Double Eyelid Line Disappeared? How the Revision Method Is Chosen: Re-Suture or Incision

When a double eyelid line fades or disappears, the first thought is often ‘I’ll just have it tied again the same way.’ But the revision method is not decided by the loosening alone. Fixing a loosened double eyelid does not necessarily mean using the same method as the first surgery. This post walks through how to tell whether the crease has really loosened, what decides between re-suturing and switching to incision, what else is checked, and when revision can be done.

Cover image on a navy background. On the left are the header ‘1mm Eye Surgery Notes’, the title ‘Double eyelid line disappeared?’, the subtitle ‘Re-suture or switch to incision: how the revision method is chosen’ and four chips reading ‘Skin & sagging · Fat · Eye-opening strength · Previous surgery’. On the right, labelled ‘Concept illustration’, is an eye illustration whose double eyelid crease fades into a dotted line towards the inner corner — Cover image for a post on how the revision method is chosen for a loosened double eyelid. The eye is a concept illustration.

If your double eyelid line has disappeared, has it really loosened?

A common thought
I can barely see the crease any more. It must have come undone, right?

There is more than one reason a double eyelid line can look faded. The fixation that held the crease may really have weakened, or the crease may still be there but look loosened for another reason. Based on 1mm Plastic Surgery’s procedure information, these can be grouped into three broad cases.

Diagram on an ivory background with three eye illustrations side by side, titled ‘Three reasons a crease can look faded’. From the left: an eye whose crease fades into a dotted line towards the inner corner, labelled ‘1 Weaker fixation — The crease fades or disappears’; an eye whose upper lid covers the top of the iris, labelled ‘2 Eye-opening strength — A low lid can make it look loose’; and an eye with loose skin hanging towards the lashes, labelled ‘3 Sagging skin — Skin falls over the crease’. A ‘Concept illustration’ note is in the bottom right corner — Concept illustrations placing side by side three cases in which a double eyelid crease can look faded.

Weaker fixation — The connection between the eyelid skin and the tissue beneath has weakened, so the crease fades or disappears. This is what people usually mean by ‘loosening’.
Weak eye-opening strength — When the muscle that opens the eye is weak, the lid sits low, so even with a crease the double eyelid can look loosened or the eyes can look sleepy.
Sagging skin — When the eyelid skin stretches and droops, it can cover the crease and make the double eyelid look thinner or as if it has disappeared.

If the surgery was recent, there is one more thing to consider. In the early period after surgery, the crease can look different while swelling goes down and the tissue heals. So a crease that looks different cannot immediately be taken as a sign that it has loosened.

Why double eyelids loosen, and common misconceptions about the suture and incisional methods, are covered in our earlier post ‘Why do double eyelids loosen after surgery? How the suture and incisional methods differ, and what to do’. This post looks in more detail at that post’s ‘What if it has loosened?’, that is, how the revision method is chosen.

What decides the method for revision double eyelid surgery?

Even for the same ‘loosening’, the revision method depends on the current condition of the eye. What is checked in a consultation can be summed up in four factors.

Diagram on an ivory background with four eye illustrations side by side, titled ‘Four factors that shape the revision method’. From the left: an eye with loose skin hanging towards the lashes labelled ‘1 Skin thickness & sagging’; a puffy, thick eyelid labelled ‘2 Amount of fat’; an eye whose upper lid covers the top of the iris labelled ‘3 Eye-opening strength’; and an eye with a reddish scar along the crease labelled ‘4 Previous surgery’. Below is the line ‘All four are looked at together’. A ‘Concept illustration’ note is in the bottom right corner — Concept illustrations placing side by side the four factors that shape the revision method.

Eyelid skin thickness and sagging — 1mm Plastic Surgery’s information describes the suture method as recommended when the eyelid skin is thin with little sagging, and the incisional method as recommended when the skin sags a lot or is thick.
Amount of fat — A double eyelid can loosen when fat was not removed enough or the fixation was not sufficient. If the eyelid has a lot of fat, a method that also addresses the fat is considered.
Eye-opening strength — If the strength to open the eye is lacking, the crease can still look loosened even after it is re-fixed. This case is covered separately below.
Signs of previous surgery — Depending on existing adhesions, scarring and the skin’s condition, the incisional method may be needed. How the previous surgery has left its mark is checked through an examination.

