Suture technique for creating double eyelid is useful in thin upper eyelids. However, in puffy eyelids the failure rate is high because the fatty tissue in front of the levator muscle will prevent adequate adhesion between the muscle and the skin. Small incision technique in which some fat is removed is the recommended technique as it has the advantage over the full incision technique in having a shorter downtime. However, some patients are adamant in having any incision done to the eyelids for fear people would know they have had double eyelid surgery. In such patients, I modify my suture technique to increase the longevity of the double eyelids by removing fat through the mini-incisions.
A patient with puffy eyelids but didn't want any incision technique.
Modified suture technique. a. Three markings were made 7 mm above the eyelid
margins; b. 3 stab incisions were made through the markings and the orbicularis
and orbital septum were removed using forceps and Vanner scissors; c. fat was
prolapsed through the small incisions; d and e. the fat was clamped and excised;
f, g and h. 6/0 vicryl sutures were used to form the double eyelid.
The picture below was taken two weeks after the operation.
Another patient with the modified suture technique.
The picture below was taken four months later.
Another patient with the modified suture technique.
The picture below was taken 6 months later.
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