Why Incisional Double Eyelids Can Come Undone: Suture Technique Makes All the Difference

Incisional double eyelid surgery has a significantly lower risk of coming undone compared to the non-incisional (buried suture) method.

However, even with an incisional procedure, the crease can still unravel depending on the suturing technique used.

Gangnam Seoyeon Plastic Surgery explains the reasons behind loosening and the key differences of dynamic fixation suturing.

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■ The Bottom Line First

There are two primary reasons why an incisional double eyelid crease might come undone.

First, the surgical method chosen initially was not suitable for the patient's anatomy.

Second, although an incision was made, the suturing technique was unfavorable for long-term line retention.

Unlike the buried suture method, incisional surgery creates a crease by meticulously rearranging the eyelid tissue itself,

meaning the inherent risk of loosening is extremely low.

However, even with an incision, if a dynamic fixation technique is not used during suturing,

the crease can weaken or become unstable over time.

At Gangnam Seoyeon Plastic Surgery, we always apply dynamic fixation suturing after incisional procedures

to ensure long-lasting, reliable durability for your crease.

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■ Non-Incisional vs. Incisional: Why Do Loosening Risks Differ?

To understand why double eyelids come undone, you must first grasp

how each technique creates a crease.

[ How the Non-Incisional (Buried Suture) Method Works ]

The non-incisional method anchors the crease by tying eyelid tissues together with surgical sutures without cutting the skin.

Because the crease is maintained entirely by the thread holding it together,

if the suture loosens or snaps, the double eyelid line unravels as well.

In particular, if the eyelid skin is thick or contains excess fat,

the sutures may fail to support the tissue weight, increasing the chance of loosening.

[ How the Incisional Method Works ]

In an incisional procedure, the eyelid skin is opened, and excess thick skin, fat, and connective tissue are cleared

so that the tissue itself naturally folds into a crease.

Because the anatomical tissue structure forms the line rather than relying on a single suture,

the risk of unraveling is remarkably lower than with non-incisional methods.

This is why, even within "incisional surgery," the precision of tissue manipulation

and the specific suturing technique used determine the final outcome.

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■ 3 Reasons Why Incisional Double Eyelids Can Come Undone

If your crease loosens or fades even after undergoing an incisional procedure,

it is likely due to one of the following three reasons:

[ Reason ① Uncorrected Ptosis (Blepharoptosis) ]

When the muscle responsible for opening the eye (levator aponeurosis) is weak—known as ptosis—

simply creating a crease causes the eyelid to continually pull down on the line.

If an eyelid lacking opening strength exerts constant downward drag on the fold,

the crease can weaken or appear undone over time.

In such cases, double eyelid surgery must be performed in conjunction with ptosis correction (eye shape correction)

to keep the line stable and defined.

[ Reason ② Insufficient Tissue Debulking/Clearing ]

Even if an incision is performed, if thick skin, excess suborbicularis fat, or fibrous fascia

are not adequately trimmed and cleared,

the sheer weight of the remaining tissue will continuously pull down on the crease,

making the line look faint or partially unraveled.

This is why precision in tissue handling matters far more than just the fact that an incision was made.

[ Reason ③ Non-Dynamic Fixation Suturing ]

The long-term longevity of an incisional fold heavily depends on the suturing technique.

Conventional static fixation suturing can cause an unnatural indentation along the scar line when the eyes are closed,

and the anchored site may loosen as time passes.

In contrast, dynamic fixation suturing is specifically engineered to maximize crease longevity,

making its application a decisive factor in long-term results.

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■ What is Dynamic Fixation? — Core Technique of Gangnam Seoyeon Plastic Surgery

Dynamic Fixation is an advanced suturing technique engineered to keep the crease

completely natural both when opening and closing the eyes.

Comparison with Conventional Double Eyelid Suturing (Static Fixation):

Dr. Dong-il Choi of Gangnam Seoyeon Plastic Surgery applies

dynamic fixation suturing in every incisional double eyelid surgery.

