I’ll explain the differences between natural adhesion, buried, and incisional double eyelid surgery, along with the selection criteria.

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During the winter vacation season, many people visit plastic surgery clinics to get double eyelid surgery, which is commonly called "ssangsu." The reason is that there is enough time to recover, so not only middle and high school students but also parents look into it. Since the eyes are an important area in determining first impressions, many people hope to achieve a more refined image by changing to bigger, clearer eyes through double eyelid surgery.

Double eyelid surgery is a procedure that creates a crease on the eyelid to make the eyes look bigger and more defined, and it is performed using natural adhesion, buried, or incisional methods. Since each method has its own pros and cons, applying the method that suits you best can lower the chance of revision surgery later. That is why I’d like to explain the buried method, natural adhesion, and incisional method.

Buried method

The buried method is a procedure in which tiny incisions and holes are made at the desired line without cutting the skin, and a thread passes back and forth through the holes and through the conjunctiva to create adhesion. The thread that moves back and forth to create adhesion becomes hidden inside, so there is no visible thread on the outside and a line with almost no scar is completed.

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Because the buried method forms the line using micro-incisions, it is suitable for people with thin skin, little fat, and a certain amount of eyelid-opening strength. For that reason, it is mainly chosen by younger people who do not have drooping eyelids.

Natural adhesion

The natural adhesion method is performed in the same way as the buried method. Because a small incision is made and adhesion is created in the desired skin tissue, it becomes barely noticeable over time and looks natural, which is why many people prefer it. As with the buried method, it can be recommended for cases where the skin is thin, there is little fat, and the eyelid-opening strength is moderate.

Many people choose it because of its natural look and the fact that it does not look like they had surgery, but there is something to be careful about.

If the incision is made a little too long, the mark can sometimes look unattractive. One of the main purposes of choosing natural adhesion or the buried method is to make the scar less visible, so keeping the incision small is an important point.

It is good to remember that if multiple long incisions are made, the result can sometimes look more noticeable than an incisional procedure.

In the case of natural adhesion, the adhesion is characterized by being relatively weak. If the adhesion is created well, it can actually be less likely to come undone than the buried method, but because the adhesion is generally made weaker, there may be cases where it loosens over time. Therefore, it would not be correct to say that natural adhesion is less likely to come undone than the buried method; rather, it should be understood as a difference in the surgeon’s technique.

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Incisional method

The incisional method is a surgical procedure in which the designed line is incised, the skin’s fat and muscle are removed, and then the fascia is sutured together to create the double eyelid line. Therefore, it is suitable when the skin is thick, the eyelid-opening strength is weak, and there is a large amount of fat.

Because an incision is made, recovery is slower than with natural adhesion or the buried method, and scarring may be visible. However, if there are many factors that interfere with creating eyelid-opening strength and adhesion, choosing the incisional method can lead to a more defined eye shape.

Therefore, the most important part when deciding on a double eyelid surgery method is the patient’s own condition. However, sometimes the incisional method is recommended for design reasons as well.

If the patient wants a more dramatic, higher outer-line design, the incisional method may be chosen even if the eyes could be treated with the buried method or natural adhesion.

The surgeon’s skill is important!

Because the incisional method involves making a full incision along the line, the scar can last longer than with the buried method or natural adhesion. However, it has the advantage of allowing more options in terms of design.

Today, we looked at the double eyelid surgery methods: the buried method, natural adhesion, and the incisional method.

Since each method has its own pros and cons, I would like to say that it is important to find the method that suits you best through sufficient consultation with a specialist.

If you are curious about which surgical method is right for you, and whether the result you want is possible, please visit us and receive detailed consultation from Dr. Park Byeong-ho, a plastic surgery specialist.