Permanence of the Incisional Technique
The incisional approach to double eyelid surgery creates a lasting structural change in the upper eyelid. By making an incision along the planned crease line and removing a strip of skin, muscle, and fat, the surgeon establishes a direct adhesion between the skin surface and the underlying levator aponeurosis or tarsal plate. This adhesion is reinforced by the body's natural scar tissue formation during healing.
Because the tissue has been physically restructured, the crease formed by incisional surgery is considered permanent. It will not spontaneously disappear or unfold. The eyelid will continue to age naturally over the decades that follow, and some patients may notice subtle changes in skin laxity with age, but the fundamental crease remains intact.
Longevity of the Non-Incisional Technique
The non-incisional or suture technique creates a crease by placing buried stitches that connect the skin to the deeper eyelid tissue. No tissue is removed. While this produces a visible fold, the connection depends entirely on the holding strength of the sutures and the adhesion that forms around them.
In many patients, particularly those with thin eyelid skin and minimal fat, the non-incisional crease can last for many years. However, the sutures may gradually cut through or loosen over time, especially in patients with heavier lids. Published studies estimate that between 5 and 20 percent of non-incisional patients may experience partial or complete loss of the crease, though rates vary depending on the specific technique used and patient selection.
Factors That Affect How Long Results Last
Several anatomical and lifestyle factors influence the durability of double eyelid surgery results. Eyelid skin thickness is among the most significant. Thicker, heavier skin places more tension on the crease and may cause a non-incisional result to weaken sooner. The volume of orbital fat also plays a role, as fuller eyelids exert more downward force on the fold.
Ageing causes gradual changes to all eyelid structures. The skin loses elasticity, and the brow may descend over time, adding weight to the upper lid. These changes do not cause a well-formed incisional crease to disappear, but they can alter its appearance. Some patients may eventually choose a brow lift or upper blepharoplasty to address age-related changes separate from the original crease.
Rubbing or repeatedly stretching the eyelids, whether from habit or from conditions such as allergic dermatitis, can place stress on a non-incisional crease and contribute to earlier loosening.
When Revision May Be Needed
If a non-incisional crease fades or becomes asymmetric, a revision procedure can restore it. This may involve repeating the suture technique or converting to the incisional method for a more durable outcome. Incisional revisions after a failed suture procedure are generally straightforward because the eyelid anatomy has not been significantly altered by the first surgery.
Consult your surgeon about the expected longevity of your specific procedure and whether the incisional or non-incisional technique is more appropriate given your eyelid anatomy.
