How long do full-incision Double eyelids last? What research can tell us and its limitations

While high satisfaction with the surgery is reported, research demonstrating how long the results last is still limited. Upper eyelid surgery is said to have high satisfaction among both patients and surgeons[1], and improvements in visual field narrowing and quality of life have also been reported[2][3]. However, there are few long-term follow-up studies examining how well the Double eyelid shape is maintained, and the range of what can be said at this point is wide[4].

Can we say satisfaction is high?

Textbooks describe upper eyelid surgery as a technique with high satisfaction among both patients and surgeons.[1]There are also retrospective reports examining postoperative outcomes of upper blepharoplasty in Asian patients, demonstrating effectiveness in cases involving Sagging (skin laxity) and similar conditions[5]. However, research using standardized scales answered by patients themselves is still limited, and it has been noted that evidence in this field is still developing[6].

How much do vision and physical condition change?

Cases have been reported where reduction in ptosis improves visual field narrowing. The Japan Society of Plastic Surgeons guideline proposes implementation of surgery for eyebrow ptosis and associated upper eyelid drooping, as improvements in both symptoms such as visual field narrowing and appearance can be achieved.[3]There are also prospective studies examining quality of life related to headaches and dry eyes before and after Sagging (skin laxity) surgery, with postoperative improvements reported.[2]. However, the same effects cannot necessarily be applied to full-incision surgery for cosmetic purposes.

How common are complications and revision surgeries?

I can only provide a range of figures. The American Society of Plastic Surgeons' guidelines indicate that for upper eyelid surgery addressing visual field impairment, complication rates are 2–10%, and revision surgery rates vary by technique from 1–72%.[7]The upper limit of 72% represents a specific technique and does not reflect the revision rate for cosmetic Double eyelids surgery itself. This wide range reflects the lack of standardized procedures and target populations.

Is the difference between suture types settled?

This is relatively clear. A systematic review comparing absorbable and non-absorbable sutures in upper eyelid surgery concluded that clinical outcomes were equivalent.[6]Another comparative study reported no significant difference in primary outcomes and complication rates.[8]However, the former explicitly acknowledged its limitation of being based on limited heterogeneous data, and quantifying the burden of follow-up visits and suture removal remains a future task.[6].

How much long-term stability has been confirmed?

The longest direct data available is 4.5 years. A 4.5-year retrospective cohort of buried-suture techniques reported that the revision surgery rate decreased and long-term stability of Double eyelids shape improved in the group where upper eyelid fat was removed.[4]This is knowledge about buried-suture techniques, and no randomized controlled trial directly comparing the longevity of full-incision versus buried-suture methods has been found. When asked how long results last, the honest answer is that we are not yet at a stage where we can answer with established figures.

How do we use this range in clinical examination?

The practical approach is to take the range of figures and reframe it as a question for your own situation. The range of 2–10% complications and 1–72% revision surgery must be reapplied to your own surgical technique and goals to be meaningful.[7]The guidelines cite checking for asymmetry and eyelid closure difficulty at 1–3 months postoperatively and, ideally, at 9 months to 1 year as good clinical practice.[7]In your consultation, confirm your own prognosis and which research study the basis comes from with your physician.