It is hard to give the chance of a suture-method crease coming undone as a single number. How long it lasts depends on eyelid skin, fat volume, eye-opening strength, crease design, fixation method and the surgeon's skill. A Korean study of 204 patients (392 eyes) treated with the suture method also confirmed a difference in loss rates of 19.3% vs 8.6% depending on the fixation method.
Contents
What is the chance of a suture-method double eyelid coming undone?
It is hard to state the chance of a suture-method crease coming undone as a single number. The reason is that there are several fixation techniques within the suture method, and studies differ in their patients, follow-up period and surgical method.
- Korean suture-method comparative study of 204 patients (392 eyes): crease loss rate 19.3% vs 8.6% depending on fixation method
- Even with the same suture method, how it is fixed changes how long it lasts
So a single-number explanation like "10% of suture creases come undone" is not accurate. What matters is checking whether your eyes have the conditions to form a stable line with the suture method.[1]
4 reasons the suture method comes undone
The suture method is a technique that connects the eyelid to the eye-opening structure with sutures, without cutting the skin. If the sutured area loosens over time, the line can fade.
| Factor | Effect |
|---|---|
| Eyelid thickness and fat | The thicker the lid and the more fat, the greater the tissue load on the suture line |
| Crease design | A line that is too high or doesn't suit the eye's structure increases the load |
| Fixation method | Longevity differs with the number of points and continuous vs interrupted technique[2] |
| Eye-opening strength and eyelid structure | The structure itself affects longevity |
In other words, how long a suture-method double eyelid lasts is not determined simply by "how many sutures are used."
Which eyes are more likely to lose a suture-method crease?
- Conditions favorable to the suture method: thin eyelid skin · not much fat · little sagging
- Conditions where the suture method alone is hard to maintain: thick eyelids · lots of fat · significant sagging · weak eye-opening strength
When weak eye-opening strength makes the eyelids look droopy, creating a crease line alone is hard to solve it, and whether another procedure such as ptosis correction is needed must also be checked.[3]
So the judgment that "the suture method is always better than the incisional method" is not accurate. The method is chosen after comprehensively checking skin thickness, fat volume, sagging, eye-opening strength and the desired line.
Related readingIf weak eye-opening strength makes the eyelids look droopy, you also need to check whether ptosis correction is needed. The criteria are covered in detail in "Droopy eyelids (ptosis): how do incisional and non-incisional approaches differ?" (Korean).
What really makes it last
The most important thing is choosing a surgical method and fixation method suited to the eye's condition from the start. After surgery, lifestyle habits alone can hardly change the structural longevity of the suture method.
- Whether your eyes suit the suture method
- Check eyelid skin and fat volume
- Whether the line height and design suit the eye's structure
- How many points and which technique to fix with
- Whether there is a problem with eye-opening strength
- Compare when the suture method vs the incisional method each suits
After surgery, the basics are not rubbing or pulling the eyes hard in early recovery, and starting makeup and contact lenses at the advised time.
The difference by fixation method was also confirmed in a larger study. When 1,000 suture-method cases in Japan were followed for 4 years, the reoperation rate was 13.4% with the continuous technique and 26.2% with two-point fixation, lower with the continuous technique.[2]
Common myths and facts — the suture method
| What many people think… | What the evidence shows |
|---|---|
| "The suture method always comes undone easily." | There is a large difference in loss rates depending on fixation method, and if it suits the eye's conditions it can last stably. |
| "The incisional method always lasts longer." | Not for every eye. An unnecessary incision on thin eyelids can actually be a burden. |
| "The line right after surgery is final." | Early on, swelling can make the line look high or asymmetric. As the swelling goes down during recovery, the shape of the line changes. |
| "More sutures means it won't come undone." | The fixation method and how well it suits the eye's structure matter more for longevity than the number of points. |
| "You can choose a clinic by price or promotions." | Choosing a surgeon who accurately sets out an analysis of the eye's condition and a surgical plan before surgery is decisive for the result. |
What if the suture crease has come undone?
A suture-method double eyelid coming undone does not always mean incisional revision is needed.
