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Suture Method VS Cutting Method For Double Eyelid Surgery: 4 Important Factors You Must Consider

Posted on 2 Apr 2018
Dr Samuel Ho
Plastic Surgeon
Singapore
(5 Reviews)
Consult Doctor
FOLLOW

Dr Samuel Ho
Plastic Surgeon
Singapore
(5 Reviews)
Posted on 2 Apr 2018
Consult Doctor

When I was training in Seoul, South Korea, I was told, to my horror, that Korean surgeons considered single eyelids a “congenital deformity”. 

If you have single eyelids, it's really because the attachments between the levator aponeurosis* and the eyelid skin are few, or absent. This results in an absent upper eyelid crease. (*not a Harry Potter spell - it's part of the muscle that raises your upper eyelid.)

I previously wrote a detailed guide on double eyelid surgery in Singapore here. Below, I compare the various methods you can use to achieve double eyelids.

What are the main methods and cost of double eyelid surgery in Singapore?

There are 2 types of double eyelid surgery:

  1. Non-incisional "suture" double eyelid surgery
  2. Incisional "cutting" double eyelid surgery

In Singapore, non-incisional double eyelid surgery costs between $3200 - $3500, while incisional double eyelid surgery costs about $3800 - $4500.

To get a more detailed breakdown of costs, you can read this post on the price of double eyelid surgery in Singapore. 

Are there any methods to get double eyelids without surgery?

Before coming to see me, many of my patients have had a go with using double eyelid tape or glue to create a temporary upper eyelid crease.

However, this method has some disadvantages:

  1. It's a daily slog to put on glue or tape, as opposed to a more permanent solution (akin to putting on contact lenses vs going for LASIK surgery, for example)
  2. The double eyelid adhesive can result in skin rashes
  3. Both tape and glue can come undone quite easily throughout the day, requiring reapplication

How does double eyelid surgery work?

A double eyelid crease is created by using sutures to form attachments between your upper eyelid muscle and the overlying upper eyelid skin. 

Formation of “internal” scar tissue after the surgery helps to anchor down the resultant double eye lid crease.

What are the differences between the suture method versus the cutting method for double eyelid surgery?

You may be surprised to learn that both terms are actually misnomers! 

Small 1 - 2 mm stab incisions are still required for the suture method, and both procedures still require sutures.

I perform both techniques just as frequently. In my experience, the 4 main differences which can help you to weigh up your decision are:

  1. How long the surgery takes
  2. The size of your double eyelid scar after surgery
  3. How long the double eyelid crease will last for
  4. Whether you can correct other eyelid issues at the same time, such as droopy eyelids

1. How long the surgery takes

Suture method double eyelid surgery: 

  • Procedure lasts 15 - 30 minutes
  • Downtime of 5 - 10 days
  • Mild swelling and minimal bruising
  • Natural looking eyelids result 4 - 6 weeks after the surgery

Cutting method double eyelid surgery:

  • Procedure lasts 45 - 60 minutes
  • Downtime of 2 - 4 weeks
  • Mild to moderate swelling and mild bruising
  • Natural looking eyelids result 2 - 3 months after the surgery

I take between 15 - 30 minutes for the suture method, and 45 - 60 minutes for the incisional technique. Personally, I feel that the 30 minute difference in surgery time is negligible compared to the other factors (even though other surgeons may extol to you the benefits of a quicker surgery with the suture method).

The differences in downtime after your surgery however, is significant – Suture technique patients tend to recover faster, and experience less bruising; this is mainly due to lesser tissue being cut.

2. The size of your double eyelid scar after surgery

Suture method double eyelid surgery:

  • Between three to five 1 - 2 mm incisions along the upper eyelid crease

Cutting method double eyelid surgery:

  • Surgical incision along the entire length of the double eyelid crease (usually between 35 - 40 mm)

Factors which affect scar formation include:

  • How meticulous your surgeon is with stitching
  • Which type of suture is used
  • Whether there's any post-surgery infection or wound breakdown
  • Your genetic propensity to form bad scars: if you're prone to keloids, your chance of developing bad surgical scars is much higher

The difference in surgical scar size between the 2 methods may seem like a lot, but your upper eyelid skin heals wonderfully. 

It's highly unlikely that any scars will be noticeable 4 - 6 months down the line, regardless of technique chosen.

3. How long the double eyelid crease will last for

Suture method double eyelid surgery:

How long the double eyelid crease lasts for depends on various factors:

  • The strength of suture over time
  • Whether there is adequate formation of scar tissue
  • Post-surgery aftercare (not rubbing your eyes excessively)

Cutting method double eyelid surgery:

  • Your double eyelid crease is permanent

I prefer the cutting method for double eyelid surgery due to the permanence of the double eyelid crease.

On the other hand, survival of your double eyelid crease for the suture method depends on variable factors. I have improved on the suture method by using a multiple suture technique, which requires 6 sutures for both eyelids instead of the usual 2.

4. Whether you can correct other eyelid issues at the same time

Suture method double eyelid surgery:

  • Not able to correct other eyelid problems, such as significant skin excess, droopy eyelids, excess eyelid fat and asymmetry

Cutting method double eyelid surgery:

  • Able to correct other eyelid problems

During the pre-operative consultation, I always assess my patient for other concurrent issues that may require correction. 

The presence of these problems may require using the cutting method to fully correct these additional problems, which enables the best possible aesthetic outcome with a single procedure.


In summary, it's never easy to choose a technique for your double eyelid surgery, and that burden shouldn't fall solely on you or your surgeon.

Rather, it should be a thorough consult on the pros and cons of each, combined with a meticulous assessment by your surgeon. He should then be able to recommend the most appropriate treatment for you.

Dr Samuel Ho is a plastic surgeon at Allure Plastic Sugery. He has worked alongside top plastic surgeons at plastic surgery centres in Korea, such as the Hanyang University Hospital, 101 Plastic Surgery Clinic and BIO Plastic Surgery Clinic. Aside from regular work, Dr Samuel is a supporter of a not-for-profit medical volunteer organization that provides reconstructive facial surgery to young children in Indonesia.

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