Incisional Double Eyelid Surgery: What It Can Do for Heavy Eyelids

If your eyelids are thick or you have excess skin and fat, incisional surgery can remove the extra tissue and set a stable crease. However, swelling can take a while to subside, scars may be visible, and side effects can occur. It is not the right choice for every eye.

Here is an overview of who the incisional method suits and what the recovery process looks like.

What is incisional double eyelid surgery?

The incisional method creates the crease by making an incision in the upper eyelid. Through this opening, the surgeon can remove as much excess skin, thick muscle, or fat as needed. This is what sets it apart from the buried suture method, which forms the crease by tying thread inside the eyelid.

This is a procedure diagram from the clinic's website, not an actual surgical photo.

We covered which eyes suit the buried suture method in a previous post.

Who is a good candidate for the incisional method?

The buried suture method is an option for eyelids that are thin, have little fat, and do not droop significantly. When these conditions do not apply, we consider the incisional method or the partial incision method.

· Thick or excess skin — Removing the extra skin can make the eyes look more open. In a study of 168 people aged 17 to 30 in China, those who received only the incisional method without inner-corner surgery saw the visible eye area increase by about 19% after 90 days.

· Puffy eyelids from thick fat or muscle — The goal is to trim the thick tissue so the crease lasts. In a study from another Korean clinic that followed 680 patients for 2 to 8 years, most creases were maintained.

· Weak eye-opening strength — If the eyes have weak lifting strength, we consider ptosis correction alongside double eyelid surgery. Ptosis correction strengthens the eye-opening muscle, since double eyelid surgery alone does not increase this strength. We will check your eye-opening strength during the consultation and explain our recommendation.

This is an AI-generated illustration, not an actual patient photo. Results vary from person to person.

The incisional method can hold the crease in place reliably, but swelling may be significant and the incision scar may be visible. For eyes without much excess skin, the partial incision method, which makes an incision only in the center and uses buried sutures for the rest, may be a better fit. The head physician will examine you and recommend the right method during an individual consultation.

How long do swelling and scarring last?

Recovery varies depending on the surgical method and the individual's healing speed. The timeline reported in studies from other medical institutions is as follows.

· Swelling — In the study, most patients hardly noticed swelling by around 4 weeks, although mild swelling can persist for several months. Bruising or blood pooling is usually absorbed within a short period, but this varies from person to person.

· Crease — At first the crease may look higher due to swelling, then it settles lower. In the study, the height of most creases did not change after about 3 months.

· Stitches — In the study, skin sutures were typically removed 3 to 7 days after surgery. At Seorae Plastic Surgery, the head physician personally handles everything from the consultation to surgery and stitch removal.

· Scarring — In the early stages, the incision line may look red, and the crease area may appear slightly sunken. In the 680-patient study mentioned above, this depression became noticeable around week 3 and faded over 12 weeks, but most patients still had a slight indentation afterward.

We will go over the full schedule with you during your consultation.

This is an AI-generated illustration, not an actual patient photo.

Side Effects and Post-Surgery Care

The following reactions or side effects may occur after surgery.

· Asymmetry — The height or shape of the creases on each side may differ. Differences right after surgery often even out over time.

· Shallow or loosened crease — Even with the incisional method, the crease may partially or fully loosen.

· Crease shape differs from expectations — The crease may be set too high, making the area beneath it look puffy, or multiple creases may form.

· Hollow-looking eyelid area — This can occur if a large amount of fat is removed.

· Deep or raised scars — The scar may look noticeably sunken or, rarely, become thick and raised.

· Dryness and light sensitivity — Your eyes may feel dry or sensitive to light for a while. Dryness usually improves by around 3 months.

· Incomplete eye closure or drooping — This may occur temporarily due to swelling or anesthesia. It can also result from removing too much skin or muscle, or from injury to the muscle that opens the eye.

· When combined with ptosis correction — The correction may be insufficient or excessive, swelling and recovery time may be prolonged, and the risk of other side effects may increase.