"Unlike the non-incisional method, tissues are reorganized to create the crease from within, making loosening exceedingly rare.

At Gangnam Seoyeon, we add dynamic fixation suturing to guarantee lasting durability."

— From Chief Director Dr. Dong-il Choi's Q&A

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■ Preservation of the Orbicularis Oculi Muscle — A Core Principle at Gangnam Seoyeon

Another key foundation of incisional double eyelid surgery at Gangnam Seoyeon Plastic Surgery is preserving the orbicularis oculi muscle.

The orbicularis oculi is the essential muscle responsible for closing your eyes.

If this muscle is unnecessarily compromised during incision, the following complications may occur:

- Inability to close the eyes completely (lagophthalmos)

- Tear pump dysfunction (impaired tear drainage)

- Worsening dry eye syndrome

- Increasing eyelid asymmetry over time

Many clinics damage the orbicularis oculi muscle during the incisional process.

At Gangnam Seoyeon Plastic Surgery, performing incisions while preserving this muscle

is one of our most strictly guarded surgical principles.

This approach prioritizes both the aesthetic naturalness of the fold and the functional health of your eyes.

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■ Misconceptions About Incisional Double Eyelid Surgery

There are many persistent myths surrounding incisional blepharoplasty.

Here are answers to the questions we hear most frequently at Gangnam Seoyeon Plastic Surgery.

"Incision always leaves visible scars." → False.

When precise surgical design, muscle preservation, and delicate suturing come together,

the scar is cleanly hidden within the double eyelid crease,

becoming virtually invisible over time.

"Incisional surgery causes prolonged swelling." → It doesn't last as long as you think.

Major swelling subsides within 1 to 2 weeks, and most patients comfortably return to daily routines in 3 to 7 days.

"Incision creates overly thick, sausage-like lines." → Not when tissues are meticulously refined.

By accurately debulking thick skin and fat while preserving the orbicularis oculi,

we can create a clean, slender, and exceptionally natural crease.

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■ Dynamic Fixation Incisional Double Eyelid Surgery at Gangnam Seoyeon

Board-certified plastic surgeon Dr. Dong-il Choi, with 23 years of experience,

personally oversees the entire process from consultation to surgery.

Our 5-Step Incisional Double Eyelid Protocol:

① Precision Design Planning — Defining the optimal line tailored to each individual through 1:1 consultation

② Micro-Incision — Making delicate incisions strictly along the planned line

③ Trimming Excess Tissue — Removing excess skin, fat, and fascia to eliminate structural weight that pulls down the crease

④ Muscle Preservation + Dynamic Fixation Suturing — Our hallmark technique ensuring a natural crease and enduring hold

⑤ Intra-Crease Fine Closure — Meticulously closing the incision so scars remain naturally concealed within the fold

You can watch real patient video reviews after dynamic fixation incisional surgery and ptosis correction

on our official YouTube channel, Gangnam Seoyeon TV.

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■ Procedure Details

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■ Frequently Asked Questions (FAQ)

Q1. Can incisional double eyelids ever come undone?

A. Incisional surgery reconstructs tissues directly to form the crease, making the risk of unraveling exceptionally low.

However, if ptosis is left untreated, excess tissue is insufficiently cleared, or dynamic fixation suturing is not utilized, even an incisional crease can weaken over time.

Q2. What exactly is dynamic fixation?

A. Dynamic fixation is an advanced suturing technique engineered so that the fold looks natural whether your eyes are open or closed.

Unlike standard static suturing, the incision line does not look indented when your eyes are closed, scars nest naturally within the fold, and long-term durability is significantly enhanced.

Q3. If I have ptosis, will my incisional crease come undone?

A. If you have ptosis (weak levator function) and undergo double eyelid surgery alone,

the eyelid continuously sags and exerts tension on the fold, which can destabilize the line.

In this scenario, incisional blepharoplasty should be paired with ptosis correction to achieve a stable, long-lasting crease.

