Services 》Suture Double Eyelid Operation

After seeing the videos below, you can have a guick understanding about suture double eyelid operation and epicanthoplasty. 

Double eyelid operation is quite common in Oriental country. 
People with double eyelid folds look brighter and eyes look larger than people with single eyelid folds.
Upper eyelids of people with single eyelid folds cover upper part of eyes, so that their eyes look smaller and sleepy. 
The other reason of small eyes is ptosis which will be dicussed below.

The basic principle of double eyelid operation is to produce adhesion between skin and underlying levator or tarsus. 
There are two ways of producing adherence. One is suture method (non-incision method) . The other is incision method (the introduction of incision method was presented in another section of website).

The procedure of suture method is simple. Before operation doctor will discuss with patients the location where to put sutures. 

Then non-absorbable stitches are inserted into eyelids under local anesthesia. Small pinhole wounds are left on eyelids, so that no scars will be seen.   The stitches do not have to be removed.

Suture method originated in Japan. Dr. Jong visited Otsuka Clinic in Tokyo in 1997 and modified their way of suture method.  The fading rate is lower than original method. The recovery is quick. Most of people can go shopping right after surgery. Because there are only pinhole wounds on eyelids, wound healing is quick. Make-up on eyelids is allowed on next days.There is almost no down- time for most of people.

                          Before                                               Ten minutes after surgery

The other advantage of suture method is that it is a reversible procedure.
It means that if you do not like the result( rarely occurred), the stitches can be removed and eyelids back to original appearance. The location of stitches can be adjusted if asymmetric occur.
Because the recovery is quick, many women with lower folds visit our clinic to heighten the folds.

Preoperative preparation
Contact lens do not have to be removed in the operation. Eyelash extension and artificial eyelashes may interfere with operation, so that it is better to remove them before surgery.

  before                                                  immediately after surgery               five months after surgery

 before                                                  immediately after surgery               9 months after surgery

before                                                    immediately after surgery              4 months after surgery

    If asymmetric occurs, old stitches can be taken out and put another stitches to adjust height of folds.
Below case showed how the higher right fold was lowered.

    The below case showed before (left) and one year after suture method(middle).  Later on she regretted the choose she made. She wanted to have higher folds. Right picture showed the result of higher the folds on three months after second suture double eyelid operation.

    Below case has underwent incision double eyelid operation at another clinic. Unfortunately the folds were fading(loss of folds) (Below left). She was satisfied with the result after suture double eyelid operation in our clinic.( Below right)

    In cases with good eyelid condition (thin eyelids, young age), fading rate after suture double eyelid operation is low.
Below shows some cases with long follow up.

before                                                   immediately after surgery                4.5years after surgery

before                                                    immediately after surgery               6.5years after surgery

before                                             7 years after surgery

Before                                   Immediately after surgery       1.5 years after surgery              No scars were seen.          

Before                                            Immediately after surgery      9 days after surgery               4 years after

If the patients with puffy eyelids decided to undergo suture double eyelid operation, it would take longer time to have natural look than patients with thin eyelids. The fading rate of double eyelid folds was higher and fading may occur in half a year. Dr. Jong will advise the patients on the appropriate method during the consultation.

  • Is the result of suture method the same as incision method?

    If your eyelids are puffy, it is better to choose incision method

    The left picture of below case was taken one year after suture method. The left double eyelid fold is very good. Her left fold existed but loosed, so that left upper eyelid skin covered the roots of the eyelashes, making right eye looked smaller than left eye. She decided to switch to incision method.
    Below right picture was taken on two years after incision method. Her eyes are symmetric. She is happy with the result. 
    Eyelids are asymmetric in some people. Right eye usually is puffier than left eye. The double eyelid folds after incision method is stronger and last longer than suture method. So that incision method is recommended for people with puffy eyelid. 

    The recovery from incision method maybe faster than suture method.
    The following lady decided to receive suture method firstly. Below left picture was taken immediately after suture method. 
    Because of fading of double eyelid folds, she decided to receive incision method.          Below middle was the picture immediately after incision method. Below right was the picture on fifth day after incision method when she came for stitch removal. She thinks that the recovery from incision method is quicker that suture method for her. 
    Is the result of cutting and sewing the same?
    Below left picture: Before the operation, she sometimes has double eyelid fold on her right eye, but single fold on left eye.
    Bottom middle picture: Immediate picture after suture method.
    Bottom right picture: Two years after suture method. She though her folds were not long enough, especially right fold. She decided to receive incision method. 

    Below left picture: Immediate picture after incision method. It is not so swelling, comparing with suture method. 
    Below right picture: Picture on one year after incision method.

