Buried Suture vs. Incisional — Which Double Eyelid Surgery Suits Your Eyes?

In a nutshell

How it works — why buried sutures can loosen and incisional lasts longer

A double eyelid forms where the muscle that lifts the lid (or its membrane) connects to the skin and folds when you open your eyes. Buried suture creates this connection with fine thread. Because the skin isn't opened, recovery is quick, but the connection depends on the thread, so if the lid is heavy or the thread is under constant strain, the crease can become shallower or loosen over time.

Incisional surgery opens the skin, tidies the fat, muscle and drooping skin that get in the way of folding, and then joins the tissue together. As it heals, the tissue itself bonds and holds the crease, so loosening is less common and the result is considered semi-permanent. In exchange, swelling and recovery last as long as the wound takes to heal. Partial incision sits in between: a small opening removes a little fat to reduce the strain on the thread.

Which is your eye? — Decision checklist

Suited to buried suture

• Thin eyelids, and not much thick fat when you pinch the lid
• Drooping skin doesn't cover the lashes even without lifting your brows
• Eye-opening strength is good and you don't look sleepy
• You want a low, natural crease
• Your stay is a short 3–5 days, and you're willing to redo it if it loosens later

Suited to incisional (or partial incision)

• Thick, fatty eyelids
• Drooping skin covers the crease or presses down on the outer corner (common after your 30s–40s)
• Weak eye-opening strength, so ptosis correction is needed
• A buried suture loosened before, or you want a high, defined crease
• You can stay 7–10 days or more

When is partial incision considered?

Partial incision opens only 1–2 cm to remove a little fat and fix the crease. It is often discussed for eyes where you want something more lasting than buried suture but have little drooping skin.

• When there's some fat and you worry buried suture alone will loosen
• An eye where a buried suture has loosened once
• When there's almost no drooping skin and you want to keep scarring minimal

Loosening — what affects it?

No one can predict exactly when a buried suture will loosen. Many last for years, but the chance rises when the factors below add up.

• Thick eyelids or a lot of fat — the thread has to hold more weight
• A high crease line — the higher it is, the more strain on the thread
• Frequent eye rubbing, allergies or rhinitis
• Skin drooping with age
• Fixation method (point fixation, continuous fixation, etc.) — differs by clinic

Scars — eyes open and eyes closed

The incision scar sits inside the fold of the double eyelid, so it usually isn't noticeable when your eyes are open. However, keloid-prone skin, sun exposure and touching the wound can make a scar darker, so sun protection matters for a few months after you return home.

Crease height — a difference in choices

Because buried suture is supported by thread alone, it is most stable with a low, natural crease. A high crease made by buried suture is more likely to loosen or look puffy. Incisional lets the doctor adjust height while tidying fat and skin, so there is a wider range of choices and it is easier to design a defined line like an outline crease.

Swelling & recovery — day by day

• Day of surgery
  Common: swelling and tightness; rest with cold compresses and your head raised
• Days 2–3
  Swelling peaks. Buried suture feels like ‘puffy, sleepy eyes’; incisional may bruise
• Days 4–7
  Major swelling goes down with buried suture, so going out in sunglasses is easier. Stitches come out on day 5–7 for incisional and partial incision
• Weeks 2–3
  Most people return to daily life after buried suture. After incisional, bruising is mostly gone and light makeup is possible
• Months 1–3
  Buried suture looks natural. After incisional, the remaining swelling goes down and the crease settles lower
• Months 3–6
  The incision scar fades and the final crease is complete

How your trip schedule differs

Revision — which is easier to change, which is harder

If a buried suture loosens or you're not happy, the thread can be removed or buried again, and if you have a lot of fat you can switch to partial incision or incisional. Being relatively easy to reverse is an advantage of buried suture.

With incisional surgery the tissue bonds and fixes in place, so lowering a crease that was set too high is tricky and recovery may be longer than the first time. That's why the first incision is often set slightly lower than what you want.

• Early asymmetry is mostly a swelling difference — whether to revise is usually decided after 3–6 months
• Bring records of your previous surgery (method, fixation) if you have them
• For revision, choosing a more experienced doctor than the first time matters even more

Questions to ask at your consultation

You'll usually get only one or two consultations, so take notes with you. Your manager will prepare and interpret them for you.

1. Given my eyelid thickness, fat and drooping skin, which suits me — buried suture, partial incision or incisional? Why?
2. If we do buried suture, how likely is it to loosen?
3. Can the crease height I want be done with this method? Can you show me in a mirror?
4. Is my eye-opening strength sufficient? Do I need ptosis correction?
5. What fixation method is used, and on which day are the stitches removed?
6. Can I fly home with my schedule (○ nights)?
7. Will the doctor who consults with me also perform the surgery?
8. What are the criteria for revision if it loosens or becomes asymmetrical?
9. Can you review my progress by photo after I go home?

How to choose a clinic

• Does the doctor explain why that method suits your eye structure — rather than recommending ‘buried suture for everyone’ or ‘incisional for everyone’?
• Does a board-certified specialist experienced in eyelid surgery consult with you and operate personally, and is the doctor who consults the one who operates?
• Does the clinic do buried suture, partial incision and incisional, so it doesn't insist on just one method?
• Are the criteria for loosening and revision explained before surgery?
• Monitoring system under sedation, and whether you can request CCTV recording in the operating room
• Foreign-language support and photo follow-up after you return home

KBEAU connects you with partner clinics in Gangnam and Apgujeong led by board-certified plastic surgeons. Send photos with your eyes open and closed and we will tell you in advance which method, buried suture or incisional, is possible and how many days you need to stay, and a dedicated manager will accompany you and interpret through consultation, surgery and stitch removal. We can also arrange a recovery hotel near the clinic and an airport pickup car.