Why do double eyelids loosen after surgery? How the suture and incisional methods differ, and what to do

For anyone considering double eyelid surgery, or who has already had it, one common worry is the crease loosening. A crease can weaken or loosen after surgery for a variety of reasons. Not only the surgical method but also your eyelid condition, the characteristics of your tissue and how you recover after surgery are among the many factors that can play a part. Here we look at why double eyelids loosen after surgery, the traits of eyes prone to loosening, how the surgical methods differ, and the right way to respond.

Video thumbnail: a close-up of two eyes with no visible double-eyelid crease, with the words ‘Why your double eyelids keep loosening’ overlaid at the bottom — Video thumbnail — “Why your double eyelids keep loosening”

Why do double eyelids loosen after surgery?

[Frequently asked] If my double eyelid loosens, does that mean the surgery went wrong?
Does the suture method loosen easily, and the incisional method never?
If my double eyelid loosens after surgery, do I need another operation?

Video screen on a grid background with the title ‘Why double eyelids loosen after surgery’ and two lines, ‘① The adhesion weakens ② The eye’s structure doesn’t suit the method’, with a member of the medical team explaining in a circle at lower left — From the video — “① The adhesion weakens ② The eye’s structure doesn’t suit the method”

Double eyelid surgery creates a connection between the eyelid skin and the tissue beneath it, so that a crease forms naturally when you open your eyes.

But if this connection weakens or comes loose over time, the crease can fade or disappear.

In particular, how well the crease holds can vary with conditions such as the following.

Eyelid thickness
The amount of eyelid fat
Skin condition
Tissue characteristics

The key point

In other words, loosening does not arise from one cause alone; several conditions can act in combination.

If a double eyelid loosens, did the surgery go wrong?

A loosened double eyelid is not, on its own, grounds to conclude that the surgery must have gone wrong. Besides the surgical method and how the crease was fixed, factors such as the characteristics of your eyelid tissue and your recovery can also have an effect.

However, in cases like the following, the current condition needs to be checked.

The crease did not form properly from right after surgery
The crease on one side alone disappears quickly

It is important to first identify why the loosening happened, and then decide on a correction method that fits.

Do eyes prone to loosening have anything in common?

Video screen on a grid background: under the title ‘Traits of eyes prone to loosening’, five items are listed with the first, ‘Thick eyelids’, highlighted; a line drawing of a face is on the right, and the subtitle below reads ‘If your eyelids are naturally thick, or…’ — From the video — ‘Traits of eyes prone to loosening’. Subtitle: “If your eyelids are naturally thick, or…”

Because eyelid thickness, fat, skin elasticity and the degree of skin laxity differ from person to person, how well a crease holds can differ too. For example:

Thick eyelids or a lot of eyelid fat — this can be a disadvantage for keeping the crease
Significant skin laxity — how well the crease will hold needs careful consideration
Planning a crease that is too high for the structure of the eye — this, too, calls for careful consideration of how well it will hold

What to check before surgery

So before surgery, it is necessary to check the current structure of your eyelids and the condition of the tissue, not just the crease height you want.

Does the suture method always loosen easily?

Video screen on a grid background with the title ‘The suture method loosens easily?’ and the words ‘The suture method itself isn’t the problem’, with a member of the medical team explaining in a circle at lower left — From the video — “The suture method loosens easily?” — the explanation is that how well a suture-method crease holds can depend on how well the method suits the eye’s conditions.

The suture method forms the crease with thread, through small holes made in the skin. Its incision area is small, but that does not mean a crease made with the suture method will always loosen easily.

Where the eyelid skin is relatively thin, there is little laxity and the conditions suit the surgery, a stable crease can be expected with the suture method too.

Conversely, where the eyelids are thick or skin laxity is significant, it may be difficult to achieve enough holding power with the suture method alone.

In short

In other words, how well a suture-method crease holds can vary not only with the method itself but also with your individual eye condition and how well the method suits it.

Does the incisional method never loosen?

Video screen on a grid background: under the title ‘The incisional method never loosens?’, large highlighter-green text reading ‘The incisional method can loosen too’ sits over a faded grey thinking-face emoji — From the video — “The incisional method never loosens?” “The incisional method can loosen too”

The incisional method involves making an incision in the skin along the crease line, adjusting the necessary tissue, and then forming a connection with the tissue beneath.

A firmer fixation can generally be expected, but choosing the incisional method does not mean there is no chance at all of loosening. Depending on factors such as your tissue condition, how well adhesion forms and your recovery, there is still a possibility that the crease weakens or changes.

Aspect	Suture method	Incisional method
Method	Forms the crease using thread through small holes in the skin	Incises the skin along the crease line, adjusts the necessary tissue and forms a connection with the tissue beneath
To consider	Its incision area is small	Because the skin is incised, the incision scar and the recovery period also need to be considered
Common myth	“It always loosens easily”	“It never loosens”
In reality	A stable crease can be expected under suitable conditions, but with thick eyelids or significant laxity it may be difficult to achieve enough holding power with the suture method alone	A firmer fixation can generally be expected, but depending on tissue condition, how well adhesion forms, recovery and so on, the crease may weaken or change

This table is not a comparison of which method is better; it summarizes common misconceptions about the two methods.

How to choose a method

So rather than thinking of them as ‘the incisional method never loosens and the suture method always does’, it is important to choose the surgical method that suits your eyes.

What should you do if your double eyelid loosens after surgery?