- When it has partially weakened: consider re-fixing the loosened area
- When the eyelid condition makes a suture crease hard to maintain: consider revision, including the incisional method
- In revision, existing adhesions, scarring, remaining sutures and the current eyelid condition are checked together
Rather than simply deciding "it came undone, so suture again," the revision method is decided after checking the current eye condition.[4]
In suture-method consultations, I often say that what matters is "not how good a procedure the suture method is, but whether the suture method suits these eyes." For someone with a lot of eyelid fat, a simple suture method may look nice at first, but the line easily fades over time. Conversely, making a wide incision on thin eyelids is also a burden. Rather than "Please do the suture method," deciding together on the method that suits your eyes is decisive for longevity.[3]
The longevity of a suture-method double eyelid is determined by the fixation method and how well it suits the eye's structure. It cannot be stated as a single chance of coming undone, and the initial choice matters most. If revision is needed, the order is to check the current eye condition first.
🔬 Supporting research
Peer-reviewed international journal articles that support this article. Click a title to open the PubMed abstract.
- Journal of Craniofacial Surgery 2015 — retrospective comparison, 204 patients · 392 eyes Comparison Between Continuous Buried Suture and Interrupted Buried Suture Methods for Double Eyelid Blepharoplasty. Key finding: crease loss rate continuous suture 8.6% vs interrupted suture 19.3% (p=0.026) In text [1] · PMID 26413962 · DOI
- Aesthetic Plastic Surgery 2025 — retrospective cohort, 1,000 cases · 4 years Comparison of Long-Term Stability Between Continuous and Two-Point Buried Suture Methods in Double Eyelid Surgery: A 4-Year Retrospective Cohort Study of 1000 Cases. Key finding: reoperation rate continuous 13.4% vs two-point fixation 26.2% — fixation method affects longevity In text [2] · PMID 40571750 · DOI
🎬 Watch — Dr. Park Seong-Soo · BongBong Plastic Surgery
Related videos from BongBong Plastic Surgery's official channel and Dr. Park Seong-Soo's channel. Videos are in Korean and play on YouTube.
See the full video archive (Korean) →
Frequently asked questions (FAQ)
What percentage of suture-method double eyelids come undone?
It is hard to answer with a single number. A Korean study confirmed a difference of 19.3% vs 8.6% depending on fixation method, and it varies with the eye's conditions, design and the surgeon's skill.
Which lasts longer, the suture method or the incisional method?
It can't be said definitively. Which suits depends on eyelid thickness, fat, sagging and eye-opening strength.
Does using more sutures stop it coming undone?
The fixation method and how well it suits the eye's structure matter more for longevity than the number of points.
The line looks faint right after surgery. Has it come undone?
No. In early recovery, swelling can make the line look high or asymmetric. As the swelling goes down, the line becomes natural.
If the suture crease comes undone, is the revision done with the suture method again?
It depends on the case. Partial weakening calls for re-fixation, and if the conditions make a suture crease hard to maintain, revision including the incisional method is considered.
📖 References
Click a [number] in the text to jump to its source, and ↩ to return. Only papers whose title, journal and year were verified on PubMed are listed.
- ↩ Baek JS, Ahn JH, Jang SY, Chee E, Jang JW. Comparison Between Continuous Buried Suture and Interrupted Buried Suture Methods for Double Eyelid Blepharoplasty. J Craniofac Surg. 2015;26(7):2174-6.PMID 26413962 · DOI— Korea, 204 patients · 392 eyes — crease loss rate continuous 8.6% vs interrupted 19.3%
- ↩ Okumura K, Tamura T, Tamura T, Funakoshi Y, Teranishi H. Comparison of Long-Term Stability Between Continuous and Two-Point Buried Suture Methods in Double Eyelid Surgery: A 4-Year Retrospective Cohort Study of 1000 Cases. Aesthetic Plast Surg. 2025;49(15):4200-4205.PMID 40571750 · DOI— 1,000 cases followed for 4 years — reoperation rate continuous 13.4% vs two-point fixation 26.2%
- ↩ Kiranantawat K, Suhk JH, Nguyen AH. The Asian Eyelid: Relevant Anatomy. Semin Plast Surg. 2015;29(3):158-64.PMID 26306082 · DOI— review of Asian upper-eyelid anatomy and the mechanism of crease formation
- ↩ Yang CC. Revision of Asian Upper Blepharoplasty. Clin Plast Surg. 2023;50(1):111-120.PMID 36396250 · DOI— Revision double eyelid surgery in Asians — principles for resolving each type of complication
BongBong Plastic Surgery · Dr. Park Seong-Soo, Medical Director
Contact us for a consultation