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Double eyelid surgery is one of the most popular cosmetic surgical procedures in Asia. In 2015 alone there were more than 1.3 million double eyelid surgeries performed. Predominantly done among the South East Asian population, double eyelid surgery, also known as Blepharoplasty, first gained popularity in South Korea and Japan. Many of the techniques that local surgeons in Singapore use are inspired by the pioneering plastic surgeons in these regions.
Double or single eyelid?
The skin on the eyelid is made up of 3 main layers – skin, fat and connective tissue (Levator Aponeurosis). An eyelid crease is formed when the skin and connective tissue on the eyelid are firmly attached to each other. Where there is no attachment between the layers, no visible double eyelid crease is created. In cases where the attachment is weak, there may be undefined crease lines or multiple crease lines on the eyelid.
From single to double: How is it done?
Double eyelid surgery mimics the attachment between the two layers by pinning the skin on to the connective tissue using sutures. This is a general idea, but let me share the types of double eyelid surgery techniques available today.
What are the options- Types of double eyelid Surgery?
There are three ways to attain double eyelids through aesthetic surgery:
The incision method involves cutting and is suitable for all types of eyelids. Excess fat on the eyelid is removed, loose skin can also be eradicated using this method. With the unnecessary fat and skin out of the way, the skin can be stitched more firmly onto the muscles. Hence the incision technique creates a more defined, permanent and long-lasting eyelid crease.
The recovery period for patients who undergo this procedure is comparatively longer than those who choose the sutured method, with an average downtime ranging from 7 – 10 days. During the recovery period, the initial puffiness of the eyelids post-surgery will subside and the double eyelids will gradually look more natural.
The suture method of attaining double eyelids is a minimally invasive process that creates a neat crease on the eyelids by stitching skin to connective tissue. Commonly known as the ‘sewing method’, this is a popular option for those who are hesitant to go under the knife (incision). However, the suture method is not suitable for those with droopy eyelids (Ptosis), or eyelids with excess skin. The recovery period for the suture method is short and patients can return to their normal daily activities 4-7 days after surgery.
This method of double eyelid surgery combines both the use of sutures and the full-incision technique to minimise scarring and to achieve a more natural look. An incision is made to remove excess fat in the eyelids before stitches are used to pin the skin onto the muscle to create the desired crease. This method is good for individuals who have thick eyelids but have no issues with excess skin. Complete recovery takes up to 2 weeks.
Variations of Suture Double Eyelid Surgery
Innovations in suture techniques have come a long way. Today, many different variations of the suture method exist to cater to the diverse types of eyelids, to achieve the best results.
Here are some of the more commonly used variations:
Hata method (3 sutures)
Invented in 1933, the Hata method is suitable for those with very thin eyelids. Just 3 knotted stitches at different points on the eyelid help to form a double eyelid crease. While this is an old method, it is still being applied in modern aesthetic surgery.
Multi-suture method (5 sutures)
With sutures at 5 points across the eyelid, this is regarded as a more secure way to create double eyelids. Eyelid thickness can be adjusted as well. The result: natural-looking double eyelids with a short recovery period.
Double Suture and Twist (DST)
The Double Suture and Twist (DST) technique was in 2001 by Dr Akihiro Minami, a famous plastic surgeon in Japan. Commonly performed by surgeons in Japan, South Korea and in Singapore, the difference of this technique lies in the extra twisting of multiple knots at each point along the eyelid before they are tied. This method provides more security in holding the double eyelid crease in place.
Twin Lock Burial Method (Dream Technique)
The twin lock burial method works differently from the other techniques and this unique technique is used at Dream Plastic Surgery for creating a natural double eyelid crease.
Instead of pinning the skin down with multiple knots and multiple sutures, this technique creates double eyelids using just one suture. This achieves minimal scarring with short a post-surgery recovery time.
Weaving: The suture is weaved along the double eyelid in a figure-of-8 shaped path. Each time the thread intersects itself, it fixes a point on the skin and is tied down only where the crease line ends. A major advantage of this is the elimination of any uneven tension at various intersections (points), with tension distributed more evenly across the eyelid with a gentle massage post-surgery.
