Incisional Double Eyelid Surgery (Blepharoplasty): When Is This Procedure Preferred?
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incisional double eyelid surgery - when is it preferred

Incisional Double Eyelid Surgery (Blepharoplasty): When Is This Procedure Preferred?

Incisional Double Eyelid Surgery, also known as Incisional Upper Blepharoplasty, is a type of cosmetic procedure with the primary goal of enhancing and defining the upper eyelid crease. The immediate results of this short procedure and its ability to significantly accentuate the eyes have caused the Incisional Double Eyelid Surgery to gain a lot of popularity all over the world, and the trend continues to rise. (1)

Why Are There Different Double Eyelid Surgery Techniques?

There are different double eyelid surgery techniques currently being practised, which include:

  • Incisional Technique
  • Non-Incisional Technique

These different eyelid surgery techniques allow the surgeon to choose the approach and technique that might suit the patient the best, according to their eye anatomy and desired results. If the patient does not have excess skin on their eyelid, then the Non-incisional or Suture Technique might be more ideal for them. On the other hand, the presence of excess skin may require an incisional technique, as the loose skin needs to be removed first in order to get the desired results. Moreover, the removal of the excess skin is also necessary to prevent the upper eyelid fold from sagging and disappearing too quickly.

Another reason that differentiates the two techniques is their levels of invasiveness, the resulting healing time, and the longevity of results. The Non-cutting or Suture technique is significantly less traumatic and minimally invasive in nature; hence the patient is expected to heal faster after this surgery but is considered a temporary solution. However, the Open Technique or Incisional technique is comparatively more invasive, with longer recovery time and long-lasting results. Depending on the patient’s comfort level and the downtime they can afford, the plastic surgeon will recommend which technique is most ideal.

How Is Incisional Double Eyelid Surgery Different From Non-Incisional Method?

Differences In Technique Approach

incisional double eyelid surgery method

Incision (Open) Double Eyelid Surgery

The Incisional Double Eyelid Surgery is considered the permanent solution to hooded or creaseless upper eyelids due to the longevity of the results of this type of eyelid surgery. It involves an incision on the top of the eyelids, from where the excess skin or fat may be removed. This is followed by the careful stitching of the eyelid skin to the muscles underneath in order to create a well-defined eyelids crease.

non incisional double eyelid surgery method

Non-Incisional Double Eyelid Surgery 

Non-incisional Double Eyelid Surgery is comparatively a less invasive procedure conducted to define the crease of the eyelid. Unlike the Incisional Double Eyelid Surgery, the Non-incisional approach does not involve the removal of excess skin of the eyelids and results are semi-permanent.

The surgery involves two to three small incisions, after which a suture is passed, which binds the eyelid skin to the deeper tissues. The preferred suture material is usually a permanent Nylon suture, and it may be passed multiple times in order to facilitate a stronger eyelid fold.

Benefits Of Going For Incisional Method

1. Correction Of Hooded Eyes:

This type of eyelid surgery facilitates the correction of the eyes’ hooded appearance, which is characterized by the presence of an extra skin layer that droops over the crease. That makes the eyes appear much less defined and also smaller. Incisional Methods allow the removal of the extra skin drooping over the crease, in turn enhancing the crease of the eyes, lifting the eyelids and making them appear much more open.

 

2. Fat Removal From The Eyelids:

Since the incisional method allows the surgeon to remove fat from the eyelids after making the incision, this allows the adjustment of the overall fat volume and helps even out any dissimilarities between the two eyes. Not only does that help to improve the appearance of heavy-looking eyelids, removal of fat where necessary can also help to improve overall eyelid symmetry.

3. Minimal Scar Formation:

Even though the incisional double eyelid surgery was previously associated with a significant scar formation on the target site, newer approaches and advancements in this surgical technique have significantly improved the appearance of post-surgical scarring reduced to a minimal.

