Do I Need an Incisional Double Eyelid Surgery? Self-Assessment Included

How Are Double Eyelids Formed?
To open the eyes, we rely on the levator muscle.
The levator acts like a hand that lifts the tarsal plate (the firm structure beneath the eyelashes) to open the eyelids.

If the levator muscle adheres to the skin, opening the eye will pull the skin inward and upward, creating a fold—this becomes a double eyelid.
The goal of double eyelid surgery is to create a stable attachment between the skin and the levator muscle or tarsal plate where the crease is designed to appear.

Types of Double Eyelid Surgery

There are two main techniques:
Non-incisional (suture) method and Incisional method.
The non-incisional approach is popular because it leaves minimal scarring, but the incisional method is more suitable in the following four cases:

1. Excess skin requiring removal
2. Thick eyelids due to tissue that cannot be reduced with micro-liposuction
3. Moderate to severe ptosis that cannot be corrected by the non-incisional approach
4. Revision surgery when lowering a previously high crease

My eyelids are thick, does that mean I must choose the incisional method?

This is a very common concern.
The ” puffiness” may come from different structures (from superficial to deep):

• Subcutaneous fat
• Orbicularis oculi muscle
• Submuscular fat
• Orbital fat
• Brow bone projection

Any of these may cause heaviness or puffiness.
Only an in-person examination can determine the true source.

Incisional surgery is not always necessary

If the heaviness comes from excess orbital fat:

• It is often difficult to create a crease with eyelid tape
• But the good news is: orbital fat is soft and removable through a tiny puncture
• No skin incision is required

If combined with double eyelid creation:
Non-incisional double eyelid + micro-liposuction
is usually stable and natural.‬

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Incisional surgery is recommended when:

• Orbital fat is not excessive
• Brow bone height is normal
• Puffiness comes from thick muscle or submuscular fat

In these cases:

• Only the incisional method can effectively remove the excess tissue
• The orbicularis muscle can only be partially, carefully trimmed
• Over-resection may cause incomplete eyelid closure

Thus, when thickness originates from deeper muscular layers—not orbital fat—the incisional approach is safer and more effective.

Bottom Line: Even with heavy eyelids, sutures may still be an option!

Many patients can achieve stable, beautiful results through:
Suture method + micro-liposuction

Only certain anatomical conditions truly require the incisional technique.

Still unsure whether you need suture or incisional surgery?

Use the self-assessment checklist below
to receive an initial recommendation.