· Infection and bleeding behind the eye — Infection may occur rarely. Very rarely, bleeding that collects behind the eye can affect vision.

After surgery, especially on the day of or the day after, please contact us right away, without waiting, if you experience severe pain or pressure around the eyes, sudden worsening of swelling, or if you have trouble seeing clearly.

If your eyes feel dry, you may use eye drops such as artificial tears. For all other aftercare, please follow your medical team's instructions.

If you are considering the incisional method, what should you do now?

· Share your medications and supplements — Please tell us during your consultation about blood-thinning medications such as aspirin, as well as herbal remedies and supplements. Whether to stop any of them will be decided together with your medical team.

· Share your eye and general health history and past surgeries — Please let us know about dry eye, vision correction procedures such as LASIK or LASEK, the timing and method of any previous double eyelid or eye surgeries, and chronic conditions such as high blood pressure.

· Think about the crease you want — Having an idea of the height and shape you prefer makes it easier to adjust the result to suit your eyes. Please also check any existing differences between your left and right eyes before surgery.

Seorae Plastic Surgery determines the surgical method only after assessing your eye-opening strength, skin thickness, and fat volume.

Frequently Asked Questions

Q. Can incision scars from double eyelid surgery be seen when the eyes are closed?

When you close your eyes and look downward, the incision line may appear as a thin line or an indentation. How visible it is depends on your skin type, and it may become more noticeable if the crease is set too low.

Q. If a buried suture method has come loose, can it be redone with the incisional method?

Reports indicate that it can be. The incisional method is generally recommended for revision surgery, and it is also suitable for removing any remaining buried sutures at the same time. However, the outcome depends on factors such as the amount of skin remaining after the previous surgery, so an examination is required.

Consultation and Booking Information

If you have trouble finding us, please give us a call. View on Google Maps

References

· Jin S, Zhong F, Del Hernandez ARR, Zhu S, Zang M, Li S, et al. Surgical Decision Making in Incisional Blepharoplasty in Asians. Aesthetic Plast Surg. 2026;50(2):616-627. PMID 41198885.

· Li D, Yan H, Zhang H, Yang E, Liu X. Application of retaining the vessels around the orbicularis oculi muscle in blepharoplasty. J Cosmet Dermatol. 2024;23(10):3319-3326. PMID 38769823.

· Lu M, Lin W, Liu J, Wei D, Shen X. Photo-Assisted Anthropometric Analysis of Double Eyelid Blepharoplasty in Young Chinese. J Craniofac Surg. 2023;34(8):2501-2505. PMID 37603893.

· Kim HS, Hwang K, Kim CK, Kim KK. Double-eyelid surgery using septoaponeurosis junctional thickening results in dynamic fold in asians. Plast Reconstr Surg Glob Open. 2013;1(2):1-9. PMID 25289207. — Study from a Korean medical institution

· Kruavit A. Asian blepharoplasty: an 18-year experience in 6215 patients. Aesthet Surg J. 2009;29(4):272-83. PMID 19717058.

· Ge C, Ge C, Zhang Y, Yang K, Li K, Huang J. Correlation and Responsiveness of Objective and Subjective Measures in Evaluating Periorbital Swelling After Upper Blepharoplasty: A Retrospective Study Using 3D Stereophotography and Visual Analogue Scale. Ann Ital Chir. 2026;97(6):1112-1119. PMID 42304158.

· Liu J, Song B. Review of complications in double eyelid surgery. Indian J Ophthalmol. 2022;70(5):1460-1465. PMID 35502011.

· Chen WPD. Techniques, Principles and Benchmarks in Asian Blepharoplasty. Plast Reconstr Surg Glob Open. 2019;7(5):e2271. PMID 31333982.

