Transcutaneous versus Transconjunctival Fixation in Non-Incisional Double Eyelid Surgery: A Long-Term Survival Analysis of Crease Retention.

BACKGROUND

Non-incisional double eyelid surgery is widely performed in East Asia. However, crease loss is a common concern after surgery and a frequent reason for revision. Both transcutaneous and transconjunctival fixation techniques are commonly used; however, their relative effectiveness in long-term crease retention is controversial.

METHODS

This retrospective observational study examined 423 consecutive patients who underwent non-incisional double eyelid surgery clinic with transcutaneous or transconjunctival fixation at a high-volume esthetic surgery between July 2020 and July 2021. Crease loss was defined as the need for revision surgery due to the patient reporting fading or disappearance of the crease. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to evaluate factors associated with crease retention. Multivariable models were adjusted for age, sex, eyelid thickness, eyelid design, and puffy eyelid status.

RESULTS

Of the 423 eyelids analyzed, 174 underwent transcutaneous fixation, and 249 underwent transconjunctival fixation. Baseline demographic and anatomical characteristics were comparable between the two groups. Kaplan-Meier analysis revealed a significantly higher rate of crease retention in the transconjunctival fixation group (log-rank p < 0.001). Univariable analysis revealed a significant association between fixation method and crease loss (hazard ratio [HR] = 0.43, 95% confidence interval [CI]: 0.29-0.64, p < 0.001). This association remained significant in the multivariable analysis (HR = 0.43, 95% CI: 0.29-0.64, p < 0.001). Sex, eyelid thickness, eyelid design, and age were not independently associated with crease loss.

CONCLUSION

Following non-incisional double eyelid surgery, transconjunctival fixation was associated with a significantly reduced risk of crease loss compared with transcutaneous fixation. The fixation method appears to be the primary determinant of long-term crease stability, underscoring its importance in surgical planning.

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