Double Eyelid Surgery

1. 1

   Consultation & marking — surgeon marks the desired crease line/height on closed eyelids while you're sitting up (since lying down can change how the skin sits)

2. 2

   Anesthesia — local anesthetic injected into the eyelid; you're awake but numb

3. 3

   Tiny punctures — instead of a full cut, the surgeon makes 3–5 small holes (sometimes just pinpricks) along the marked crease line

4. 4

   Suturing — a thin surgical thread is passed through these tiny openings, looping through the eyelid tissue in a way that connects the skin to the deeper tarsal plate or levator muscle

5. 5

   Knot tying — the sutures are tied and buried under the skin so they're not visible, creating a fold when the eye opens (the skin "catches" on the thread and folds inward)

6. 6

   No cutting, no stitches to remove externally — since the knots are internal, there's nothing to take out afterward

7. 7

   Recovery — ice packs immediately after, swelling peaks in the first 2–3 days, mostly resolved in 1–2 weeks

The whole procedure usually takes 20–40 minutes and is done under local anesthesia, often without sedation.

The non-incisional method creates a double eyelid fold using specialized sutures placed through small openings in the eyelid without making a full surgical incision.

• Patients with minimal excess eyelid skin

• Younger individuals with good skin elasticity

• Those seeking a shorter recovery period

• Patients looking for a natural-looking crease

Most patients can resume daily activities within a few days. Swelling typically improves significantly within 1–2 weeks, with final results becoming more apparent over the following months.

• No full incision required

• Less swelling and bruising

• Faster recovery time

• Minimal scarring

• Shorter procedure time

This is the more "surgical" of the two main approaches, involving an actual cut along the eyelid rather than just stitches.

1. 1

   Marking — The surgeon marks where the new crease will sit, usually based on your eye shape, brow position, and what you want (e.g., width of the crease).

2. 2

   Incision — A cut is made along the marked line on the upper eyelid, following the curve of the eye.

3. 3

   Tissue removal — Through this opening, the surgeon can:

   • Remove excess skin (useful if you have sagging or hooded eyelids)
   • Remove or reposition excess fat
   • Adjust or strengthen the muscle that opens the eyelid (levator muscle) — this is also how ptosis (droopy eyelid) gets corrected at the same time
4. 4

   Crease formation — The skin edges are stitched in a way that fuses the skin to the underlying tissue, creating a permanent fold/crease when the eye opens.

5. 5

   Closing — Fine sutures close the incision; these are typically removed in about a week.

• More control — Because there's a real opening, the surgeon can directly see and adjust skin, fat, and muscle.

• Handles more complex cases — Better suited for individuals who have:

  • Thicker or puffier eyelids
  • Excess/sagging skin
  • Significant fat deposits
  • Ptosis (drooping eyelid needing muscle correction)
  • Asymmetric eyes needing more precise reshaping

• More durable — Since the crease is formed by actual tissue fusion (not just stitches holding skin together), it's much less likely to loosen, fade, or disappear over time compared to the non-incisional method.

• Customizable — Crease height, shape (in-fold vs. out-fold), and width can be designed pretty precisely.

Recovery — significant swelling and bruising for the first week, with results gradually settling over 4–8 weeks, final look often not fully apparent until 2–3 months and fully healed by 6 months.

• Permanent results

• Works on more eyelid types

• Can address multiple issues at once

• More precise crease customization

• Better for dramatic changes

• More predictable long-term