The key point

A first surgery done with the suture method does not automatically mean a suture revision, and an incisional first surgery does not automatically mean an incisional revision. Even when revision is needed, the same method as the previous surgery is not always applied. The four factors are looked at together to choose a method that suits the eye as it is now.

Re-suturing or switching to incision: what is the difference?

There are two main ways to fix a loosened crease again: the suture method (natural adhesion), which re-ties the crease through tiny openings, and the incisional method, which opens the skin, tidies the tissue underneath and then fixes the crease.

Diagram on an ivory background with two closed-eye illustrations side by side, titled ‘Re-suturing or switching to incision’. On the left, three small dots are marked on the eyelid, labelled ‘Suture method (natural adhesion) — Re-tied through tiny openings’. On the right, a single curved line is drawn on the eyelid, labelled ‘Incisional method — Tissue trimmed and fixed through an incision’. A ‘Concept illustration’ note is in the bottom right corner — Concept illustrations placing the suture method (tiny openings) and the incisional method (incision line) side by side.

Item	Suture method (natural adhesion)	Incisional method
Method	The crease is fixed by tying knots inside the muscle through tiny openings.	The skin is opened along the crease, excess fat and part of the muscle are trimmed, and the skin is then fixed to the deeper tissue (the tarsal plate and the eye-opening muscle).
Eyes it is considered for	Eyelid skin that is thin with relatively little sagging	Skin that sags a lot or is thick, eyelids with a lot of fat, or cases where adhesions or scarring from previous surgery call for an incision
Advantages	With a smaller area of incision, the burden of swelling and recovery time tends to be relatively low.	Fat and tissue can be addressed at the same time, and a firmer fixation can generally be expected.
Points to consider	If the eyelid is thick or the skin sags a lot, the suture method alone may not give enough hold.	The scar at the incision and the recovery time need to be considered. Depending on the tissue and the degree of adhesion, the crease may still weaken or change.

This table is not a comparison of which method is better; it sets out which eyes each method is considered for. The exact method is decided after an examination and consultation.

1mm Plastic Surgery’s natural adhesion information explains that there is no fixed number of openings (holes): between 4 and 12 are planned after looking at the condition of each section of the eye and the symmetry of both eyes. Fewer holes are used when the eye-opening strength is strong, and more when it is weak, and the number and height of holes in each section depend on tissue volume and whether there is an existing crease. For revision, the signs of the previous surgery are also taken into account.

If eye-opening strength is weak, is re-fixing the crease enough?

1mm Plastic Surgery’s ptosis correction information explains that when there are signs of ptosis, double eyelid surgery without ptosis correction can leave the double eyelid looking loosened or the eyes looking sleepy. In other words, if the cause of a faded-looking crease lies in eye-opening strength, re-fixing the crease alone may bring less change than expected.

Diagram on an ivory background with two front-view eye drawings side by side, titled ‘Same crease, different look: eye-opening strength’. Both eyes have a double eyelid crease drawn at the same height. On the left, the upper lid margin rests at the top edge of the iris, labelled ‘Enough strength’. On the right, the upper lid margin covers much of the iris and sits closer to the crease, labelled ‘Weak strength’. Below is the line ‘An exact assessment needs a consultation’. A ‘Concept diagram’ note is in the bottom right corner — A simple diagram showing how the same double eyelid crease can look different depending on eye-opening strength.

In such cases, ptosis correction is considered alongside re-fixing the crease. According to 1mm Plastic Surgery’s information, if eye-opening strength is still lacking after double eyelid surgery, ptosis correction can be considered without touching the existing crease. ‘No visible change after double eyelid surgery’ is also listed among the cases recommended for non-incisional ptosis correction. More details are on 1mm Plastic Surgery’s ptosis correction page.

Revision for causes other than loosening, such as multiple creases, different left and right eyes or a crease that is too thick, is covered cause by cause in our earlier post ‘Double Eyelid Revision: What to Know Before Going Back — Six Causes and the Right Timing’.

How is revision different from a first surgery, and when can it be done?

Revision means operating again on an eyelid that has already had surgery. That is why it matters to remove scar tissue from the previous surgery and limit tissue damage during the operation. Scars that already exist cannot be removed completely. However, the plan takes the size and position of the scar into account so that as little additional scarring as possible is left.

