also reported.
- Proportion complaining of asymmetry between left and right: 12.9%
- Proportion complaining of dissatisfaction with eyelid crease width (too wide or too narrow): 19.7%
The data showing that approximately 1 in 8 patients felt left-right asymmetry and approximately 1 in 5 felt dissatisfied with crease width demonstrates the importance of carefully aligning width and shape with the surgeon before the procedure.
② Improvement Rate Following Revision Surgery
A 2022 study titled "Secondary blepharoplasty for unsatisfactory double eyelid results" reported the outcomes of secondary revision blepharoplasty for patients dissatisfied with their initial surgery. Subjects were primarily divided into the following 3 groups and followed for an average of 12 months (maximum 2 years).
| Reason for Revision | Number of Patients | Complete Satisfaction Rate | Good Rating Rate |
|---|---|---|---|
| Double eyelid line too high (abnormally high crease) | 63 patients, 141 eyes | 92.1% | ― |
| Multiple eyelid lines (multiple crease) | 6 patients, 8 eyes | 100% | 83% |
| Loss of double eyelid line | 14 patients, 24 eyes | 85.7% | 92.9% |
The combined overall satisfaction rate across all cases was 91.6%, a high figure demonstrating that even when initial surgery does not meet expectations, there is considerable potential for improvement through appropriate revision surgery. However, revision surgery also carries risks of complications.
- Hematoma incidence rate: 3.1% (4 patients, appearing 3–5 days post-operation)
- Lagophthalmos (inability to fully close the eye) incidence rate: 6.2% (8 patients, all recovered within 30 days)
- Average duration of edema: 30.7 days (14–60 days)
Revision surgery may place greater burden on tissues compared to initial surgery. "Approaching your ideal result in the first surgery" is the best choice in the long term.
③ Periocular Anatomical Factors Predicting Post-operative Deformities
In a prospective controlled study examining the relationship between periocular muscles and post-operative deformities following upper blepharoplasty (Double eyelids incision surgery), predictive accuracy (C-index) was calculated for multiple post-operative complications.
- Crease asymmetry: frequency 25.7%, C-index 0.654
- Shallow crease: frequency 23.2%, C-index 0.783
- Low crease: frequency 19.3%, C-index 0.750
- Anterior eyelid lamella fullness (eyelid fat thickness): C-index 0.947 (95%CI 0.880–1), showing the highest predictive accuracy
Particularly noteworthy is that after age 30, the risk of "shallow crease" increases with an odds ratio of 2.670 (95%CI 1.345–5.298), approximately 2.7 times, and when skin thickness is greater, the risk of "anterior eyelid lamella fullness" increases with an odds ratio of 4.230 (95%CI 1.226–14.590), approximately 4.2 times. Age, skin thickness, and eyelid structure significantly impact the final result. It is important to thoroughly confirm your eye characteristics with your surgeon during consultation.
④ Risk of Hyaluronic Acid Filler History on Surgery
Many patients consider "trying filler first before considering surgery," but research shows that prior filler injection can affect subsequent surgery. In a study of 48 patients with prior hyaluronic acid filler injection, the following was reported.
- Proportion with any adverse effect identified: 83.3% (40 of 48 patients)
- Incidence of infraorbital edema (under-eye puffiness): 25.0%
- Proportion with filler remaining in the preseptal (superficial) plane: 60.4%
- Proportion with suspected filler in the postseptal (deep) plane: 12.5%
- Proportion with abnormal tissue findings confirmed intra-operatively: 37.5%
- Proportion experiencing prolonged post-operative edema: 43.8%
Even in cases where hyaluronidase (filler dissolving agent) was attempted preoperatively for dissolution, 87.5% (42/48 cases) had unclear original filler volume, making it difficult to determine residual amounts. If you have a history of filler injection, you must always inform your surgeon before the procedure. Concealing this information can lead to unexpected risks.
⑤ Skin Excision Techniques and Scar Assessment Indices
In a randomized trial comparing two skin excision techniques in Double eyelids incision surgery, the following were used as primary evaluation indicators.
- Anterior eyelid lamella exposure (objective indicator of eye appearance): the clinically meaningful difference threshold is 1.3mm. The average anterior eyelid lamella exposure in eyes rated as most attractive is 26.1% of iris width, while in the least attractive examples it is 38.8%, providing reference values.
- POSAS (Patient and Observer Scar Assessment Scale): evaluated on a scale from 6 points (equivalent to normal skin) to 60 points (equivalent to worst scar). Continuous evaluation occurs at post-operative 6 and 12 months.
- Sutures are removed at post-operative day 7.
The beauty of scarring and the appearance of the double eyelid line are affected not solely by the surgical technique, but by a combination of skin excision amount, suturing technique, and post-operative care. Maintaining diligent post-operative follow-up is a shortcut to achieving favorable results.
What the Data Reveals: Knowledge Leads to Better Choices
Summarizing the research data above, the following can be said:
- Satisfaction rate for incision-method Double eyelids surgery is generally 80–83% and high, but approximately 20% of patients may feel dissatisfied with width or asymmetry.
- Even if initial surgery leaves dissatisfaction, appropriate revision surgery achieves 91.6% satisfaction. However, revision increases tissue burden.
- Depending on age, skin thickness, and eyelid structure, the risk of post-operative deformity can vary more than 4 times.
- History of hyaluronic acid filler carries the risk of 83.3% probability of some adverse effect on surgery.
- Scar quality is evaluated on a 12-month timeline, completing so slowly.
These data do not mean "Double eyelids surgery is dangerous," but rather demonstrate that "accurate understanding of your condition and discussion with your surgeon leads to the best results." At Zexis Clinic, during consultation we conduct careful risk explanation based on this evidence and propose surgical methods suited to each individual patient.
References
- Zhang S, et al. "Surgical outcome and patient satisfaction after Z-epicanthoplasty and blepharoplasty." International Journal of Ophthalmology. 2018; DOI: 10.18240/ijo.2018.12.07
- Author name and journal name undisclosed. "Secondary blepharoplasty for unsatisfactory double eyelid results." Published 2022.
- Author name and journal name undisclosed. "Prospective controlled study on periocular muscles and upper blepharoplasty outcomes." Publication year undisclosed.
- Author name and journal name undisclosed. "HA filler history and lower blepharoplasty outcomes." Publication year undisclosed.
- Author name and journal name undisclosed. "Randomized trial of skin excision techniques in upper blepharoplasty." Publication year undisclosed.
Summary: Regret can be prevented
While Double eyelids surgery is a frequently performed procedure, it is common for people to make decisions somewhat haphazardly. Thorough pre-operative research and choosing a trustworthy surgeon are your greatest weapons against regret.