A common question in consultation is: "Should I have an incisional, partial-incision, or suture technique?" The answer starts by clarifying that these three terms are not interchangeable — and that the names are used inconsistently between clinics. Before deciding, patients should understand the surgery behind each name.
The three techniques defined
Incisional (full-incision) technique
An open operation: the surgeon makes a continuous incision along the planned crease, may remove a strip of excess skin and fat, and sutures internally to fix the crease durably. This is the most invasive technique but also the most stable in the long term. It suits patients with skin redundancy, excess fat, or thicker eyelid skin — and most older patients.
Partial-incision (suture-and-pinch) technique
A hybrid approach: the surgeon makes 1–3 short incisions (3–5 mm) on the eyelid and uses sutures to fix the skin to the levator aponeurosis, creating the crease. Less invasive than full incision, with faster recovery — but less stable in the long term, particularly when skin or fat is in excess.
Suture (non-incisional / DST) technique
No skin incision. Buried sutures fix the crease internally. No external scar, the fastest recovery, but the least stable of the three. It suits younger patients with thin skin and no excess fat. A proportion of patients have crease loosening or loss within a few years.
Long-term stability of each technique
This is the most important point and the one most often glossed over in consultation:
- Full incision: the crease typically remains stable beyond 10 years, sometimes permanently. The fine scar usually heals well and fades over 6–12 months.
- Partial incision: the crease typically remains stable 5–10 years. Adjustment may be needed as skin laxity increases with age.
- Suture technique: a proportion of patients experience crease loosening or loss within 2–5 years. Revision requests are not unusual.
These ranges are general references drawn from the literature and clinical experience. Individual results depend on eyelid anatomy, skin thickness, levator function, and habits (eye rubbing, contact lens use).
Anatomy that determines the right choice
The surgeon assesses in consultation:
- Eyelid skin thickness: thicker skin holds a stable crease less readily through non-incisional techniques.
- Pre-aponeurotic fat: significant fat usually needs to be removed via an incision.
- Skin redundancy: lax skin needs to be excised and re-draped — it cannot be hidden through a suture technique.
- Levator function: a weak levator (latent ptosis) needs to be addressed at the same time, not just a crease created.
- Desired crease shape: a parallel crease and a tapered crease require different techniques.
Latent ptosis — an often-missed factor
Some patients seeking eyelid surgery in fact have undiagnosed mild ptosis. A weak levator palpebrae makes the eye look "sleepy" and the two sides may be asymmetric. Creating a crease without addressing the ptosis tends to produce an unnatural or asymmetric result.
Measuring levator function is a basic step of an eyelid-surgery consultation — but it is too often skipped in hurried consultations. If you have not had your levator function measured, that alone is a reason to seek a second opinion.
Recovery by technique
Each technique has its own recovery timeline:
- Suture: swelling 3–5 days, return to office work 5–7 days, the crease looks natural at 2–3 weeks.
- Partial incision: swelling 5–7 days, return to office work 7–10 days, the crease looks natural at 3–6 weeks.
- Full incision: swelling 7–10 days, return to office work 10–14 days, the scar fades over 3–6 months, the crease shape settles at 3–6 months.
Frequently asked questions
I am 20 with thin eyelid skin — which technique should I choose?
Most younger patients with thin skin and no excess fat are suited to suture or partial-incision techniques. The final decision depends on in-person assessment. If you want crease stability beyond 10 years, full incision remains the safest choice even in young patients.
Is the suture technique truly scar-free?
Not entirely. There is no continuous external incision, but the suture-passage points leave small puncture marks — most fade within 1–2 weeks. In some patients the fixation points can produce small subcutaneous nodules that may be palpable. This is not "scar-free" in the strict sense.
How long until the crease looks natural?
The main swelling resolves in 1–2 weeks, but the crease usually takes 2–6 months to look fully natural depending on technique. In the first few weeks the crease looks higher and sharper than the final result because tissue is still swollen and has not yet remodelled.
Can I convert from a suture technique to a full incision later?
Yes. This is a common form of revision when a suture-technique crease loosens or fades. A subsequent full-incision operation is feasible, although the surgeon must account for the position of the prior sutures and the condition of the tissue. Many patients start with a suture technique for the minimal intervention and later convert to full incision as the face changes with age.
My two eyelids are not even — can this be fixed?
Small asymmetry is normal in every face. Eyelid surgery can improve but not create perfect symmetry — especially if the cause is a difference in levator function or in the bony orbit. Identifying the cause of asymmetry is an important part of consultation.