Incisional vs. Partial Incisional Double Eyelid Surgery

The answer should be neither, but a NON-INCISIONAL double eyelid surgery. You’re an 18-year old patient and that means you should have no or very minimal excess upper eyelid skin that needs to be removed. Most 18-year-old patients who have double eyelid surgery do not need their skin removed. What I am trying to say is that if a double eyelid surgery can be performed then your eyelid shouldn’t be any different from that of any other person who has a natural double eyelid crease.

In terms of incisional versus partial-incisional, the incisional method is an older technique which is performed under very specific circumstances such as having excess eyelid skin hooding or in certain cases of ptosis surgery where an incision has to be made. However, ptosis can also be corrected without making an incision. So then the question is how about partial-incisional double eyelid surgery? The partial-incisional double eyelid surgery was created because a scar needed to be made for the crease to become more firm and adherent. However, this is not a good procedure because you’re making a partial incision and therefore some amount of scar is made on the eyelid where it really doesn’t have to be made. The suture technique is a much superior technique in that there is no visible scar left and the eyelid finctions/looks like the natural crease. A well-performed and a properly designed suture technique should be suffice and therefore decision has to be made whether an incision has to be made or go without one.

In conclusion, there has been a lack of deep understanding about the suture technique double eyelid surgery. The suture technique double eyelid surgery is very effective if done properly. It is by far the most common procedure for double eyelid surgery in Korea. Surgeons in Korea pioneered advancements in suture technique.  If done properly, it is by far the most superior technique in surgically creating double eyelids. In terms of whether the incisional double eyelid surgery is more permanent than the suture technique, that also is not correct. In an incisional technique, the fold is made by scar formation and even with incision, a loss of fold can happen. Since there has recently been so much advancement in the suture technique, a well-performed suture technique can stand to the point where the patient will ultimately need another surgery because the skin is actually hooding over. It should in his or her forties when a patient needs an incision because that would be when the skin actually starts hooding over. Until then, I highly recommend non-incisional suture technique as this creates a far more natural-looking result. It is important to create a natural-looking eyelid rather than a static double eyelid fold that is created with scar. 

Going back to the fact that you’re an 18-year old, there shouldn’t be a reason to make the incision so you should have a suture, non-incisional technique. In terms of you having one eyelid that doesn’t have the fold and the other eye having a double eyelid crease, that’s a very interesting and also an important point. There is a reason why you do not have a crease on one of the eye. If you look very closely, the eye that doesn’t have the crease will most likely have ptosis. Now, the ptosis can be mild, moderate or severe. In your case, you will fall under borderline ptosis. What that means is that, the ptosis is not clinically evident. However, upon examination and upon giving your eyelid a load of force or stressing your upper eyelid muscle, ptosis will occur. What that means is that without the double eyelid crease, ptosis is not readily noticeable. However, once the fold is made then ptosis will occur. It will be difficult for you to understand that one of the eyes has borderline ptosis or a mild weakness. However, a plastic surgeon who specializes in eyelid surgery will have a good feel and understanding of this concept. In terms of pseudo-ptosis, “pseudo” means not a real ptosis. People sometimes use the word “pseudo-ptosis” to describe the skin that is hooding down. That is not a good term; as I mentioned, it should be whether you have a borderline or a mild/moderate/severe ptosis, or you have excess skin hooding down. If you have excess skin hooding, then that’s what it should be—it should be excess skin. Therefore, I recommend that you get a suture technique double eyelid surgery, and it is highly likely the eyelid that doesn’t have the crease will need a ptosis surgery. You need a good thorough checkup prior to surgery.

 

This can be confusing because well informed patients like yourself do their research- and there are some examples conflicting things they read.
- Open incision is more permanent but takes longer to heal. 
- Closed technique is better, it leads to quicker recovery.
- Partial incision is better, its best of both worlds.
The truth is that different surgeons get better results in their hands with particular technique they prefer in particular circumstances. For instance above three examples are a little bit of an over generalisation because even my best Korean plastic surgical colleagues who do this day in day out have differing opinion on all of the above! In general above advice are true, but open incision with appropriate control of bleeding (which is better visualised because you're seeing the vessels as opposed to closed where you're "blind" and may puncture vessels leading to more swelling and bruising) can have LESS swelling and partial incision may be the WORST of both worlds for a particular individual (not enough exposure and less permanent result). Added to differing opinion on the surgeons and expertise, you add in your individual difference in anatomy (and EVERYONE is different) it's extremely difficult to say with accuracy what is right and what is not without a proper history taking the time and a thorough examination. This is why you need to see a specialist plastic surgeon and be not afraid to seek a second opinion if needed- if your surgeon does not react well to you getting a second opinion that is a bad sign. I personally encourage it because both the patient and the surgeon need to be on the same page and everything needs to be done to REDUCE the chance of things going wrong because nothing we do in medicine and in life is perfect.
Wish you the best in your journey.
Dr Leo Kim, Specialist Plastic Surgeon in Sydney

The eyelid anatomy in those of asian descent is unique. So are the goals of surgery. Forming a low, natural crease, remove a small amount of skin, repositioning some of the eyelid fat, may all be options to help you reach your goal. In this instance I prefer the incisional technique for its long term stability and reliability.

It is usually best to undergo the incisional procedure on the eyelid for better control of results.   Good long lasting results require a total access to the preoperative conditions there causing the asymmetrical single and double eyelid fold.  

Incisional Eyelid Surgery is more accurate and longer lasting than partial and no incision approaches.  The incisional approach allows the surgeon to see the structures that need to be adjusted to create the crease. This, in turn, allows the surgeon to directly work with these structures instead of doing it blind through partial and no incision techniques.  The incisional technique also allows the surgeon to expose the structures that need to be cleared of tissue to allow the crease to be more definitely formed.  Also with partial and no incision techniques, because of the blind approach, are more likely to have discontinuous creases, loss of the crease, and asymmetric results.

Thanks for reading, Dr Young

It sounds that you had an ophtalmology work up, if not you need a full opthalmology work up for the evaluation of ptosis or pseudoptosis, excursion of the lavator muscle, present fold evaluation,

Open technique seems the appropriate approach in the presence of ptosis or pseudoptosis, which can be corrected at the same time.

Pictures would be helpful in this case but with your history of pseudoptosis, an incisional procedure may be more definitive for you in the long run.