    Bottom left picture: the enlarged view of the right eye after suture method. 
    Bottom right picture: the enlarged view of the right eye after incision method. 
    You can see the difference between them. The fold after incision method is stronger and longer than suture method. The reason is that the fat in the eyelids was not treated in suture method. The fat will interfere the depth and stability of folds , so that folds were loose and shorter after suture method.  

  • There is a special subject in my website which introduced incision double eyelid operation.  Please refer to it.

    After incision double eyelid operation, tissue ahderence will be formed.  That is stronger than stitches used in suture method.  The fat can be treated at the same time.  So that fading rate is lower than suture method.  Below showed the situations that is more suitable for incision method.

    (1) Puffy eyelid.  Fading may occur in half an year after suture double eyelid operation in cases with puffy eyelids.
    Below case 1 showed the appearance after suture method.  The fold on her right eye was faded on fifth month due to puffiness of her eyes.  Case 2 showed shallow of fold (not complete fading).  Case 3 showed the appearance on 1.5 year after suture method. Shallow of left eye was noted.

    (2) Ptosis.  To correct ptosis, levator surgery is needed.  Please refer to Incision Double Eyelid Section in website.
    The left eye of below case was ptosis, so that left eye was small than right eye. Below left was the picture after suture method.  Left eye was smaller because ptosis was not corrrected in suture method.

    (3) Sunken eye.  Fat injection to sunken eye is recommended.  Otherwise the fold on sunken eye would be shallow.
    Below left was the before picture.  Middle was the appearance immediately after suture method.  Left wasthe picture at 2 months  after surgery.  Left eye fold was shallow than right eye because the fat on left eye was less than right eye. 

    (4) Aged eyelids.  Fading after suture method is higher on patients with aged eyelid.  The hooding of aged eyelids can not be corrected by suture method.  It is better to excise the hooded eyelid skin by upper blepharoplasty (incision method).
    Below was a 43 years old woman.  Left was before.  Middle was the picture immediately after suture method.  Right was the picuture at 2 months after surgery.  Fading on lateral fold of left eye was noted. 
  • Epicanthal fold or Mongolian fold is a unique feature of Asian population.  

    The medial canthal area shows distinctive variation.
    In some Asian people the epicanthal fold cover lacrimal lake (the arrow on the next second picture pointed to lacrimal lake), so that eyes look far apart.
    After epicanthoplasty, lacrimal lake is not covered by epicanthal fold.

    Above pictures: Lacrimal lake (arrow) was not coved by epicanthal fold after epicanthoplasty.

    There are three types of double fold.
    1. Inside fold fold      3.parallel fold
    Inside fold: the double fold at medial end intersects with eyelid margin.
    Fan-shaped fold: double fold at medial end separated a little bit with eyelid margin.
    Parallel fold: the fold is parallel with eyelid margin.
    The latter two types belong to outside folds.
    Here are the eyes of famous female stars.

    As can be seen from the above photos, most of the stars' eyes are fan-shaped folds.
    Basically, outside folds look bigger than inside folds.
    How to make outside folds?
    (1)Start with the design of double fold operation.
    The folds may be parallel when suture at high position

    Upper left picture: Before surgery.
    Upper middle picture: After suture method, the right eye is fan shaped. Left eye is inside-fold.
    Upper right picture: The left fold was revised by suture method. After revision, two double folds are fan-shaped and symmetrical.
    Upper left picture: Before surgery.
    Upper right picture: After suture method, double folds are parallel.
    Upper left picture: Before surgery. The right eye was inside fold. Left fold was fan-shaped.
    Upper right picture: After suture method, double folds on both eyes are parallel.

    2Epicanthoplasty is needed.
    Upper left picture: Before the operation.
    Upper right picture: Picture after suture method. Although the suture position is high, the folds are inside due to the traction of epicanthal folds (marked with red line ).

    Upper left picture: Before the operation,
    Upper middle picture: After suture method, folds were inside.
    Upper right picture: After epicanthoplasty, the folds are parallel.

    Upper left picture: Before the operation. Her eyelids are puffy. Her epicanthal folds are not obvious.
    Upper right picture: The result after suture method. Her eyes are bigger than before surgery. It is not easy to make parallel folds for patients with puffy eyelids after double eyelid operation and epicanthoplasty.

    (3) Parallel folds may not be beautiful.


    Upper left picture: Before operation.
    Upper right picture: After double eyelid suture. Parallel folds are beautiful or not is a matter of person judgment.

    Before the operation, the doctor will discuss with you the design of double folds by mimicking the appearance of double eyelid folds by two iron sticks as shown below.

