Background: 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.
Methods: 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.
Results: 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).
Conclusions: 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.