The timing also differs from a first surgery. 1mm Plastic Surgery’s double eyelid revision information explains that it is advisable to have revision at least one year after the first surgery, because an accurate assessment is only possible once the eye tissue has settled. However, depending on the surgeon’s judgement, revision is sometimes done in the early period after surgery, before the scar hardens.

Why the wait matters and what to do while waiting are covered in our earlier post ‘How Soon Can You Revise Double Eyelid Surgery? Why the Wait Matters’.

Timeline diagram on an ivory background running from left to right, titled ‘When can revision be done?’. Three boxes are joined by arrows: ‘First surgery’; ‘Recovery — The crease may look different as swelling settles’; and ‘After at least 1 year — Tissue settles, so an assessment is possible’. Below is the line ‘In some cases the surgeon may decide to proceed earlier’. A ‘Concept diagram’ note is in the bottom right corner — A diagram setting out, in order, the revision timing given in 1mm Plastic Surgery’s double eyelid revision information. Timing may differ depending on the individual’s eye condition.

Who revision is for and how each cause is improved are explained on 1mm Plastic Surgery’s double eyelid revision page.

Side effects and precautions

Common recovery reactions — Swelling, bruising and differences between the left and right eyes may occur. The course of recovery differs from person to person and is checked through follow-up care.

Scarring — A scar may form at the incision, and scars that already exist cannot be removed completely.

Inflammation and infection — Inflammation or infection may occur after surgery. If anything feels unusual, please have it checked through follow-up care.

Changes in the crease — Even after revision, depending on the individual’s tissue, the degree of adhesion and the course of recovery, the crease may weaken again or look different from what was expected.

What should you prepare before a revision consultation?

With revision in particular, thorough communication matters. 1mm Plastic Surgery’s information explains that a consultation checks what you are currently unhappy with, what the medical team sees as the problem, and the improvement you hope for, before the surgical plan is discussed. Preparing the following in advance can make the consultation easier.

When and how the first surgery was done — Note when you had surgery and whether it was the suture or incisional method, as far as you know.
When and how the crease changed — Write down whether the crease never formed well from right after surgery, faded over time, or changed on one side only.
What bothers you now — Be specific, for example a faint crease, a sleepy look or a difference between the two sides.
The direction you hope for — Be ready to talk about what you would like for the height or shape of the crease.

In the consultation, this information is looked at together with the examination, and the revision method, timing and side effects are explained. Even for the same ‘loosening’, the plan can differ when the cause and the condition of the eye differ.

Loosened double eyelid revision: frequently asked questions

My suture-method double eyelid loosened. Can it be redone with the suture method?

It depends on your eyes. If the eyelid skin is thin with little sagging, the suture method may be considered, but depending on existing adhesions, scarring and the skin’s condition, the incisional method may be needed. This is decided after the current state of the eyelid is checked through an examination.

I had the incisional method and it still loosened. Will the revision also be incisional?

With the incisional method too, the crease can weaken depending on the individual’s tissue, the degree of adhesion and the course of recovery. The revision method is decided after the current state of the eye is checked. If the cause of the faded-looking crease lies in eye-opening strength, ptosis correction may also be considered.

Will the crease stay after revision?

Revision aims to redesign the crease and fix it so that it does not loosen again. However, depending on the individual’s tissue, the degree of adhesion and the course of recovery, the crease may still weaken again or change.

What happens in a consultation

Beyond the fact that it loosened,
we look at why it loosened and how your eyes are now

Checking the previous method, adhesions and scarring
Checking skin thickness, sagging and fat
Checking eye-opening strength and left–right differences
Explaining the revision method, timing and side effects

We check the current condition of your eyes and the direction you hope for, and discuss a suitable revision method. Results and the course of recovery may differ from person to person.

Consultation and booking

Enquiries	[email protected] Getting in touch in advance can help reduce your waiting time.
Telephone	+82-2-552-1171
WhatsApp	+82 10-9451-1171
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Website	1mmpsglobal.com

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This post was written by the founder of a medical institution to provide medical information. The procedure information is based on the double eyelid revision, natural adhesion double eyelid, incisional double eyelid and ptosis correction pages of 1mm Plastic Surgery’s website. The eye images in this post are concept illustrations and diagrams made to aid understanding; they do not show real people and are not before-and-after images. For any surgery, its suitability for you, the result and the course of recovery may differ depending on your eye condition and surgical history, and side effects may occur. Please confirm the details through a consultation.