Q4. My incisional crease came undone. Can I get revision surgery?

A. Yes. If an incisional crease has loosened or lost definition, it can be corrected through revision incisional surgery.

We examine the previous surgical technique, elapsed recovery time, and current tissue condition to establish a customized revision strategy.

Bringing prior surgical records to your consultation can be very helpful.

Q5. My non-incisional crease came undone. Will switching to incisional surgery prevent it from loosening again?

A. Switching to incisional revision surgery typically provides much greater long-term durability.

However, the outcome depends on how much time has passed since your prior surgery, current eyelid tissue volume, and whether ptosis is present. A thorough in-person evaluation is essential.

Q6. Does incisional double eyelid surgery truly leave no visible scar?

A. An incision does not automatically result in prominent scarring.

When performed with accurate design, muscle preservation, and dynamic fixation suturing,

the scar settles neatly into the natural fold and becomes barely perceptible over time (within 3 to 6 months).

Q7. What is the orbicularis oculi muscle, and why must it be preserved?

A. The orbicularis oculi is the circular muscle that enables your eyelids to close.

If it is damaged during surgery, issues such as incomplete eye closure or dry eye-related tear circulation problems may develop.

At Gangnam Seoyeon Plastic Surgery, muscle preservation is a cornerstone of our operative safety.

Q8. How do I schedule a consultation at Gangnam Seoyeon Plastic Surgery?

A. You can book an appointment by phone at 02-535-8889 or via our KakaoTalk Channel.

Office Hours: Weekdays 09:30–18:30, Saturdays 09:30–16:30.

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* Postoperative side effects such as bleeding, infection, and inflammation may occur depending on individual characteristics,

and subjective satisfaction can vary from person to person.

Please ensure you receive a precise diagnosis and tailored surgical plan through a direct 1:1 consultation with a board-certified specialist.

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Dr. Dong-il Choi

Board-Certified Plastic Surgeon

Current) Chief Director, Gangnam Seoyeon Plastic Surgery (2015–Present)

Former) Director, BK Plastic Surgery (2011–2013)

Former) Director, Regen Plastic Surgery (2013–2015)

Adjunct Professor of Plastic Surgery, Korea University College of Medicine

Academic Chairman, Eye Plastic Surgery Research Society, Korean Society of Plastic and Reconstructive Surgeons (KSPRS)

Adjunct Professor of Plastic Surgery, Kangdong Sacred Heart Hospital

Full Member, Korean Society of Plastic and Reconstructive Surgeons

Full Member, Korean Society for Aesthetic Plastic Surgery

Full Member, Korean Cleft Palate-Craniofacial Association

Member, International Confederation for Plastic, Reconstructive & Aesthetic Surgery (IPRAS)

Full Member, Korean Society for Surgery of the Hand

Full Member, Korean Association of Plastic Surgeons

Academic Committee Member, Korean Society of Plastic and Reconstructive Surgeons

Editorial Reviewer, Korean Society for Aesthetic Plastic Surgery

Former Financial Director, Current IT Director, Korean Association of Plastic Surgeons

Telecommunications & PR Committee Member, Korean Society for Aesthetic Plastic Surgery

Full Member, Eye Plastic Surgery Research Society, KSPRS

Former Secretary General, Eye Plastic Surgery Research Society, KSPRS

Full Member, Rhinoplasty Research Society, KSPRS

Gangnam Seoyeon Plastic Surgery strictly complies with medical regulations. The photographs in this post were taken under standardized conditions with the explicit prior consent of the patient. Individual side effects such as bleeding, infection, and inflammation may occur following aesthetic surgery or procedures.

Feel free to visit us for a personalized

1:1 consultation with a board-certified plastic surgeon :)

If you have any questions or would like to book a consultation,

please leave a comment, contact us via KakaoTalk Plus Friend @강남서연성형외과의원,

or call us at +82-2-535-8889 :)