Complete Analysis of 7 Eye Surgery Methods - Which Method Is Right for My Eyes?

An Accurate Selection Guide from Incisional to Non-Incisional Methods

• Detailed Mechanisms of 7 Surgical Methods
• Suitability Matrix by Skin Thickness and Fat Volume
• Difference in Recovery Period: 14 Days vs. 4 Days

The Most Frequently Asked Question in the Clinic — “Isn’t the non-incisional method always better?”

In the first consultation, 8 out of 10 patients request, “Please do the non-incisional method.” However, if the skin thickness is 1.5mm or more and the ptosis is 2mm or more, the risk of the non-incisional method coming undone within 6 months exceeds 40%.

Eye surgery is broadly divided into four categories: buried suture method (non-incisional), incisional method, eye shape correction, and epicanthoplasty. Each is further divided into 2-3 detailed methods. The 2019 guidelines of the Korean Society of Plastic and Reconstructive Surgeons recommend prioritizing anatomical conditions over patient needs. This article explains those criteria through 7 surgical methods. Key Point: When choosing a surgical method, 'my eyelid structure' comes first, not 'the line I want.' Ignoring structural factors increases the reoperation rate by three times.

• Conditions for Non-Incisional Supplementation: Skin thickness 1.2mm or less, fat grade 2 or less, ptosis less than 1mm
• Scar Width for Incisional Method: Micro-incision 0.5-0.8mm, Partial incision 1-1.5mm, Total incision 1.5-2mm
• Liver Muscle Resection Amount for Eyelid Correction: Mild 1mm, Moderate 2mm, Severe 3mm

Buried Suture Method (Non-Incisional) — The Truth About 3 Knot Types and Duration

The buried suture method is a technique that fixes the skin with sutures without cutting it. However, 'non-incisional = no scars' is only half true. 6 to 8 needle marks remain for two weeks, and if there is a lot of fat, the sutures dig in, causing micro-indentations. There are three main methods: continuous buried suture, partial buried suture, and multi-knot method. The continuous buried suture method uses a single thread to stitch multiple points, resulting in a natural look, but if one spot comes undone, the entire structure collapses. The multi-knot method is safe due to independent fixation but creates a sense of thickness. According to 2022 data from the Journal of Plastic Surgery, the 5-year retention rate for the buried suture method is 82% when the skin thickness is 1.0 mm or less, but drops to 38% when it is 1.5 mm or more. For fat grade 3 or higher, the rate of loosening within one year was 65%. Recovery is fast. Swelling lasts 3-4 days, and bruising lasts 7-10 days. However, the incidence of perisuture granuloma is reported to be 5-8%, and in such cases, re-operation is required within 6 months. Clinical suitability of the buried suture method is primarily determined by the 'eyelid pinch test'. If the thickness is 1cm or more, the incision method should be considered.

Incision Method — Differences between Micro/Partial/Full Incision and Strategies for Minimizing Scarring

The incision method opens the skin and adjusts fat and muscle. Although it results in scarring, the retention rate for over 10 years is reported to be over 95%, and the reoperation rate is one-quarter that of the buried suture method.

The micro-incision method involves making an incision only 8-12mm in the center of the double eyelid line and fixing the eyelids without removing fat. Swelling subsides quickly within 7-10 days, but the effect is limited if there is a lot of fat. Partial incision involves removing a portion of fat through a 20-25mm incision, while total incision involves making an incision along the entire line to adjust fat, muscle, and skin. Scar width varies depending on the suturing method. It is 1.5-2mm with 7-0 nylon simple sutures, 1-1.2mm with 6-0 absorbable continuous sutures, and reduced to 0.8mm or less when combined with tissue adhesive (Dermabond). A multi-center study showed that combining Healite LED treatment, approved by the Ministry of Food and Drug Safety in 2021, for 3 days immediately after surgery promotes collagen rearrangement, reducing scar width by an average of 28%. Caution: The use of double eyelid tape is strictly prohibited for 2 weeks after the incision method. Suture compression increases the risk of hypertrophic scarring (keloid) threefold.

• Suitable for micro-incision: Grade 1-2 fat, skin sagging 1mm or less, for line alteration
• Suitable for partial incision: Grade 2-3 fat, eyelid swelling, asymmetry correction
• Suitable for full incision: Grade 3 or higher fat, accompanied by ptosis, revision surgery

Eyelid correction — 70% improvement in eye-opening strength through levator muscle adjustment

Eyelid correction is a surgery that strengthens the ability to open the eyes by shortening or folding up the levator muscle. It is indicated when ptosis is 2mm or more.

