Do Puffy Eyes Always Require Double Eyelid Incision Surgery?

Puffy eyes are mainly caused by thickening of the following tissues:

▲ Orbital fat
▲ Sub-orbicularis oculi fat
▲ Orbicularis oculi muscle

The orbicularis oculi muscle and the fat beneath it are distributed across the entire upper eyelid. If puffiness is caused by thickening of these two tissues, a full-length incision—namely, incisional double eyelid surgery—is necessary in order to remove the excess muscle and underlying fat.

However, if the puffiness is caused purely by orbital fat, the situation is different. Orbital fat is compartmentalized into small pockets, so it can be removed through a small, minimally invasive incision without the need to fully open the eyelid.

Therefore, although both conditions are referred to as “puffy eyes,” the surgical approach depends on which tissue is responsible for the thickness. This determines whether incisional double eyelid surgery is required, or if a suture (non-incisional) double eyelid procedure combined with minimally invasive fat removal is sufficient. A thorough preoperative evaluation is essential to determine the most suitable, customized double eyelid surgery for you.