[JAYJUN Plastic Surgery · Dermatology] Principles and Differences of Non-Incisional, Partial-Incisional, and Incisional Double Eyelid Surgery!

Many people ask, "Is the non-incisional method better, or is the incisional method better?"

Some also believe that the non-incisional method looks more natural, while the incisional method looks more noticeable.

However, these are simply different surgical methods, and it is not possible to say definitively that one method is better than the other.

The important thing is to choose the surgical method that matches your current eye condition and desired results.

Today, I will explain in simple terms the principles and differences of the three representative methods of double eyelid surgery—non-incisional, partial-incisional, and incisional surgery—as well as who each method may be suitable for and the advantages and disadvantages of each procedure.

First, understanding how double eyelids work makes it much easier to understand the surgical methods.

When you open your eyes, the eye-opening muscle inside the eyelid—the levator palpebrae superioris—pulls the skin upward.

People who naturally have double eyelids have a connection between the skin and the eye-opening muscle, creating a crease when they open their eyes.

Conversely, people with monolids or double eyelids that frequently disappear have a weak or absent connection.

Double eyelid surgery ultimately centers on:

"Creating a crease by appropriately connecting the skin and the eye-opening structures" and "forming adhesion between the tissues"!

1. Non-Incisional Method (Buried Suture Method, Natural Adhesion)

The non-incisional method creates a double eyelid line using medical sutures without making an incision in the skin.

Because no incision is made, swelling and recovery time are relatively short, and there is less concern about scarring.

Since the procedure is relatively quick, it continues to be a popular choice among students and office workers.

Recommended for eyes with:

Thin eyelid skin

Little excess fat

Minimal sagging

A desire for a natural-looking crease

A first double eyelid surgery

Advantages

Fast recovery

Less concern about scarring

Relatively natural-looking results

Points to consider

The crease may loosen if the eyelids are thick or contain a lot of fat

There are limitations when correcting significant sagging

✅ If the eyelid skin is thin and there is little fat, satisfactory results can be achieved with the non-incisional method alone.

2. Partial-Incisional Method

The partial-incisional method can be understood as an approach between the non-incisional and incisional methods.

A small incision is made to remove some fat or tissue before creating the double eyelid line.

To some extent, it can provide both the natural appearance of the non-incisional method and the durability of the incisional method.

Recommended for eyes with:

Slightly thick eyelids

A moderate amount of fat

Concern about the durability of the non-incisional method alone

A desire for both a natural appearance and durability

Advantages

Fat removal is possible

More durable than the non-incisional method

Less recovery burden than the incisional method

Points to consider

More swelling than with the non-incisional method

A wider range of corrections may be difficult compared with the incisional method

✅ If the eyelids are neither very thin nor very thick, the partial-incisional method may be a good choice.

3. Incisional Method

The incisional method creates a double eyelid line by making an incision along the desired crease, removing excess fat and sagging skin, and then forming the line.

Of the three methods, it creates the most definitive crease and offers excellent durability.

Recommended for eyes with!

Thick eyelids

A lot of fat

Sagging skin

Weak eye-opening strength

A need for revision surgery after a double eyelid crease has loosened

Advantages

Excellent durability

Fat and sagging skin can be corrected together

Applicable to a wide range of eye conditions

Points to consider

Swelling and recovery time are relatively longer

Incision marks may be visible initially

✅ When the eyelids are sagging or the upper eyelids are full, the incisional method often produces more satisfactory results.

Q. Does incisional double eyelid surgery make your expression look stronger?

A. Not necessarily.

The people for whom the incisional method is usually recommended generally have thicker tissue.

Because stronger fixation is needed to prevent the crease from loosening, the relatively longer recovery period may make it seem that way.

However, by designing the crease to suit the eye structure and facial proportions and setting the fixation at a shallower depth, it is possible to create a sufficiently natural and gentle appearance even with the incisional method.

Q. Can I create the double eyelid crease I want regardless of the surgical method?

A. To some extent, yes, but there may be limitations depending on the condition of your eyes.

Various crease designs are possible, including an inner line, an inner-out line, and an outer line.

However, the range that can be achieved varies depending on eyelid thickness, the degree of skin sagging, and the strength of the eye-opening muscles.

Therefore, it is important to plan the surgery while considering both the desired crease and the actual conditions of your eyes.

Q. Can incisional double eyelid surgery also look natural?

A. The incisional method does not equal an unnatural appearance.

Many people worry, "Won't incisional surgery give me sausage eyelids?" However, that is not necessarily the case.

Naturalness is not determined by whether an incision is made. What matters more is whether the crease was designed to suit the eye conditions and whether the tissues were handled appropriately.

In fact, if someone with thick or sagging eyelids chooses the non-incisional method too aggressively, the crease may become unstable or look unnatural.

Q. Do the sutures used for double eyelid surgery remain inside the eyes permanently?

A. Yes. In non-incisional surgery, also known as the buried suture method, and in some partial-incisional procedures, the sutures used to maintain the double eyelid crease remain inside the eyelids.

However, these sutures are medical-grade materials designed to coexist with human tissue for a long time.

Because they are not exposed on the skin's surface and are positioned deep inside the tissue, most people hardly notice that the sutures are there during their daily lives.

Over time, fibrous adhesions naturally form around the sutures, helping maintain the double eyelid crease.

Q. Could the remaining sutures eventually protrude or cause problems?

A. In most cases, no.

The sutures are placed safely beneath the skin during surgery, so they do not become exposed unless a particular problem occurs.

In fact, most people continue to live without any significant discomfort even years after surgery.

However, in very rare cases, the sutures may be palpable or partially exposed in the following situations:

• The skin is very thin

• The suture knot is positioned too shallowly

• There is a habit of rubbing the eyes frequently

• Inflammation or external irritation occurs

Even if one of these situations occurs, it can usually be resolved with a simple treatment or suture removal.

Sometimes people insist on the non-incisional method because they are afraid of an incision. Conversely, some insist on incisional surgery because they believe it will be more definitive.

However, the best results come not from choosing the most popular surgical method, but from selecting the method most appropriate for the current condition of your eyes.

The important thing is to accurately analyze the eye structure and choose the most appropriate method while considering the desired image and the condition of the eyes.

If you are considering double eyelid surgery, rather than asking, "Which surgery is best?"

we recommend first consulting about, "Which surgery is most suitable for my eyes?"

Natural-looking double eyelids that last begin at that point.