Single knot: Only one anchoring point is required and the knot is usually fixed at the outer corner of the eye, at the end of the eyelid crease.
I personally prefer this method because it preserves the benefit of a traditional method but circumvents the possibilities of having uneven depressions which can arise from multiple knots with varied tensions. This results in a more even and natural looking crease.
How is it done?
A patient may choose to have local anaesthetic applied to the eyelids or to be sedated. When this is done, the surgeon makes 3 puncture holes along the upper eyelids and a single suture is threaded through these incisions.
The suture is weaved in an 8-shape, pulling eyelid skin and connective tissue closer to each other in its path before it is knotted at the end. The knot is reinforced by twisting the suture a few more rounds before being tied down securely. The entire process is straightforward and takes about 30-40 minutes.
The Pros and Cons of Double Eyelid Stitching
- Pros - In addition to being less invasive than incision methods, Double eyelid stitching is quick, with most procedures being under an hour long. It also involves a much shorter recovery time. In cases where a patient cannot adapt to double eyelids or experiences prolonged discomfort, this suture method is also reversible via a procedure that returns eyelids to their original appearance.
- Cons - Double eyelid stitching ensures results that can last 5-10 years, or more. Further surgery may be required to maintain the eyelid crease as the double eyelids will become less defined over time. Unlike the incision method, which is able to address other issues in the eyelids such as being able to remove excess fats and loose skin, the suture method is effective only in the formation of creases on the eyelids that mimic natural double eyelids. Therefore, it works best on thin eyelids (i.e. absence of loose skin, droopy eyelids). If the eyelids have excess fat tissue, this method can still create double eyelids, but the crease will be less defined, and there will be a limit to how high the crease line can be positioned.
I don't have thin eyelids
If your eyes are heavy-lidded, meaning that your upper eyelids have more fatty tissue, you can consider a partial-incision. The short incision will allow for extra fats to be removed before pinning the skin onto the muscle.
However, if you have a combination of heavy lids and excess loose skin on your eyelid, the only option is to go for the incisional method, so that these issues can be removed. Non-incisional methods are hampered by the weight of extra tissues and so would be very likely to come undone easily on these types of eyelids.
Procedure Durations and Downtime
Post-surgery downtimes for incisional, partial-incision and non-incisional double eyelid surgery vary depending on the level of invasiveness of each procedure.
- Lasts 45 to 60 minutes in the procedure room
- Has a downtime of 7 - 10 days post-surgery
- Lasts 45 to 60 minutes in the procedure room
- Has a downtime of 7 - 10 days post-surgery
- Lasts 30 minutes or less in the procedure room
- Has a downtime of 4 to 7 days as you rest and heal
Will I regret it?
Some may regret their decision after having had the surgery. Fortunately, the effects of double eyelid surgery can be reversed with non-incisional methods. Of course, if you are dead set on the surgery and are absolutely sure it is something you want permanently altered, then an incisional method is the way to go.
Which is more popular?
For its low invasiveness, reduced scarring/swelling, shorter post-surgery downtime and reversibility, non-incisional techniques are much more popular.
In terms of cost, non-incisional methods are also more affordable. Compared to incisional surgery that will set you back between $3,800 to $5,000, a non-incisional suture procedure is typically priced between $3,200 to $3,900.
Ultimately, the outcome of double eyelid surgery, regardless of whether it’s an incision, partial-incision or suture procedure that you opt for, is largely dependent on the skills of your chosen plastic surgeon. It is therefore important to do ample research both about the procedures and implications of each surgery type, as well as about the experience and expertise of the plastic surgeon who will perform the procedure.
I hope this article has been helpful in your research as you weigh your options for double eyelid surgery. If you have any questions or if you are curious about recent medical advancements in the field of plastic surgery, you are welcome to contact me at +65 6871 8888. I can also be reached via https://dreamplasticsurgery.com.