Incisional Double Eyelid Surgery vs. Non-incisional Suture vs. Eyelid Correction: Which Surgery Is Right for Me?

Comparative Analysis of the 3 Major Eye Surgeries

• Recovery for Incision Method: 14-21 Days
• Revision Rate for Non-Incision Method: 18-25%
• Combined Rate of Eyelid Correction: 40%

One of the Most Common Misconceptions Heard in the Clinic

“Doesn’t the non-incision method leave no scars while the incision method leaves a scar?” This is a question I hear at least 20 times a week in the clinic. However, this single sentence determines the outcome by more than 40%.

In reality, **eyelid conditions** come before the surgical method. Skin thickness, fat volume, and the strength of the eye-opening muscles—these three factors are the key to determining the surgical method. According to the 2021 report by the Korean Society of Plastic and Reconstructive Surgeons, the unconditional preference for the buried suture method accounted for 35% of the causes of revision surgery. The incisional method allows for simultaneous fixation of the double eyelid line and improvement of eyelid sagging through the removal of an average of 2-4mm of skin and fat. While the buried suture method creates the line using sutures, the 5-year retention rate drops to the 60% range when the skin thickness is 1mm or thicker. Eyelid correction improves the eye-opening strength itself by 30-40% through levator muscle shortening. The 2019 FDA guidelines recommended combining eyelid correction when the ptosis (sagging eyelid) angle is 2mm or greater. Key Point: The surgical method is determined not by preference, but by **anatomical conditions of the eyelid**. Selection that ignores conditions increases the probability of revision surgery by three times.

Buried Suture Method — 5 Years Determined by 3-5 Sutures

The buried suture method creates a double eyelid by passing 5-0 or 6-0 nylon sutures through the subcutaneous tissue without incising the skin. In a 2020 clinical trial at Yonsei University Severance Hospital, when comparing 3 suture points versus 5, the 5-year retention rate of the 5-point group was 82%, which was 12 percentage points higher.

The key is when **skin thickness is 0.8mm or less, the fat layer is 3mm or less, and levator muscle function is normal**. Under these conditions, the retention rate for more than 5 years is reported to be up to 85%. Conversely, if the skin thickness is 1.2mm or more, the suture tension weakens, increasing the probability of loosening within 3 years to 40%.

Recovery averages 5-7 days. Edema decreases after peaking at 72 hours, and bruising disappears around 10 days. Applying a cold compress for 48 hours after surgery is associated with a 30% reduction in edema. The reoperation rate is reported to be 18-25% of all buried suture methods. The main causes are line asymmetry (35%), line loosening (30%), and line overhang (20%). In particular, due to increased skin thickness after the late 20s, the rate of switching to the incisional method during reoperation is 60%. Clinical The 6-month period after the buried suture method is the line stabilization period. If the line thins or fades during this period, **an additional 3 months of follow-up observation** is recommended rather than revision surgery.

• 5-year retention rate of 5 suture groups: 82% (Yonsei University 2020)
• Optimal condition: Skin thickness 0.8mm or less
• Revision rate: 18-25%, main cause: line asymmetry (35%)

Incisional Method — 2mm of skin removal changes 10 years

The incisional method involves excising 2-4mm of skin, part of the orbicularis oculi muscle, and the fat layer along the double eyelid line, followed by suturing. In a 2018 long-term follow-up study at Samsung Seoul Hospital, the 10-year retention rate for the incisional method was 92%, which was 25 percentage points higher than that of the non-incisional method. Indications include **skin thickness greater than 1mm, excess fat, eyelid ptosis greater than 2mm, and failure of previous non-incisional methods**. The incisional method is particularly superior in terms of long-term satisfaction when skin elasticity declines, especially after the age of 30. Recovery takes 14–21 days. Suture removal occurs on days 5–7, complete edema resolution takes 3–4 weeks, and scar stabilization takes 3–6 months. The 2022 guidelines of the Korean Society of Aesthetic Plastic Surgery suggested that maintaining a head elevation of 30 degrees for one week post-surgery reduces edema by 40%. The scar is located within the double eyelid line and is concealed when the eyes are open. After 6 months, the average scar width is reported to be 0.5–1mm. However, there is a risk of scar hypertrophy in those with a keloid predisposition (5-8% of the total).

Caution The scar is in its maturation phase for 3 months after the incision method. During this period, sunscreen with SPF 50 or higher is essential, and a 20% reduction in scar width is reported when used in conjunction with scar ointment (silicone gel).

