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Double eyelid surgery — the suture and incision methods are different operations
Creates a crease in the upper eyelid. The suture method and the incision method differ in how long recovery takes and in how much can be undone.
Last checked Sep 19, 2026
At a glance
- Time in surgery
- 30–60 min
- Anaesthesia
- Local
- Downtime
- 7–14 days
- Until the final shape
- 3–6 months
- Scarring
- Where it does not show
- Can it be undone
- Only partly
- Relative cost
- Lowest
Cost is not an amount but a band among the surgeries on this site. It is measured on a different scale from the cost band on the procedure pages, so the two cannot be compared.
What the operation does
This creates a crease that folds when the upper eyelid opens. The principle is simple: link the muscle that opens the eye to the eyelid skin, and the skin folds at that point when the muscle pulls.
The suture method makes that link with stitches, without cutting. Swelling settles faster, and if you dislike the result the stitches can be released. In exchange, the crease can fade or come undone over time.
The incision method opens the eyelid, trims loose skin and fat, then forms the crease. It lasts, but recovery is longer and undoing the crease is much harder.
Thick eyelids or loose skin often do not hold a suture-method crease. Which one fits is decided by looking at the thickness and condition of the lid.
What to know
Swelling lasts longer than people expect. It takes about two weeks to look presentable, but three to six months for the height of the crease to settle. Judged before then, it almost always looks too high.
The two sides will not match exactly. Eyes are not symmetrical to begin with. Lid thickness and the strength of the opening muscle differ side to side, and surgery narrows that gap rather than closing it.
Revision is not rare. And an eyelid that has already been cut leaves less to work with next time.
If the eye does not close fully, or it keeps feeling heavy when you open it, that may not be swelling. Tell the surgeon who operated.
What decides the result
Check first whether you also need ptosis correction. If the eye looks small because the opening muscle is weak rather than because of skin, a crease alone will not make it look bigger. These are two different operations.
A lower crease is the safer choice. Raising a low crease is easier than lowering a high one.
Smoking slows healing. Less blood flow means worse swelling and worse scars.
Say in advance if you take aspirin or a blood thinner. It bears directly on bleeding and bruising.
Before you decide
Rather than what you want the eye to look like, start with what bothers you about it now. Bringing a photo helps, but the eye in that photo has someone else's lid thickness and someone else's muscle.
How much can be undone depends on the method. For a first operation, the suture method leaves more options open.
You do not have to decide now. Eyelids change with age, and this is an operation you can decide on after seeing that change.
What has been checked about this operation
Thirteen small-incision studies, 4,177 patients — 5% total complications
A review pooled 13 studies and 4,177 patients of small-incision double-eyelid surgery. The pooled total complication rate was 5%.
The number of incisions did not separate the groups. One incision (2,460 patients), two (645), three (700) and four (372) were compared, and no significant difference was found between them.
One thing to know while reading that figure: these were not randomized. Studies reporting a technique were pooled, so which patient received which method may have been skewed from the start. This site therefore keeps it at moderate evidence.
The review also covers small-incision techniques only. It is not a comparison against suture or full-incision methods.
- Observational study in people (13) · 4,177 participants · Compared with another technique · Funding not declared · Endpoint clinical events (cancers, lesion counts) PMID 36348097 · abstract read
Fold loss 2% — but the follow-up periods differ
The most common question about this operation is whether the crease comes undone. In the same review, the pooled fold-loss rate was 2%.
That figure should not be read without a time frame. The 13 pooled studies followed patients for different lengths of time, and the review did not fold them into one period. This data cannot say 2% within how many years.
Fold loss depends on how firm the fixation is, which is why the thickness and fat of the individual eyelid is said to matter more than the method. This site has not yet recorded a comparative trial supporting that sentence.
How far it can be undone differs by method — suture techniques leave room to release, incisional ones do not.
- Observational study in people (13) · 4,177 participants · Compared with another technique · Funding not declared · Endpoint clinical events (cancers, lesion counts) PMID 36348097 · abstract read
The brow drops an average of 2.52mm after surgery
There is one consequence that is almost never discussed: upper-eyelid surgery lowers the eyebrow.
Pooling 9 of 17 studies, brow height measured from the pupil centre fell by an average of 1.45mm after upper-eyelid surgery (95% CI 0.87–2.07, P < 0.0001). By technique:
- Double-eyelid surgery 2.52mm
- Ptosis correction 2.10mm
- Simple upper blepharoplasty 0.67mm
Double-eyelid surgery dropped it the most, and the drop was larger in studies from East Asian authors (P = 0.001).
Why? A heavy lid makes people lift the brow with the forehead muscle to clear their field of vision. When surgery lightens the lid, that effort is no longer needed and the brow settles back. The operation did not pull the brow down so much as release what had been holding it up.
How much skin was excised did not affect brow height — which does not match the common explanation that removing more skin pulls the brow lower.
This pools observational studies and has no control group.
- Observational study in people (9) · sample size not reported · Compared with no control group (before-and-after only) · Funding not declared · Endpoint instrument measurement PMID 36890345 · abstract read
Where this operation sits
The concern it belongs to
Other operations in the same slot
- Epicanthoplasty and lateral canthoplastyOnly partly
- Lateral canthoplastyCannot be undone
- Ptosis correctionOnly partly
Whether to have it done is a decision to make with a doctor.