For mild ptosis, a 1mm resection of the levator muscle increases pupil exposure by 1-1.5mm. For moderate cases, a 2mm resection improves by 2-2.5mm, and for severe cases, a 3mm resection improves by more than 3mm. However, the incidence of overcorrection is reported to be 18% when resecting more than 3mm. If overcorrection occurs, a 1-2mm gap forms when closing the eyes, causing lagophthalmos. In this case, artificial tears 6-8 times a day are essential, and re-surgery to re-lengthen the levator muscle is required. In 2020, the Korean Ophthalmological Society recommended 'real-time monitoring of the levator muscle resection amount with the patient seated during surgery.' Local anesthesia plus sedation offers higher accuracy than general anesthesia. Tip: Eyelid correction is often performed simultaneously with double eyelid surgery. At K-Dia, 'Eyelid Correction Concurrent Surgery' Compare experienced hospitals.

Eyelid Opening Surgery — 3 Selection Criteria for Epicanthoplasty, Lateral Canthoplasty, and Lower Eyelid Opening

Eyelid opening is a surgery that increases the horizontal and vertical length of the eye. Epicanthoplasty involves the excision of the epicanthal fold, lateral canthoplasty involves the incision of the lateral canthal ligament, and lower eyelid opening involves the lower eyelid margin.

There are three methods for epicanthoplasty: W-type, Z-type, and simple incision. The W-type has a significant scar dispersion effect, but a red line remains for 6 months. With the Z-type, the scar fades within 3 months, but the cost is 20-30% higher. Simple incision allows for faster recovery, but the recurrence rate is 15%. Lateral canthoplasty lengthens the eye by incising the lateral canthal ligament by 2-3mm. However, if the ligament is over-incised, a side effect of the outer corner of the eye drooping downwards to create a 'sad eye' shape is reported in 12% of cases. Lower eyelid canthoplasty lengthens the vertical length by incising the conjunctiva of the lower eyelid. Scleral show increases by 1-2mm, and the incidence of dry eye syndrome is high at 25%, making artificial tears essential for 3 months. Caution: For canthoplasty, the 'eye spacing and ratio' must be measured before the 'eye size target'. If the medial canthal gap is 32mm or less, epicanthoplasty will look unnatural.

• Suitable for Epicanthoplasty: Mongolian fold 2mm or more, medial canthal gap 34mm or more
• Suitable for Lateral Canthoplasty: Lateral obtuse angle 120 degrees or more, eye length 28mm or less
• Suitable for Lower Eyelid Canthoplasty: Vertical length 9mm or less, insufficient sclera exposure

Suitability Matrix — Surgical method determined by 3 elements: skin, fat, and muscle

The choice of eye surgery is a combination of three factors: skin thickness, fat volume, and levator muscle function. If skin thickness is 1.2mm or less, fat grades 1-2, and the levator muscle is normal, the buried suture method is used alone; if skin thickness is 1.5mm or more, fat grade 3, and the levator muscle is weakened, the full incision method is combined with eyelid correction. For those in their 20s, skin elasticity is high, so the 5-year retention rate for the buried suture method is 75%, but for those in their 40s, due to skin sagging, the 3-year retention rate drops to 45%. From the late 30s onwards, partial incision reduces the revision rate by 30%. Men have an average skin thickness of 1.8mm, which is 0.4mm thicker than women, and have more fat, resulting in a 70% rate of full incision. For women, the distribution is 40% for the buried suture method, 35% for partial incision, and 25% for full incision. For revision cases, the incision method is chosen in 90% of cases. Micro-incisions are not suitable because previous surgical scar tissue and adhesions must be separated. Key Point: Knowing your eye structure accurately is the first step. K-Dia’s ‘Precision Analysis System’ Find a hospital equipped with these features and receive a 1:1 consultation.

Key Comparison of Buried Suture vs. Incision vs. Eyelid Correction

Common Misconceptions

Contraindications to Check Before Surgery

• Patients with hyperthyroidism or proptosis have a 2x higher risk of overcorrection during eyelid correction (consultation with an endocrinologist is essential)
• Patients with a keloid predisposition have a high risk of scar hypertrophy with the incisional method — combine micro-incision + silicone sheet for 6 months
• Lower eyelid surgery is contraindicated for patients with severe dry eye syndrome (relative contraindication if Schirmer test is 5mm or less)
• If taking aspirin or Omega-3, discontinue use 2 weeks prior to surgery (increased risk of bleeding and bruising)
• Reoperation is recommended after at least 6 months (tissue adhesion stabilization is necessary)

Frequently Asked Questions

This content is for informational purposes only and does not replace medical advice. You must consult a specialist before the procedure.

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