Open Technique vs. Suture Technique: Understanding Your Options for Asian Eyelid Surgery

Open Technique vs. Suture Technique: Understanding Your Options for Asian Eyelid Surgery


Double eyelid surgery, also known as Asian eyelid surgery, creates a visible crease above the upper lash line if you don't have this feature naturally. This is one of the most popular cosmetic procedures among Asian patients worldwide. 

Over the years, surgeons have developed different ways to perform the double eyelid operation. The two primary methods are the open technique and the suture technique. If you are considering this surgery, you should understand the options available and how they can impact your recovery and results. 

Below, we'll explore these two techniques and provide insights from Dr Ellis Choy, an experienced specialist plastic surgeon for Asian eyelid surgery in Sydney, Australia.

What Is Double Eyelid Surgery?

Double eyelid surgery creates a crease in the upper eyelid. Many men and women of East Asian and Southeast Asian heritage have "monolids," or eyelids that do not have an upper "supratarsal" crease. This is a natural and distinctive feature that, the vast majority of the time, does not affect a person's vision or pose any other problems. However, some people prefer the look of double eyelids.

Asian eyelid surgery changes the appearance of the upper eyelid and does not affect the lower eyelid. The goal of the procedure is not to produce a more Western-looking eyelid but rather to create an upper eyelid crease while preserving the patient's individuality and Asian heritage. 

Monolids are not a requirement for this procedure. If you have double eyelids but they are not as defined as you would like them to be, or if your eyelid creases are asymmetrical, this type of blepharoplasty may be able to address your concerns.

The Open Technique (Incisional Method)

The open technique involves making a full incision along the upper eyelid where the crease will appear. This approach gives the surgeon maximum access to the skin, muscle, and fat in the area so that adjustments can be made. It also produces more substantial and longer-lasting changes than the suture technique.

Advantages of the Open Technique for Double Eyelid Surgery

  1. Precision and Customisation: The open technique enables Dr Choy to create a precise, tailored crease that complements the patient's eye shape and facial features,
  2. Versatility and Control: With direct incisional access, Dr Choy can remove excess skin, sculpt the underlying fat and securely anchor the new crease.
  3. Creativity: The open technique allows for fine-tuning of the crease height and shape according to the patient's preferences.
  4. Durability of Results: The strong attachment made during the open technique creates a more permanent crease that is less likely to fade over time.
  5. Patient Comfort: The open technique is performed under local anaesthesia, which is typically well-tolerated by patients.

Disadvantages of the Open Technique for Double Eyelid Surgery

  1. Longer Recovery Time: Compared to the suture technique, the open technique may involve more swelling and bruising, and require more time off work or social activities.
  2. Higher Risk of Complications: There are risks such as infection, bleeding or unfavourable scarring any time an incision is made in the skin.
  3. Scarring: While the incision line is usually well-concealed within the crease, some patients may be concerned about visible scarring. Keloid scarring is of particular concern for Asian patients; fortunately, it is rare in the upper eyelid.
  4. Possibility of a More Noticeable Result: Due to the scar along the crease and the more significant degree of change it can accomplish, this technique may leave behind more evidence of a procedure.

The Suture Technique (Non-Incisional Method)

The suture technique, also known as the non-incisional method, involves no cutting of the skin. Instead, sutures are used to create a crease by "tying" the skin to the underlying muscle. This approach is best suited for younger patients and those with very thin eyelid tissue; it may be less effective for patients with thicker skin or more excess skin and fat.

Advantages of the Suture Technique

  1. Quick Procedure: The suture technique is quicker to perform, since no incisions are made.
  2. Shorter Recovery Time: Patients typically experience less swelling and bruising and can return to normal activities more quickly.
  3. Minimal Scarring: Because there are no linear incisions, there is minimal risk of visible scars. This can be appealing for Asian patients who are concerned about discretion and poor scarring.
  4. Reversibility: If the patient is unsatisfied with the results, the sutures can be removed, allowing the eyelid to return to its original state.

Disadvantages of the Suture Technique

  1. Less Precise: The suture technique does not give Dr Choy as much control over the crease shape and height.
  2. Limited Access: Without making incisions, Dr Choy cannot remove excess skin or reposition the underlying fat, which limits the adjustments that can be made.
  3. Higher Failure Rate: The suture technique may not create a permanent crease, and the results may reverse over time.
  4. Less Patient Comfort: Dr Choy must manipulate the eyelid back and forth while placing the sutures, which can be uncomfortable and unnerving for some patients.
  5. Higher Rate of Revision: Dr Choy estimates that around two-thirds of the revision patients he sees have previously undergone the suture technique.

What to Consider When Choosing an Asian Eyelid Surgery Technique

Cosmetic surgery is an exceptionally personal matter. No one should advise you whether you should or shouldn't have surgery unless it's a medical necessity that affects your health. It is up to you to decide if you want Asian eyelid surgery, a decision that should be made in collaboration with a specialist plastic surgeon.

If you are interested in the procedure, your surgeon will help you choose which technique is right for you. This decision will involve multiple considerations, such as:

  • Your anatomy and skin characteristics: The thickness and elasticity of your eyelid skin, as well as the amount of excess skin and fat present, influence which technique is suitable.
  • Your aesthetic preferences: Discuss your desired crease height, shape and overall look with Dr Choy. He will inform you of what is a realistic result and which technique he recommends.
  • Recovery time and downtime: You may prefer the suture technique if you have a busy schedule or limited time off. Alternatively, if your schedule allows, you may prefer to invest in the recovery time of the suture technique in exchange for a more durable result.
  • Budget considerations: The open technique may cost more than the suture technique due to its greater complexity and longer procedure duration.
  • Scar tolerance and willingness to accept limitations: You may opt for the suture technique if you are highly scar-averse, but you should be aware of its limitations regarding precision and longevity.

Dr Ellis Choy's Perspective and Approach

Dr Choy has considerable experience in both the open and suture techniques for Asian eyelid surgery. Having performed both many times, he prefers the open technique due to its versatility, precision and durability. It suits a broader range of patients and has a much lower chance of fold loss.

For the suture technique to be an option, the conditions must be right. The patient must not have excess eyelid skin, there must be minimal asymmetry in the eyelids and the eyes should not show any signs of ptosis (droopy eyelids). The indication for suture double eyelid surgery is limited.

Double eyelid surgery is complex, and for this reason, you will want to select a fully qualified specialist plastic surgeon who not only has expertise in eyelid surgery but also specifically in Asian eyelid surgery. Your surgeon should have a deep understanding of Asian aesthetic preferences, cultural considerations and the unique anatomical characteristics of Asian eyelids.

Explore Your Eyelid Surgery Options With Dr Choy

The choice between the open and suture techniques for Asian eyelid surgery involves many factors. While the open technique has advantages and is Dr Choy's preferred approach, the suture technique may be appropriate in certain cases.

Ultimately, you must select a qualified, experienced surgeon who can tailor the procedure to your needs and goals. Dr Choy understands Asian anatomy and the cosmetic needs of Asian patients like few other surgeons in the region. He has extensive training and has performed many Asian eyelid surgeries as the primary surgeon.

If you would like to explore which technique might be suitable for you, contact Asian Plastic Surgery to schedule a consultation with Dr Choy today.

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