Incision-less suture techniques for Asian blepharoplasty (double eyelid surgery) are popular because they do decrease the downtime and recovery for suitable candidates. In the appropriate patient, suture techniques, such as the double-suture with twist (DST) work extremely well at creating a fairly durable (long lasting) supratarsal crease (double eyelid fold). Patients with thick upper eyelids, with significant subcutaneous/orbital fat, are poor candidates for suture ligation techniques. Incision-less techniques also can not address upper eyelid skin asymmetry or ptosis. Asymmetry of the upper eyelids is commonly encountered, and can only be fully addressed with incisional techniques.
Incisional blepharoplasty (Asian double eyelid surgery) produces the most durable, permanent solution to create an aesthetically pleasing double eyelid crease at a predictable location. In the Asian eyelid with a natural supratarsal crease (double eyelid), the muscle which opens the eye (called the levator aponeurosis) has small connections with the skin which tether the skin and create the double eyelid crease. These connections can be re-created during incisional blepharoplasty without relying on a buried suture such as in the suture techniques such as DST.
Suture techniques can provide beautiful results in patients with thin, symmetric upper lids without ptosis. However, incisional blepharoplasty provides the longest-lasting (permanent), predictable results in all patients.
