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BACKGROUND: Double-eyelid surgery is one of the most commonly performed cosmetic procedures in East Asia. The two main techniques include mini-incisional buried suture methods and incision-based operations. Mini-incisional approaches are favored due to their minimal scarring and rapid recovery. Despite numerous modifications aimed at achieving a natural appearance, complications such as loosening of the double eyelid fold and suture granulomas resembling chalazion remain challenging. To address these issues, we developed a modified continuous single-knot buried suture technique that extends the operative site from the skin to the conjunctiva, thereby establishing a stronger and more durable adhesion.

METHODS: Between April 2022 and August 2023, 40 patients (80 eyes) underwent double-eyelid surgery using this novel mini-incisional buried suture technique. Concurrent epicanthoplasty was performed in 39 patients when indicated. Outcomes were assessed based on preoperative and postoperative measurements of upper eyelid movement distance (ULMD) and cosmetic results.

RESULTS: All patients were followed for 5 to 24 months. Thirty-eight patients expressed satisfaction with their aesthetic outcomes following the initial procedure. No cases of double-eyelid loss or corneal injury were observed. The mean ULMD significantly increased from 9.13 ± 1.10 mm preoperatively to 9.86 ± 0.96 mm at 5 months postoperatively (P < 0.05). Both patients and surgeons rated the aesthetic outcomes as excellent or good.

CONCLUSION: This modified procedure is simple,effective with limited adverse effects for establishing a long-lasting double eyelid and providing satisfactory aesthetic results.