    Cases of suture double eyelid operation and epicanthoplasty.

  • Asymmetry

    Most common cause of asymmetric eyes is asymmetric folds.  Eye with lower fold looks smaller than eye with higher fold. There are two ways to correct asymmetry.  

    1. One is suture double eyelid operation on eye with lower fold.  
    2. The other is incision double eyelid operation on both eyes.  

    The reasons of why not incise only on eye with lower fold are:

    1. The fold on operated side will be higher than the other side in recovery period.
    2. After recovery, there may be some asymmetry between operated side and natural side. Another incision method may be needed to correct te problem. 

    Below showed a case with asymmetric eyes.  Left is before picture.  Middle is immediate result after suture on right eye.  Right is picture after 7 months. The recovery from sutrue method is usually quicker and it is ususlly not so swollen after suture method.

    And it is easier to correct the discrepancy of folds after suture method. So that it may consider to have suture method done on the lower fold side



  • Tarsus means the lower end of upper eyelid where is also the location of eyelashes.

    Ptosis means the tarsus is located at lower position when eye open, as the lower left eye (right eye is normal eye) of below picture. Ptosis eye looks sleepy.

    Suture method is method to make double folds. Suture method can not correct ptosis. To correct ptosis, levator or Muller muscle surgery is needed. Please refer to the introduction of incision method in the website. .

  • Cosmetic surgery is no longer for women. More and more men also want to have bright eyes.

    It seems that sleepy eyes are at a disadvantage side in searching job and romance.

    Unlike women, men who are usually more conservative will hope that the  recovery can be as soon as possible , so that the surgery can be unnoticed by others.

    The recovery from suture method is fast, so many men choose suture method.

    Comparing with women, men have higher frontal bones, lower eyebrow positions, and puffy eyelids.

    In this case, the chance of fading of double folds is higher. The doctor will evaluate your eyelids in the consultation.

    In the picture below, the male has a single fold on his right eye and double fold on his left eye.

    It was quite obvious that right eye was smaller than left eye.

    The left picture is before the operation, and the middle picture is immediate  after suture method on his right eye. The picture on the right is one month after suture method. His eyes are symmetrical.

    Left picture: before operation, middle picture: immediately after operation, right picture: one month after operation

    Because the facial structure of men is different from that of women, the double folds are usually lower than women, so that man with lower folds look quite natural. Eyes with lower folds look energetic than single folds (before operation).

    Upper left picture: before operation, middle picture: immediately after operation, right picture: one year after operation

    Upper left picture: before operation, middle picture: immediately after operation, right picture: 1.5 years after operation

    Some men choose to have higher folds, as shown in the below cases.

    Left picture: before operation, middle picture: immediately after operation, right picture: one month after operation

    Left picture: before operation, middle picture: immediately after operation, right picture: one month after operation

    Left image: before operation, middle image: immediately after operation, right image: three months after operation

    Left image: before operation, middle image: immediately after operation, right image: one month after operation

  • 1.Take painkillers( for wound pain -acetaminophen 500mg, which does not hurt the stomach ) . Take one pill at a time, one pill every 4-6 hours.

    2. Ice packing in first 3 days to release pain and swelling. Change to warm packing on 72 hours after surgery.
    There will be bruises around the eyelids, which will go away within one to two weeks. (Warm compress can accelerate the resolution of bruises).
    * The ice/warm compress time is based on the principle of 30 minutes of application and 30 minutes of rest.

    3. No need to apply any medicine to the wound.
    4. Some people have some foreign body sensation in their eyes after surgery, which will improve after 2-3 days.
    5. Please do not wash your eyelids on the night of the surgery. Wash your face and make-up normally after the next day.
    6. Please do not rub your eyes hard after the operation, and gently remove contact lens and makeup on eyelids.
    7. After suture double eyelid surgery, there may be differences in the height of the two sides due to different swelling. If the height of the two sides is very different after 1 month, please return to the clinic for checkup.
    8. If you want to have eyelash extensions, it is best to wait for the double eyelid folds to stabilize (after one month).

  • Q: Is it suitable for everyone to receive double fold surgery?
    Does everyone look better after suture or incision double fold surgery?

    A: In the consultation, Doctor will use two sticks to simulate the postoperative appearance. You can judge the appearance is beautiful or not. Most of patients like the postoperative appearance. If you doubt about the result, you may choose to have suture method. If you really do not like the eyes with double folds, you can choose to remove the stitches to resume your previous appearance. If your eyelids are puffy, incision method is recommended. Double eyelid operation is a common practice in our clinic. Most of patients are happy with the result.

