Dual-layer non-incisional double eyelid method: A novel approach for dermatochalasis-induced pseudoptosis

Dermatochalasis frequently causes pseudoptosis that complicates double eyelid formation in Asian patients. Conventional non-incisional buried suture techniques are often inadequate for managing redundant skin, while incisional methods entail permanent scarring and prolonged recovery. We report three cases of Asian patients with mild-to-moderate dermatochalasis-induced pseudoptosis treated with Dual-layer Non-incisional Double Eyelid Method (DND Method), a novel technique employing two vertically stacked buried sutures with levator aponeurosis fixation. All three patients achieved natural-appearing supratarsal folds with improved Margin Reflex Distance-1 (MRD-1), reduced compensatory eyebrow elevation, and high patient satisfaction. No significant complications were observed at 3-6 months follow-up. DND Method may extend non-incisional surgical options to patients with dermatochalasis who are unsuitable candidates for conventional buried suture techniques.