Nowaday, a lot of patients appear to obtain their cosmetic information from plastic surgery websites and want to have certain procedures because of the wonderful results some of these sites claim. I recently received an oversea email asking me to perform DST as he reads on the internet that it is a fail-safe technique for double eyelids and have little down time. DST (double sutures and twists) is a variant of the suture technique for double eyelid surgery and was described by Katsuhiro Kure and Akihiro Minami (steps as shown below). They claimed to have perform this technique for 1108 eyes over 10 years with no loss of double-eyelid line in a mean follow-up time of 32 months. However, their patients must have been very carefully selected because I have seen two cases of DST performed oversea with breakdown of the double eyelids. Some plastic surgeons claim DST stand for Durable Suture Technique to entice the patients. This technique like all suture technique only work well in patients who have thin upper eyelid without excess upper eyelid skin and fat.
Unfortunately, this patient did not meet the criteria as he had excess upper eyelid skin and fat so the best result was achieved with incision technique that removes the skin and some fat.
Preoperative appearance. Note the excess skin
and thick upper eyelid.
Immediate postoperative appearance.