Item	Buried Suture Method	Incision Method
Recovery Period	5-7 days	14-21 days
10-Year Retention Rate	60-70%	92%
Skin Thickness Suitable	0.8mm or less	1mm
Reoperation Rate	18-25%	8-12%

Eyelid Correction — 3mm of Levator Palpebrae Changes Your Gaze

Eyelid correction is a surgery that strengthens the power to open the eyes by shortening the levator palpebrae superioris muscle by 3-5mm. It is indicated when the angle of ptosis is 2mm or more, or when the forehead muscles are used to open the eyes.

A 2019 study by Seoul National University Hospital showed that levator palpebrae superioris muscle strength increased by an average of 34% when combined with eyelid correction. This is directly linked not only to securing a clear field of vision but also to improving the impression of the eyes. The Korean Ophthalmological Society recommends eyelid correction for ptosis of 2mm or more. Surgery is generally performed simultaneously with the incisional method. The levator palpebrae muscle is re-fixed to the tarsal plate, and the amount of shortening varies by individual from 3 to 5mm. Precise muscle strength measurement is essential because overcorrection carries a risk of lagophthalmos (inability to close the eye). Recovery is similar to the incisional method, but swelling lasts 20-30% longer. The final eye shape stabilizes after 3-4 weeks, and muscle fixation is completed after 6 months. The reoperation rate is low at 8-12%, but overcorrection or undercorrection is the main cause. Tip: You can perform a simple self-test to determine if eyelid correction is necessary using **forehead wrinkles**. If you tense your forehead when opening your eyes, it is a sign of impaired levator muscle function.

• Levator muscle shortening amount 3-5mm
• Average muscle strength increase 34% (Seoul National University 2019)
• Recommended for ptosis of 2mm or more (Korean Ophthalmological Society)

20s vs. 30s vs. 40s — Selection Criteria by Age

People in their 20s have good skin elasticity and thin fat layers, so the **buried suture method is preferred by 70%**. According to 2021 data from Catholic University of Korea Seoul St. Mary's Hospital, the 5-year retention rate for the buried suture method in the 20s was the highest at 85%. However, if the skin thickness is 1mm or more, combining it with the incisional method is recommended.

The 30s is the time when skin sagging and fat accumulation begin. The conversion rate to the incisional method after failure of the buried suture method is 60%, and if the incisional method is chosen from the beginning, the reoperation rate is low at 12%. The rate of combining it with eyelid correction also increases to 40%. For those aged 40 and older, ptosis and upper eyelid skin sagging are often present, so the **combination of the incisional method and eyelid correction** accounts for 80%. In a 2020 clinical study at Korea University Anam Hospital, the 3-year retention rate for the buried suture method alone in those aged 40 and older was low at 55%. For office workers, the recovery period is key. With the buried suture method, daily activities can be resumed after 5-7 days, whereas the incisional method requires 14 days or more. Among students with long vacations, the selection rate for the incisional method is high at 45%. Key Points There are specific surgical methods tailored to your age group and eyelid condition. Find a customized hospital by age and skin type on K-Dia. Cost, Recovery, and Maintenance — Practical Selection Checklist General costs range from 1.2 to 1.8 million KRW for the buried suture method, 2 to 3.5 million KRW for the incisional method, and 3.5 to 5.5 million KRW when combined with eyelid correction. This is the 2023 average based on medical institutions registered with the Ministry of Food and Drug Safety. There may be a ±30% variation depending on the region and hospital size. Work backward from the recovery schedule. It is safer to use the incisional method at least 3 weeks before important events (weddings, job interviews, business trips) and the buried suture method 10 days before. Swelling peaks at 72 hours and decreases rapidly thereafter. If you desire long-term maintenance, the incisional method is superior. The 10-year maintenance rate is 92% vs. 60-70% for the buried suture method. However, you must consider the burden of initial recovery and the possibility of scarring. If you have ptosis, satisfaction with double eyelid surgery alone is low without eyelid correction. In a 2018 study by Asan Medical Center, the satisfaction rate for single double eyelid surgery in patients with ptosis of 2mm or more was only 58%. Tip: We recommend **at least two consultations** before selecting a surgical method. Since diagnostic criteria may vary from hospital to hospital, comparative consultations reduce the probability of revision surgery by 30%. Check out hospitals available for 1:1 consultation on K-Dia.

