What Eyelid Surgery Technique Doesn't Require Stitches at All?

Thank you for your question!!

There are several ways to rejuvenate the eyelids without needing sutures- Restylane injections to correct the hollow under the eyes vs micro- fat grafting to perform the same correction, transconjuctival incision to remove puffing fat and Thermage.

The technique for eyelid shaping does depend on the shape of your eyelid, cheek contour and the expected results.

With warm Regards,

Trevor M Born MD

Lower lid transconjunctival surgery is reliable. It does have some limitations however. It is good to remove excess fat but requires the skin to shrink. It will reduce the "bags" but not help any of the "wrinkles" or "lines". It will not remove any extra skin if you have it. Laser resurfacing can be added to treat the skin problems if they are mild.

The same cannot be said about upper eyelid surgery.  The upper eyelid needs suture because of gravity.  The most important thing is the surgeon and their training, knowledge, skill, and experience.  Please choose carefully.

I have been performing lower eyelid surgery using a CO2  ( carbon dioxide) laser for over 15 years.  The advantage of this technique:


No skin incision

No stitches

No scalpel blade


This same laser helps to stop bleeding so the surgery can be faster with less swelling and black and blueness than traditional methods.  The same laser Mixto can be used to rejuvenate the skin on the lower eyelids.

The attached video is of upper eyelid surgery, where a stitch is necessary.

 

 

When there is minimal excess skin and the muscle has not been stretched beyond  a certain point, transconjunctival lower lid surgery may be appropriate. This is often combined with a form of resurfacing (Chemical Peel or Laser) to tighten the overlying skin. Although many complex fat shifting maneuvers have been described to obliterate the depression between the lid and cheek through a transconjuctival approach, I believe that a lower lid in need of big time "rehab" is better served by an open approach. The ability to tighten and suspend the muscle is the one main advantage. Younger patients and those with bags associated with allergies are the patients that I recommend the transconjuctival approach

The puffiness underneath the lower lids is created by fat bags, which can simply be removed through an incision on the inside of the lower lids.  This takes approximately a half an hour to perform under general anesthesia.  Expect approximately 10 days of bruising and swelling after the procedure.

The need for the suture is based on the incision and proper alignment of the tissue post surgery. If a surgeon promote that his/her technique is better because he/she is not using suture, I would be concern. Sutures are used at the end of the procedure and if there is a need for it,it should be used.

A transconjunctival lower blepharoplasty is done without using stitches, approaching the fat pockets of the lower eyelid through the inside of the eyelid.  I have an example of this surgery in my photos section.  The question is not so much reliability as it is patient selection.  This surgery is appropriate if the problem is limited to bulging fat and not excess skin, or it may need to be combined with a procedure that addresses the skin. 

In most eyelid procedures, the stitches are removed in 4 to 7 days. In some cases, a suture can be used that falls out by itself in a week or so. In upper eyelid procedures, a skin glue can be used that goes away in about a week, but a few dissolving stitches may be placed under the skin before the glue is applied. It is best to speak with your Board Certified surgeon about which option is best for you.

 A transconjunctival lower Blepharoplasty (lower eyelid surgery) is performed without any sutures to close the incision on the inside of the eyelids.  I wrote a scientific paper on this technique comapred to the transcutaneous technique in the eraly 1990's and found it to be superior.  There are no upper eylid surgical techniques that don't use sutures to close the skin incisions and if someone were to use tissue glue, instead of sutures, this is at the risk of the incision opening and yielding a less aesthetically attractive scar IMHO.