Double Eyelid Surgery FAQ

Non-incisional double eyelid surgery (natural adhesion) secures the crease with sutures placed through tiny openings, without a long skin incision, while incisional double eyelid surgery opens the skin along the crease line, removes excess skin or fat as needed, and then fixes the crease. The natural adhesion method usually involves relatively less swelling and an easier recovery. The incisional method can correct other eyelid issues at the same time, and the crease tends to set more firmly. Rather than one being better than the other, what matters is choosing the method that suits your eyelids.

Non-incisional double eyelid surgery (natural adhesion) is a type of buried suture method that creates a crease without cutting the skin, using sutures to guide the skin and the deeper tissue to adhere naturally. It focuses on helping the crease hold more securely than a standard buried suture technique. If the eyelids are thick or the skin is sagging, incisional surgery may be more suitable, so the decision is made after the eyelids are assessed at the consultation.

Non-incisional double eyelid surgery (natural adhesion) belongs to the buried suture method, often called 'maemol' surgery in Korea. It creates a crease without cutting the skin, using sutures to guide the skin and the deeper tissue to adhere naturally, and focuses on helping the crease hold more securely than a standard buried suture technique. Buried suture procedures go by different names depending on how the sutures are placed, and they can differ even under the same name, so it is a good idea to confirm the actual surgical method at your consultation.

The double eyelid surgery method is chosen by checking eyelid skin thickness, the degree of skin sagging, the amount of fat in the upper eyelid, and the strength of the eye-opening muscle. Natural adhesion is often considered for thin skin with little sagging, while the incisional method is often considered when the upper eyelid is thick or the skin is sagging. The crease height you want also affects the choice of method. At Steady Plastic Surgery, Dr. Dahan Kim discusses the options with you in a detailed consultation.

Swelling after double eyelid surgery varies widely from person to person. Noticeable swelling usually settles considerably within 1–2 weeks after natural adhesion and 2–4 weeks after incisional surgery. Swelling and bruising are usually worst on days 2–3 after surgery and then fade gradually, and it can take longer for the crease to settle naturally. In general, swelling tends to last longer with a higher crease or thicker skin. Cold compresses for 7 days, sleeping with your head elevated for 3–5 days, and avoiding alcohol and smoking for 4 weeks can help manage swelling, and the speed of recovery differs for each person.

After incisional double eyelid surgery, stitches are usually removed on day 7, face washing is possible from the day after stitch removal, and makeup on the sutured area from 4 weeks after surgery. With natural adhesion, washing with water and makeup on areas without wounds are possible from 3 days after surgery, and washing with cleansing foam from 7 days. Eye makeup and contact lenses are possible from 1 month after surgery. Many people return to work a few days after natural adhesion and after stitch removal with the incisional method, and it is best to avoid swimming, saunas and exercise that causes heavy sweating for 1 month.

The crease height in double eyelid surgery is decided by considering your preference, eye size, eyelid thickness, the distance between the eye and eyebrow, and your overall facial features. So-called 'sausage eyes' are more likely when the crease is set too high for the eyelid thickness or eye size. At the consultation, facial balance, skin, eye shape, and eye-opening strength are assessed first, and then a trial crease is marked on your eyelids so that, together, we can choose a line that suits your face (inline, in-out line, semi-out line, or out line).

Yes, a double eyelid crease can fade or come undone over time if the eyelids are thick or you often rub your eyes, and this is relatively more likely with non-incisional methods. That is why it is important to evaluate eyelid thickness and tissue condition before surgery when choosing the method.

With incisional double eyelid surgery, the incision is planned to sit within the crease, so in many cases it is not visible when the eyes are open after recovery. The scar may be visible when the eyes are closed. Redness or firmness can occur early on and gradually fades over several months. How noticeable the scar becomes depends on skin type, constitution, and aftercare.

Ptosis correction is not needed for every double eyelid surgery; it is considered when weak eye opening leaves the pupils partly covered, the eyes look sleepy, or eye size is asymmetric. Whether you need ptosis correction is decided at consultation after checking the strength of the eye-opening muscle.

The cost of double eyelid surgery depends on the method (natural adhesion or incisional), whether combined procedures such as ptosis correction or canthoplasty are done, and whether it is a revision. Even with the same method, the extent of surgery can differ with your eyelid condition, so the exact cost is given after consultation.

Yes, double eyelid surgery for men is common, and many men prefer a low, natural crease that does not change their look much. Men often have thicker eyelids and a shorter distance between the eyebrow and eye, so the crease height and surgical method are chosen more carefully. If the eyes look sleepy, ptosis correction may also be considered.

Double eyelid creases are classified as inline, in-out line, semi-out line, or out line, depending on where the crease starts at the inner corner of the eye. An inline crease starts inside the epicanthal fold so the front part of the crease is hidden, and an in-out line starts inside the fold and widens toward the outer corner. A semi-out line starts slightly away from the epicanthal fold, and an out line runs parallel to the lash line from the inner corner outward. If the epicanthal fold is prominent, epicanthoplasty (inner corner) may be needed to create an out line.

Whether double eyelid surgery can correct uneven eyes depends on the cause. Unevenness caused by different line heights or different amounts of skin drooping often improves with double eyelid surgery. If one eye opens more weakly, ptosis correction is needed as well, and asymmetry from differences in eyebrow height, bone structure or skin thickness may be difficult to fully match with surgery.

A hidden double eyelid has a crease that sits tucked inside the eyelid and is hard to see from the outside, so double eyelid surgery is not necessarily required. If you want a more defined line, surgery is often done higher than the existing line. Natural adhesion or the incisional method is chosen based on eyelid thickness and drooping.

After double eyelid surgery, it is best to avoid alcohol and smoking for at least 4 weeks. Alcohol can prolong swelling and bruising, and smoking reduces blood circulation, which can slow wound healing and raise the risk of infection. The same period is recommended for both natural adhesion and incisional surgery, and swimming, saunas and strenuous exercise should also be avoided for 4 weeks.

It varies widely, but the crease usually looks natural about 2–4 weeks after natural adhesion and about 1–3 months after incisional double eyelid surgery. Even after noticeable swelling has gone down, the crease may look more pronounced than intended for a while, and it gradually becomes more natural as the remaining swelling resolves and the tissue softens. Rather than judging the result from how it looks during this period, it is better to wait and see how it heals.

Double eyelid surgery usually takes about 30 minutes with natural adhesion and 1–1.5 hours with the incisional method. Both local anesthesia and IV sedation are possible. Adding ptosis correction or canthoplasty takes longer, and the type of anesthesia is decided at consultation after checking your health and the extent of surgery.

Besides temporary swelling, bruising, and a foreign-body sensation, double eyelid surgery can rarely cause asymmetry, crease loosening, a crease that is higher or thicker than planned, scarring, infection, or hematoma. Most improve over time or resolve with observation and treatment, but some may require revision surgery. Accurate assessment of the eyelids before surgery and following post-operative instructions are important.