    Q: I would like to ask will I see the stitches when I close my eyes?
    Is it true that granulation tissue will grow on the stitch sites of suture method ? In suture method, there is three-point method. Will five-point be more stable than three-point method? Will surgeon adjust the suture location to better sites for better result during the surgery? Will the stitch removal leave scars on eyelid?
    A: The sutures used to sew double eyelids are hidden under the skin. A small number of patients with thin eyelids may see small nodules caused by knots of the sutures.
    We have our own way of suture method. I think our method is more stable than three or five-point method.
    During the operation, Doctor will adjust the location of stitches to achieve the best result. Rarely will granulation tissue occur on the eyelids. There will be a very tiny wound if removing stitches are needed.

    Q: What is the material of the stitches of suture method?  Can it be absorbed by the human body?
    A: The suture is a non-absorbable suture. The thread left on the eyelids is thin and short, which has no effect on the body and does not need to be removed.

    Q: How to decrease the chance of fading of fold after suture method?
    A: Our advises are being gentle to eyelids, such as not to rub their eyes too hard, being gentle when wearing contact lenses and cleaning make-up on eyelids, etc
    The most important is the condition of eyelid. Thin and young eyelids are less likely to lose folds after suture method.

    Q: There is the so-called stapler method. Do you use stapler?
    A: Stapler method is another term of suture method. Our double eyelid method has been improved for more than ten years, with less postoperative swelling and faster recovery.
    If you use double eyelid glue to make your eyes look more energetic, and your eyes are bubble,you should consider cutting double eyelids to make your eyes beautiful once and for all.

    Q: How old is a girl who can receive double fold operation?
    If she is too young, may her eyelids be not stable?

    A: People face may not be stable before 18 years old. In Taiwan, the regulation is that the youngest old to have cosmetic eyelid surgery is 18 years old.

    Q: Can I receive double fold surgery if I already have lower folds?
    A: Eyes with higher folds look brighter than lower folds. You can receive double fold operation to increase the fold height as the same way as people with single eyelid folds.

    Q: Does the so-called "painless plastic surgery" mean intravenous or inhalation anesthesia? I want to receive double fold operation in your clinic, but I am very afraid of pain and quite nervous. I want painless plastic surgery.
    May I ask if painless plastic surgery, will anesthetics prolong the recovery time after surgery?

    A: The so-called painless refers to intravenous general anesthesia.
    If you are afraid of the operation, we recommend you have intravenous injection with the drugs of sedation and painkiller. Because you have to wake up and stand up to check the symmetry of double folds after putting the stitches for double folds, you have to cooperate and open your eyes. It is not recommended to receive general anesthesia, because you can not follow the order to open your eyes. There drugs will not interfere with the recovery.

    Q: If the eyelid covers my pupil, is it ptosis?
    A: That may cause by the hooding skin or ptosis. Please come to my clinic for evaluation.

    Q: I heard that after double eyelid surgery, some foods should be avoided , such as lamb, seafood, spicy food, etc. Is that true? Why? If so, how long does it take to avoid these food?
    A: Generally, we recommend that patients eat less irritating food during the swelling period (especially the first three days), such as too spicy food, because it will make the edema worse. Seafood and lamb are okay.

    Q: Excuse me, I have keloid character. Is there any risk in suture method?
    A: I have never seen keloids growing on the eyelids. Even people with keloids on their body can get double eyelid operation.

    Q: Will I take painkillers or anti-inflammatory drugs for double eyelid surgery?
    Will the doctor reconfirm the double fold shape with the patient before the operation?
    If I want to re-suture in the future, do you need to take out the old suture?
    A: Before the operation, I will discuss the height and shape of the double fold with you. After the operation, analgesics will be provided to the patients (although most patients only take one at most).No anti-inflammatory drugs are required.
    If you need resuture, I don’t need to remove the previous stitches which will not affect your eyes.

    Q: I would like to ask if I am dissatisfied with double folds after two or three months, the sutures should have been covered by tissues. Can the sutures be removed?
    Is the way to remove the stitches by making incisions and cutting off the stitches? Will there be scars or swollen?
    In addition, I am 29 years old. If the sutures are really removed after three months, will my eyelid skin be loosen?
    A: In the past, there were patients who wished to heighten the double eyelid after suture double eyelid operation. The way to deal with it was to suture at higher position. No need to remove previous stitches.
    A few number of patients ask to remove the suture to restore the original appearance. The method is to make a small 1mm wounds and then to remove the stitches.
    After the sutures are removed, the eyelids will return to their preoperative state. The eyelid skin will not be loosen after the above procedure.

If you live abroad, you may send your questions and pictures (such as eyes, etc) to .
We will reply you as soon as possible.