4. Long Term Results:

Due to the removal of the excessive eyelid skin and strong anchoring of the skin to muscles, it is expected to have long-term results without the eyelid fold loosening anytime soon after the surgery.

5. Used For Thick Eyelids:

The incisional method may also be an ideal approach to double eyelid surgery in those with thick eyelid skin. This is because the temporary non-incisional suture technique may not be able to hold the skin folds together, which may eventually lead to the loosening of the skin in the region. However, as the Incisional Methods involves the removal of any excess skin or fat in the eyelids, the crease may be able to appear more well-defined and last for a much longer period of time.

Who Should Consider Incisional Double Eyelid Surgery?

what does incisional double eyelid do

An individual might be a good candidate for Incisional Double Eyelid Surgery, if:

  • They have the presence of excess skin on the eyelid or droopy eyelids
  • They desire a well-defined eyelids crease permanently
  • They require an eyelid revision surgery
  • They have thick skin on the eyelids, which may not allow the non-incisional technique to be conducted.

How Is Incisional Double Eyelid Surgery Done?

The surgeon may start the Incisional Double Eyelid Surgery by carefully evaluating the patient and placing marks to locate the exact location of the double eyelid fold. After making sure that the marks are placed at the exact location on the eyelid where the patient would want their folds to be placed, the area will be anaesthetized using local anaesthesia, which is injected into the eyelids. In some cases, IV sedation may be used for a more comfortable experience. After the anaesthesia or sedation is effective, the surgeon begins by creating an incision on the skin of the eyelids. This is followed by the removal of any fat tissue or excess hanging eyelid skin in order to facilitate firm eyelid folds. The major types of fatty areas contained in the majority of Asian eyelids include the pretarsal fat, the central fat pads, and the pre aponeurotic fat. Once the surgeon is satisfied with the removal of fat and skin, the eyelid skin is pinned into the muscles using sutures, ensuring the formation of a defined eyelid crease. Non-dissolvable stitches are usually used to carry out the procedure, which requires removal after seven days. The total time that this surgery may vary; however, it usually does not take more than 60 minutes. (2)

Common Misconceptions About Incisional Double Eyelid Surgery

  • Keloid Scarring: There is a common misconception around the formation of keloid scars after incisional double eyelid surgery; however, this is a very rare occurrence, as the skin of the eyelids heals differently as compared to the rest of the body.
  • Unnecessarily Costly Procedure: People often chose the Non-incisional double eyelid surgery over the incisional method, as it appears to be the less expensive procedure. However, while the non-incisional procedure might look like the cheaper option, the post-surgery results may have shorter longevity as compared to the incisional option. Some individuals might realize the eyelids skin loosening up over time and require undergoing the surgery once more.

How Much Does Incisional Double Eyelid Surgery Cost?

The average cost of Incisional Double Eyelid Surgery ranges between $2500 to $3500. This cost comprises the surgeon’s fees, the cost of the operation theatres, medications used, type of anaesthesia, types of sutures used, follow-up reviews along prevailing local taxes (GST).

Choosing The Right Double Eyelid Surgery Technique

Incisional Double Eyelid surgery is amongst the most frequently conducted aesthetic procedures in most Asian countries, as most individuals with an Asian ethnic background may not have a defined eye crease. Before considering the double eyelid surgery, the patient should do their research regarding the different techniques of the procedure and consult their doctor regarding their primary concerns and desired outcomes.

 

References:
1.Chen WPD. Techniques, Principles, and Benchmarks in Asian Blepharoplasty. Plast Reconstr Surg Glob Open. 2019;7(5):e2271. Published 2019 May 23. doi:10.1097/GOX.0000000000002271
2.UCHIDA J. A surgical procedure for blepharoptosis vera and for pseudo-blepharoptosis orientalis. Br J Plast Surg. 1962 Jul;15:271-6. doi: 10.1016/s0007-1226(62)80041-1. PMID: 13923412.