There's a reason why people who have experienced the buried-suture method coming undone ultimately choose incision.
Among Asians, only 50% are born with a double eyelid. As a result, many people want double-eyelid surgery and first choose the easy, no-scalpel "buried-suture method." However, with the buried-suture method, the thread tends to loosen with repeated blinking, and there is always the risk of the double-eyelid line gradually fading or completely disappearing. There are clear scientific and anatomical reasons for ultimately arriving at the "incision method" to escape the loop of repeated buried sutures and obtain permanent beauty. Reading the long-term clinical data and latest techniques, this article approaches the reality of the incision method.
What Is the Incision Method—The Fundamental Difference From the Buried-Suture Method
The buried-suture method fixes the levator aponeurosis to the subcutaneous tissue of the eyelid using only medical thread. Because it relies only on the physical force of the thread, it has the structural weakness that the thread easily loosens with movements such as blinking.
In contrast, the incision method incises the eyelid skin through all layers, removes subcutaneous tissue and excess fat, and then artificially forms a "scar adhesion" between the levator aponeurosis and the skin. Rather than relying on thread tension, one's own tissues firmly adhere to each other and create a new structure, so a stable, long-lasting double eyelid can be formed.
Is "Lasting a Lifetime" True—Reading the Long-Term Outcome Data
The contrast of "if you just get through the 2-week downtime, you'll get a lifetime double eyelid" is the biggest motivation for patients who want the incision method. The incision method is indeed extremely durable compared with the buried-suture method, and the crease lasts.
However, the data show that the post-op reoperation rate is by no means zero. In a study of 159 patients, the reoperation rate of the levator advancement method was 18% (Chen et al. 2023). Also, in a study of 274 patients who underwent bilateral surgery for age-relatedptosisptosis, 32.5% of patients needed some kind of reoperation (Chen et al. 2023) or fine adjustment.
In other words, the tissue adhesion from the incision method itself is firm and can become a lifetime thing, but due to factors such as age-related skin sagging or post-op asymmetry, there are also cases requiring fine adjustment—this is the medical truth.
Full Incision vs. Partial Incision—Which to Choose?
Pros and Cons of the Full-Incision Method
This is the orthodox technique of incising the entire eyelid in a long line. It can remove excess skin, orbicularis oculi muscle, orbital fat, and so on over a wide area, and is best for improving puffy eyelids. On the other hand, the incision line is long, scars tend to be conspicuous, and downtime drags on. Removing too much tissue also risks an unnatural result.
Pros and Cons of the Partial-Incision Method
In a study where a modified partial-incision method making only three 2 mm small incisions (Chen et al. 2023) was performed on 132 patients, 97.7% of patients were satisfied with the post-op appearance, and after 3 months the scars were almost invisible. However, it is not suited to patients with extremely abundant eyelid fat or strong skin laxity.
The Evolution of the Latest Techniques—What Are Orbicularis-Sparing Incision and the DOSF Method
Orbicularis-Sparing Incision (OOM-Sparing)
In the latest technique, the orbicularis oculi muscle is preserved without being excised, and the levator aponeurosis is exposed through a small gap for suture fixation. Leaving the muscle prevents a hollow in the double eyelid and forms a natural, dynamic double eyelid, and post-op recovery is also faster. A study of 227 patients also demonstrated natural results with few scars (Lu et al. 2024).
The DOSF Method
In the DOSF method, the skin (dermis) is fixed to the SAJT (septoaponeurosis junctional thickening). In a large-scale study of 4,129 patients at Beijing Jishuitan Hospital, the FACE-Q score rose significantly from 51.43 pre-op to 73.36 post-op (Yang et al. 2025), and the majority of patients were satisfied with the result. It is easy to adapt to the puffy eyelids characteristic of Asians and can avoid a static, unnatural line.
The Reality of Downtime—The Post-Op Course Timeline
Can the Incision Method Be Revised? Recovery in Case of Failure
Revision of the incision method is possible, but the difficulty jumps sharply compared with the first surgery. The biggest risk factor is "pre-op asymmetry." The reoperation rate for patients with a difference of 1 mm or more in MRD is 42.7% (odds ratio 1.90 compared with 28.1% for no asymmetry). This is because, by Hering's law, manipulating one side disrupts the balance of the other.
As recovery measures, there is the technique of simultaneously excising and shortening the tarsus and levator, and the approach of suppressing frontalis overactivity with botulinum toxin injection before proceeding to revision surgery.
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References
- Lu et al. 2024. The Orbicularis Oculi Muscle Sparing Full-Incision Double-Eyelid Blepharoplasty. Aesth Plast Surg. 2024 DOI
- Chen et al. 2023. Small-incision, mini-dissection, orbicularis-preservation, and orbicularis-levator aponeurosis fixation technique: A modified partial-incision double-eyelid blepharoplasty. JPRAS. 2023 DOI
- Jin et al. 2020. Tarsal-Fixation With Aponeurotic Flap Linkage in Blepharoplasty: Bridge Technique. Aesthet Surg J. 2020 DOI
- Yang et al. 2025. Dermis-Orbicularis Oculi Muscle-Septoaponeurosis Junctional Thickening Fixation Technique for Double Eyelid Blepharoplasty. Aesth Plast Surg. 2025 DOI
About the Author
Hiromitsu Nakamura M.D.
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
Has a track record of research presentations at domestic and international conferences, and is also involved in technical guidance and education across Zetith Beauty Clinic. Specializing in precise cosmetic medicine based on anatomical evidence, he pursues natural results tailored to each person's bone structure and tissue.