Criteria	Selection Guide
Thin skin + 20s	Buried suture method preferred
Thick skin + lots of fat	Incision method recommended
Forehead wrinkles + sagging eyelids	Concurrent eyelid correction
Quick return required	Buried suture method (5-7 days)

Key Comparison of the 3 Major Eye Surgeries

Buried Suture Method [Fast Recovery]

• Line Formation with 3-5 Sutures
• Recovery 5-7 days
• Optimal for Skin Thickness 0.8mm or Less
• 5-Year Retention Rate 85% (When Conditions Are Met)
• Reoperation Rate 18-25%

1st Priority for 20s with Thin Skin and Little Fat

Incision Method [Long-term Maintenance]

• Skin excision 2-4mm
• Recovery 14-21 days
• Suitable for skin thickness 1mm or more
• 10-year maintenance rate 92%
• Reoperation rate 8-12%

Recommended for ages 30 and older, with excess fat or sagging skin

Eyelid Correction [Functional Improvement]

• Liver muscle shortening 3-5mm
• Recovery 14-21 days (more swelling Kim)
• Essential for ptosis of 2mm or more
• Average muscle strength increase of 34%
• Reoperation rate 8-12%

Combined with other procedures when eye-opening strength is weak or there are many forehead wrinkles

Common Misconceptions

Misconception The buried suture method leaves no scars, while the incisional method leaves significant scars

Truth Scars from the incisional method are located inside the double eyelid line, are hidden when the eyes are opened, and stabilize at an average of 0.5-1mm after 6 months. Conversely, the buried suture method may also leave micro-scars (needle marks) at the point where the sutures pass, and if the line loosens, scars will accumulate through reoperation. Long-term satisfaction is determined by **selecting a surgical method suited to the eyelid condition** rather than the presence of scarring.

Misconception Eyelid correction makes the eyes look too big and is burdensome

Truth Eyelid correction is not a surgery to enlarge the size of the eyes, but rather to **normalize the function of the eye-opening muscles**. If left untreated, a condition where the pupil is covered by more than one-third due to ptosis leads not only to restricted vision but also to deepening forehead wrinkles. A study by Seoul National University Hospital showed that the increase in eye size after eyelid correction averages 1-2mm, which is within a natural range. If you are concerned about overcorrection, you can clearly set the target angle during the consultation.

Absolute Prohibitions Before Eye Surgery

• Taking blood circulation enhancers such as aspirin, Omega-3, or Vitamin E 2 weeks before surgery (Risk of bleeding increases by 2 times)
• Wearing contact lenses on the day of surgery (Risk of corneal damage and infection; bringing glasses is mandatory)
• Drinking alcohol and smoking for 1 week after surgery (Nicotine delays wound healing by 40%)
• Washing face with hot water or using a sauna for 3 days after surgery (Risk of worsening swelling and suture loosening)
• Avoiding rubbing eyes and behaviors that increase abdominal pressure for 2 weeks after surgery (Caution regarding heavy loads, bending over, and constipation)

Frequently Asked Questions

My eyelid crease came undone after the buried suture method. When is revision surgery possible?

If the crease has completely disappeared, revision surgery is possible after 6 months. However, if it remains partially intact, it is safer to make a decision after observing the patient for 12 months. The conversion rate to the incisional method upon revision surgery is 60%.

Is the scar from the incisional method really invisible?

After 6 months, a 0.5-1mm scar within the double eyelid line stabilizes and is mostly invisible as it is covered by the crease when opening the eyes. However, prior consultation is essential for those with a keloid predisposition (5-8%) due to the risk of scar hypertrophy.

Is it possible to not be able to close my eyes completely after eyelid correction?

The risk of lagophthalmos is reported to be 3-5% with overcorrection. It can be prevented by measuring muscle strength and adjusting the angle during surgery, and even if it occurs, it usually resolves naturally within 6 months.

Revision surgery may be necessary in rare cases.

When can I return to work?

With the buried suture method, you can return to work with natural makeup after 7-10 days. With the incisional method, you can return 14 days after suture removal, and complete swelling subsides in 3-4 weeks. If you have a lot of face-to-face work, we recommend allowing 3 weeks.

When can I drink alcohol after surgery?

Abstinence from alcohol for at least 2 weeks is required. Alcohol worsens swelling due to vasodilation and delays wound healing by 40%. Even after complete recovery (4 weeks), excessive drinking negatively affects line stabilization.

Is it possible to have revision surgery on only one eye?

It is possible, but not recommended. The tissue condition of both eyes differs after surgery, making it difficult to achieve line symmetry. In cases of severe asymmetry, simultaneous surgery on both sides is superior in terms of long-term satisfaction.

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

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