Video screen on a grid background: under the title ‘What to do when your double eyelid loosens’ is a wide strip photo of two eyes, with the subtitle ‘The fixation points from the first surgery, the state of adhesion’ below — From the video — Subtitle: “The fixation points from the first surgery, the state of adhesion” — the video explains that the degree of scarring is examined along with these.

If your crease has faded or disappeared after surgery, its current condition should be checked first. The following points need to be checked in turn.

It needs to be determined whether this is a temporary change or actual loosening. In the early period after surgery, the crease can look different as swelling goes down and the tissue recovers.
If it has actually loosened, factors such as the previous surgical method, the state of adhesion, excess skin and the amount of fat need to be examined together.
A suitable correction method, such as the suture or the incisional method, should be decided after checking the current state of the eyes and the cause of the loosening.

Please keep in mind

Even when revision is needed, the same method as the previous surgery is not automatically applied.

How should you care for your eyes after surgery to keep the crease from loosening?

Video screen on a grid background with the title ‘Aftercare tips to prevent loosening’ and the handwritten words ‘Things to follow until the initial fixation settles!’, with a member of the medical team explaining in a circle at lower left — From the video — “Things to follow until the initial fixation settles!”

After double eyelid surgery, caring for the area so that it can recover stably is important. In the early recovery period in particular, it is best to avoid the following.

Rubbing your eyes hard
Repeatedly pulling on your eyelids

For activities that can irritate the eyelids, such as washing your face, wearing makeup or wearing contact lenses, it is also important to follow the recovery schedule your medical team gives you.

The limits of aftercare

Of course, not every case of loosening can be prevented through daily habits alone. But reducing unnecessary irritation after surgery and following the precautions you are given can help with a stable recovery.

Loosening: what matters more than the surgical method is the condition of your eyes

Whether a crease loosens after surgery is not determined solely by whether the suture or the incisional method was chosen. That is because conditions of the eye such as the following differ from person to person.

Eyelid thickness and fat
Skin laxity
Eye-opening strength
The state of adhesion of an existing double eyelid

And if your crease has loosened after a previous surgery, rather than simply fixing it again, it is important to understand in detail why the existing crease loosened and the current condition of the tissue.

In short

So if you are planning double eyelid surgery or are troubled by loosening after surgery, it is important to check the current state of your eyes through a specialist’s diagnosis and a thorough consultation, and then decide on a suitable surgical or correction method.

About side effects

With both the suture and the incisional method, results and recovery can differ depending on the individual’s eye condition, and side effects such as swelling and bruising, asymmetry, inflammation and infection, scarring and loosening of the crease can occur.

Frequently asked questions

If my double eyelid loosens, does that mean the surgery went wrong?

A loosened double eyelid is not, on its own, grounds to conclude that the surgery must have gone wrong. Besides the surgical method and how the crease was fixed, factors such as the characteristics of your eyelid tissue and your recovery can also have an effect. However, if the crease did not form properly from right after surgery, or the crease on one side alone disappears quickly, the current condition needs to be checked.

Does the suture method loosen easily, and the incisional method never?

Rather than thinking of them as ‘the incisional method never loosens and the suture method always does’, it is important to choose the surgical method that suits your eyes. With the suture method, too, a stable crease can be expected where the eyelid skin is relatively thin, there is little laxity and the conditions suit the surgery; but where the eyelids are thick or skin laxity is significant, it may be difficult to achieve enough holding power with the suture method alone. With the incisional method, a firmer fixation can generally be expected, but depending on factors such as your tissue condition, how well adhesion forms and your recovery, there is still a possibility that the crease weakens or changes.

If my double eyelid loosens after surgery, do I need another operation?

First, the current condition needs to be checked. In the early period after surgery, the crease can look different as swelling goes down and the tissue recovers, so it needs to be determined whether this is a temporary change or actual loosening. If it has actually loosened, factors such as the previous surgical method, the state of adhesion, excess skin and the amount of fat should be examined together, and a suitable correction method decided after identifying the cause. Even when revision is needed, the same method as the previous surgery is not automatically applied.

Are some eyes more prone to loosening?

Because eyelid thickness, fat, skin elasticity and the degree of skin laxity differ from person to person, how well a crease holds can differ too. Thick eyelids or a lot of eyelid fat can be a disadvantage for keeping the crease, and with significant skin laxity, or when planning a crease that is too high for the structure of the eye, how well it will hold also needs careful consideration.

Is there a way to care for my eyes after surgery to keep the crease from loosening?

In the early recovery period, it is important to avoid rubbing your eyes hard or repeatedly pulling on your eyelids, and to follow the recovery schedule your medical team gives you for things such as washing your face, wearing makeup and wearing contact lenses. Not every case of loosening can be prevented through daily habits alone, but reducing unnecessary irritation and following the precautions you are given can help with a stable recovery.

What happens in a consultation

Through diagnosis and consultation,
we start by checking your eyes’ conditions together

Care from a plastic surgery specialist
One-on-one consultation tailored to your features
Checking your current eyelid condition
Discussing the crease and eye shape you want

We look at the crease you want together with the current state of your eyes, and discuss which surgical method suits you.

Consultation and booking

Enquiries	global@1mmps.com 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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This post was written by the founder of a medical institution to provide medical information. The images in this post are the thumbnail and explanatory screens from a video on double eyelid loosening produced by 1mm Plastic Surgery, with the on-screen Korean text replaced by English; they are not before-and-after photographs. In the thumbnail, the area under the text (nose and cheeks) was filled in with AI image editing when the Korean text was removed; the eye area is unchanged from the original video frame. 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.