Double eyelid surgery can be permanent, but whether it stays that way depends on the technique used. The full-incision method creates structural changes to the eyelid that are considered permanent. The suture (non-incisional) method is less durable, and the crease can soften or disappear over time. Both approaches are affected by natural aging, which gradually changes the skin and tissue around your eyes regardless of surgery.
Incisional vs. Suture: How Technique Affects Longevity
The two main approaches to creating a double eyelid crease differ significantly in how long the results last. The incisional method involves making a cut along the eyelid and removing or repositioning tissue to form a crease. Because this physically restructures the eyelid, the result is lasting. As the American Society of Plastic Surgeons puts it, eyelid surgery can be expected to correct certain conditions permanently, though natural aging continues.
The non-incisional (suture) method works differently. A surgeon places stitches through the eyelid to create a fold without making a full incision. Recovery is faster, but no permanent structural change is made to the eyelid itself. The crease can naturally soften or disappear as the sutures loosen over the years.
A large retrospective study of 1,500 suture-method cases tracked patients for four years and found meaningful differences even among suture techniques. The continuous suture method retained the crease in about 81% of patients at roughly three years. The transconjunctival method held in 72% of cases, and the simpler two-point suture method retained the crease in only 65% of patients. The overall reoperation rate across all suture methods was about 20%, meaning one in five patients eventually needed a touch-up.
Why Some Creases Fade or Disappear
The most common reason suture-method results don’t last is suture loosening. In the study of 1,500 cases, loosening was the top reason patients came back for revision. The two-point method had the highest rate, with loosening occurring in roughly 23% of cases. The continuous method performed best, with loosening in about 8% of cases. A small number of patients also experienced suture exposure, where the stitch becomes visible or palpable under the skin.
Your anatomy plays a role too. Fat in the upper eyelid, particularly behind the muscle and around the eye socket, can interfere with how well a suture-created crease holds. A 4.5-year study compared outcomes in patients who had upper eyelid fat removed during their suture procedure versus those who didn’t. The group with fat removal had a reoperation rate of 17%, compared to 33.5% in the group without fat removal. Removing that tissue essentially cut the risk of needing a second surgery in half. For people with thicker, puffier eyelids, this is a meaningful consideration when planning the procedure.
What the Final Result Looks Like Over Time
Don’t judge your results too early. After surgery, swelling distorts the crease height and shape for weeks. The appearance of your eyelid continues improving for one to three months as swelling resolves and tissue settles into its final position. During this period, the crease may look higher, deeper, or more uneven than it will ultimately be.
Even with a permanent incisional result, your eyelids will keep aging. Skin loses elasticity, fat pads shift, and the brow descends over decades. This means a crease that looked crisp at 30 may appear less defined at 60, not because the surgery failed, but because the surrounding tissue changed. Some people eventually choose a secondary procedure to address age-related drooping, which is separate from the original crease creation.
Revision Surgery: How Common and Why
A seven-year analysis of complaints following Asian blepharoplasty found that asymmetry was the single most frequent source of dissatisfaction in both first-time and revision surgeries. Among revision patients specifically, 48% cited asymmetry as their primary concern, with uneven crease height being the most common type. Other reasons for complaints after revision surgery included noticeable scarring (28%), dysfunction such as difficulty closing the eye (32%), multiple eyelid creases (28%), and a shallow or absent crease (12%).
The complaint rate for revision double eyelid surgeries in that study was just under 1%, based on about 2,500 revision cases. That’s relatively low, but it’s worth noting that complaints don’t capture every patient who was mildly dissatisfied or chose not to pursue a formal report. The data does reinforce that asymmetry is the issue most likely to bring someone back, whether after a first surgery or a second one.
Choosing the Right Approach for Lasting Results
If permanence is your priority, the incisional method is the more reliable choice. It involves a longer recovery, typically more swelling and a visible scar hidden in the crease, but the structural change it creates doesn’t depend on sutures holding tension over time. For people with thicker eyelid skin or more fat in the upper lid, the incisional method is generally recommended because suture techniques have a harder time maintaining the crease in that anatomy.
The suture method makes more sense for people with thinner eyelid skin, less fat, and a natural partial crease they want to enhance. It’s also appealing because it’s reversible in the early period and recovery is shorter. But you should go in knowing there’s a real chance, somewhere between 19% and 35% depending on technique and anatomy, that the crease may weaken enough to warrant a redo within a few years. If fat removal is performed alongside the suture method, the odds of a lasting result improve substantially.