· Choi Y, Eo S. A new crease fixation technique for double eyelidplasty using mini-flaps derived from pretarsal levator tissues. Plast Reconstr Surg. 2010;126(3):1048-1057. PMID 20811237. — Study from a Korean medical institution

· Su X, Chen D, Zhuang J, Hu J, Cai N, Ou Y, et al. "A 7-year analysis of complaints related to Asian blepharoplasty". J Cosmet Dermatol. 2025;24(3):e16271. PMID 39998431.

· Zhao J, Chen C, Ju Z, Zhang B, Qin X, Hu W, et al. Prevention of Incisional Depression in Double Eyelid Blepharoplasty Using an Elevated Cephalad Orbital Septum Flap Technique. Ann Plast Surg. 2026;97(5):494-500. PMID 42623493.

· Anderson L, Vankawala J, Gupta N, Dorfman R, Pflibsen L, Vardanian A, et al. Evaluation of the Risk of Hypertrophic Scarring and Keloid Following Eyelid Procedures: A Systematic Review. Aesthet Surg J. 2023;43(8):820-829. PMID 36797842.

· Yan Y, Zhou Y, Zhang S, Cui C, Song X, Zhu X, et al. Impact of Full-Incision Double-Eyelid Blepharoplasty on Tear Film Dynamics and Dry Eye Symptoms in Young Asian Females. Aesthetic Plast Surg. 2020;44(6):2109-2116. PMID 32696159.

· Hao DY, Cang ZQ, Cui JB, Fan X, Ding JK, Wei SM, et al. Simultaneous Double Eyelid Blepharoplasty and Blepharoptosis Correction With Levator Aponeurosis Plication Technique: Clinical Experience of 108 Cases. Ann Plast Surg. 2022;88(6):606-611. PMID 35612534.

· Lee EI, Ahn TJ. Mild ptosis correction with the stitch method during incisional double fold formation. Arch Plast Surg. 2014;41(1):71-6. PMID 24511498. — Study from a Korean medical institution

· Taghioff SM, Munkwitz SE, Quan H, Slavin B, Garg S, Yasmeh J, et al. Safety Considerations in Blepharoplasty: A Comprehensive Review. J Craniofac Surg. 2026. doi:10.1097/SCS.0000000000013144. PMID 42555303.

· Mejia JD, Egro FM, Nahai F. Visual loss after blepharoplasty: incidence, management, and preventive measures. Aesthet Surg J. 2011;31(1):21-9. PMID 21239669.

· Christensen NA, Feltgen N, Horn M, Naxer S, van Oterendorp C, Koscielny J, et al. Risk factors for bleeding and perioperative bleeding complications in oculoplastic surgery: a prospective pilot study. Br J Ophthalmol. 2025;109(12):1330-1337. PMID 40695569.

· Chen WP. The Eyelid Crease Height, Depth, and Shape: A Scoring System for Revisional Asian Blepharoplasty. Plast Reconstr Surg Glob Open. 2020;8(5):e2802. PMID 33154864.

· Mizuno T. Treatment of Suture-related Complications of Buried-suture Double-eyelid Blepharoplasty in Asians. Plast Reconstr Surg Glob Open. 2016;4(8):e839. PMID 27622107.

This article is general information prepared by Seorae Plastic Surgery based on abstracts and full texts of papers indexed in PubMed, along with our in-clinic medical guidance. It does not guarantee a diagnosis or treatment outcome. All cited studies report results from other medical institutions, not from Seorae Plastic Surgery. Results and recovery periods for procedures and surgeries vary depending on each person's condition, and side effects may occur. For details, please consult a specialist during your visit.

#IncisionDoubleEyelid #DoubleEyelidIncision #IncisionBlepharoplasty #OpenBlepharoplasty #IncisionMethod #DoubleEyelidSurgery #EyelidSurgery #HeavyEyelids #PtosisCorrection #EyePlasticSurgery #DoubleEyelidScar #EyelidSwelling #SeochoPlasticSurgery #BanpoPlasticSurgery #ExpressBusTerminal #ShinbanpoStation #SeoraePlasticSurgery