Services 》Suture Double Eyelid Operation



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.


Left: Before.  Right: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.


Upper Left: before.  Middle: immediately after surgery.  Right: five months after surgery.


Upper Left: before.   Middle: immediately after surgery.   Right: 9 months after surgery.


Upper Left: before.   Middle: immediately after surgery.  Right: 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.


Upper Left: before.   Middle: immediately after surgery.  Right: 4.5years after surgery.


Upper Left: before.   Middle: immediately after surgery.  Right: 6.5years after surgery.


Upper Left: before.    Right: 7 years after surgery.


From the left to the right: Before -> Immediately after surgery -> 1.5 years after surgery -> No scars were seen.          


From the left to the right: 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.

  • For women with puffy eyelids, the result is not the same.  The below left picture showed a case on one year after suture method. Right eye looked smaller than left eye. Right eyelid fold was shallow and loose, so that roots of eyelashes were cover by eyelid. Left fold was in good condition and roots of eyelashes were not covered by eyelid , therefore right eye looker smaller.  She decided to undergo incision method on botheyes.  Below right was the result on two years after incision method.  Both eyelid folds were deep and symmetric.  For patients with puffy eyelids (one side or both sides), incision method is recommended because double eyelid folds are stronger and eyes will look brighter after surgery.
                                                                                       

    Recovery from incision method is quicker than suture method:  For patients with puffy eyelids, recovery from incision is quikcer. Below left was the immediate postoperative result after suture method. Due to fading of folds, she decided to have incision double eyelid operation. Below middle was the appearance after incision method. Swelling was less after incision method for her. Below left was the appearance at 5th days after surgery. She said that recovery from incision method was quicker than suture method.


    The result after suture method and incision method is the same? Below left picture was the preoperative appearance. Obvious fold was noted on her right eye, sometimes was not. Her left fold was quite shallow. Below middle picture was taken immediately after suture method.  Below right was the appearance at 2 years after suture method.  She thought that the fold on right eye was not long enough, comparing with her left eye. She decided to have incision method. 


     Below left was immediately result after incision method.  Swelling was a little bit, comparing with suture method. Below right was the picture , taken at one year after incision method.

    Below left was the close view of her right eye after suture method. The lateral part of fold was shorter and shallow.It was caused by the fat insite the eye. The fat was treated by incision method. So that the lateral fold on her right eye was deeper and longer after incision method, as shown on left right picture.

  • 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. 
  • Epicanthoplasty 

    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. Epicanthoplasty lengthens eye fissure, producing the image of larger and more open eyes.  



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

    There are two kinds of double folds at the medial end. One is inside fold - crease taper medially to end in epicanthal fold.The other is outside fold - parallel with upper eyelid margin. Outside fold is more popular because eyes look larger andlonger than inside fold.

    Some people only need to make higher double eyelids to get the effect of outside folds. However, some people need to undergo epicanthoplasty to achieve outside folds.

    Before surgery of below case was inside fold. After suture double eyelid operation (raise the height of fold), her medial fold become outside.



    After double eyelid operation, the result may end with outside or inside fold, depending on the structure of epicanthal fold. In some people, epicanthoplasty may be needed to form outside fold. Below left was before picture. Middle was picture after suture method. Fold was higher after suture method. Right was the result after epicanthoplasty. Inside fold became outsidefold after epicanthoplasty.




    Below left was before picture of a case with single fold. Middle was picture after suture method. Right was the picture after epicanthoplasty. Eye fissure became longer and closer after epicanthoplasty.

    Below left is before picture. She underwent suture method and  epicanthoplasty. Right is after picture. Eyes looks brighter and longer.


    Other cases underwent suture method and  epicanthoplasty:




  • Medial folds can be divided as being inside fold and fan-shaped outside folds or parallel outside folds
    At the medial fold, the inside fold is hidden inside the eyelid margin and grows wider towards the lateral fold.An outside fold refers to upper eyelid crease which exists separately from the upper eyelid margin. Outside can be fan-shaped or parallel.

    Here are the eyes of famous female stars.

    As can be seen from the above photos, the eyes of most stars are fan-shaped outside fold.Basically, eyes with outside fold look bigger than inside fold.

    How to make outside fold?

    (1) Start with double eyelid surgery design.

    Above left: before surgery,

    Above middle picture: After sutured double eyelid operation, the right eye is fan-shaped and the left eye is inside fold.

    Above right: Using suture method to adjust left folds, both folds are symmetrical and fan-shaped.

    Above left: before surgery. Right: After suture double eyelid operation, she got  parallel outside folds.

    Above left: Before surgery, right fold was inside fold. Left fold was fan-shaped fold.

    Right: After suture method to increase the width of folds, her folds were parallel outside folds.

    (2) Epicanthoplasty must be added.


    Upper left: before surgery. Upper right: Although the sutures have been make at higher locations, her medial folds were inside due to her prominent Mongolian  folds (red line).

    Above left: before surgery. Middle: After suture double eyelid operation, her folds were higher. But they were inside folds. Above right: After Epicanthoplasty, they were outside folds. .

    Above left: Before surgery, her Mongolian folds were not prominent. Her eyelids were puffy.

    Above right: After suture double eyelid operation and even epicanthoplasty, her folds were inside due to the puffiness of eyelids.

    (3) Outside folds were beautiful?

    Above left: before surgery. Above right: After suture double eyelid operation, the folds were parallel. It ’s a matter of person judgment whether higher folds and parallel folds are good-looking or not.

    Before surgery, the doctor will discuss with you how to design suitable double eyelid folds with iron rods to simulate double eyelid folds.

  • 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.  One is suture double eyelid operation on eye with lower fold.  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 

  • Incision double eyelid operation
    Incision double eyelid operation is presented in another chapter. After incision method the scar adherence is stronger, so that fading rate is lower than suture method. Fading means that the folds disappear.  But recovery time is longer than suture method.

    Incision method is recommended in below cases:

    • 1) Puffy eyes. The fat in the eyes will interfere with longevity of double eyelid fold.  It is better to treat fat (incision method) in puffy eyes.
    • 2) Ptosis. Levator muscle or Muller muscle should betreated. 
    • 3) Sunken eye. Fat should be added into eye.
    • 4) Aged eyes. The loose eyelid skin should be excised at the same ptosis: Tarsus is located on the lower margin of upper eyelid, which is the attached sites of eyelashes. When tarsus drops (ptosis), eye is smaller.


    People with ptosis look sleepy.  The way to correct ptosis is to excise levator muscle or Muller muscle.  There is special topic introducing ptosis in incision double eye operation.  Suture method can not correct ptosis problem.

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