Simplified suture techniques are practiced widely in some Asian countries and by less experienced eyelid surgeons. In Japan, the technique remains popular, where the so-called "quick double eyelid surgery" (fifteen minutes) is used commonly. In Korea and the United States, however, most surgeons favor the full incisional technique.
A major objection to the suture method is that since it does not allow for an orderly removal and realignment of internal eyelid tissues, the major anatomical impediments to true crease formation are not addressed. Such techniques are non-physiological and do not attempt to replicate the natural mechanism found in people born with a crease.
While the full inicisional approach creates a long-lasting result, the indentation formed after a suture approach may disappear within a matter of a few years as the suture weakens (or even months if the suture breaks). If one crease weakens before the other, the eyes may appear noticeably imbalanced.
Typically, no skin or fat is removed, which imposes a limitation in patients showing signs of aging. Even in the young, there is less ability to customize crease shape and height. The crease is not dynamic (that is, it is not dependent upon eyelid opening) and may be visible even when the eyes are closed.
One newer variation (known as DST or double sutures with twisting or double stranded twist) employs two sutures that are tied in three places and twisted around each other four or five times at the central tie. It is said to generate a long-lasting result (its authors reported no loss of crease in over 1,100 cases with a mean follow-up time of 32 months). While it may well create a stronger and more durable result than previous methods, we have seen several patients who have undergone this operation elsewhere only to have the crease fade as early as one to eight months following surgery.
Another variation (sometimes called "semi-open") incorporates between one to five small skin incisions and allows for removal of fat. A series of small scars then extends across the eyelid.
Compared to full incisional surgery, suture methods are much faster to perform, recovery time is significantly shorter, and costs are less. While less invasive, the risks are not negligible.
Surgery may be complicated by irritation from sutures rubbing against the cornea of the eye. Since the lid is entered through multiple small cuts without full visualization of the internal eyelid anatomy, suture placement and surgical manipulation may cause tissue injury as well as uneven skin scars. If a patient who has undergone such treatment later elects to undergo an incisional technique, internal scarring and retained suture fragments may limit the precision of the second surgery.
Dr. Meronk does not use the suture technique.
