A transcutaneous, subcutaneous, and intratarsal suturing procedure in double eyelid surgery

In double-eyelid surgery, the dynamic connection of the levator aponeurosis and skin or derma is reconstructed with the formed scar or the ligated suture. The nonincision method can shape a natural and vivid crease with a short recovery time. However, the duration of the supratarsal crease formed by the ligated suture in the nonincision method is not long.

A transcutaneous, subcutaneous, and intratarsal suturing technique was adopted. Five stab incisions were made in the designed double-eyelid line. A needle pass was made with a 7-0 nylon suture from the tarsal plane deeply and the dermis superficially. After tightening the suture and burying the four ligations under the skin, the supratarsal crease was formed.

Between October of 2003 and November of 2008, we used the transcutaneous, subcutaneous, and intratarsal suturing technique for 118 patients with a single-eyelid appearance. One hundred six of these patients underwent follow-up ranging from 3 to 36 months. Most of these patients [95 of 106 patients (89.6 percent)] were satisfied with the outcome; 11 patients (10.4 percent) expressed dissatisfaction. Of the latter, the unilateral double eyelid of three patients (2.8 percent) regressed; five patients (4.7 percent) expressed dissatisfaction with the shape and height of the formed double-eyelid line; and mild asymmetry of the formed eyelid appeared in three patients (2.8 percent).

The authors found that the transcutaneous, subdermal, and intratarsal suturing technique was successful in producing a natural supratarsal crease shape that permitted easy control. The authors also observed that even though one single knot may be loose or tight, it does not influence the final result.