Who is suitable for full incision Double eyelids? Organizing indications and limitations

Full incision Double eyelids is considered for people with thick eyelid skin or fat, excess skin, or those who want to directly adjust the fixation point. However, making an incision does not guarantee the desired outcome; design must account for scars, swelling, asymmetry, eye opening, and dry eye symptoms[1][2]。

In what cases is full incision appropriate?

Full incision becomes an option when simultaneously evaluating skin sagging (skin laxity), thick eyelids, abundance of orbital fat, and eye opening issues[2]。From the incision line, the skin, orbicularis oculi muscle, fat, and levator aponeurosis area can be directly visualized, and the Double eyelids fixation position can be adjusted. Recent techniques involving modifications to the fixation layer have been reported, but no single fixation method has been established as optimal for all patients[3]。

Is the only difference between full incision and buried suture method durability?

The difference between full incision and buried suture method is not simply a matter of duration. The buried suture method can limit the incision range because it uses sutures for fixation; however, the risk of re-operation due to suture loosening has been studied[4]。Full incision allows direct tissue adjustment but comes with the trade-offs of incision scarring and tissue changes during revision. Because long-term comparative data under equivalent conditions is limited, selection based on eyelid condition and acceptable recovery process is appropriate.[4]。Full incision allows direct tissue adjustment but comes with the trade-offs of incision scarring and tissue changes during revision. Because long-term comparative data under equivalent conditions is limited, selection based on eyelid condition and acceptable recovery process is appropriate.

How should scars and asymmetry be considered?

Scars and asymmetry are limitations that should be explained from the design stage of full incision. The very fact that methods for precisely designing the Double eyelids width shape and techniques for correcting excessively wide Double eyelids have been reported demonstrates that fixation position, skin volume, and tissue adhesion influence the outcome[5][6]。When there is pre-existing asymmetry in eyebrow height, eye opening, and skin volume, making the line symmetrical on both sides does not guarantee that the appearance will match.[5][6]。When there is pre-existing asymmetry in eyebrow height, eye opening, and skin volume, making the line symmetrical on both sides does not guarantee that the appearance will match.

Confirm dry eye and eye opening as well

In upper eyelid surgery, not only appearance but also lid closure and tear status are confirmed. Textbooks note that blepharoplasty of the upper and lower eyelids can cause dry eye, so careful candidate selection and surgical technique are necessary[7]。When ptosis is present, Double eyelids formation alone may be insufficient, and studies combining levator advancement have also evaluated dry eye symptoms[7]。When ptosis is present, Double eyelids formation alone may be insufficient, and studies combining levator advancement have also evaluated dry eye symptoms[1]。

Examination determines more than just the Double eyelids width

During examination, in addition to the desired line, excess skin, fat volume, eye opening, asymmetry, dry eye symptoms, and past surgical history are confirmed. Whether full incision is appropriate, or whether other options including buried suture method or ptosis treatment are better, is determined by the physician after assessing eyelid function and desired changes.