Removing a Deep-Fixation Buried Suture
A few thoughts on this today.
Honestly, it is rare for a buried-suture double eyelid to end up with a deep, pinched fixation.
By definition the suture is meant to be buried, and once it embeds itself the fixation naturally softens into a shallower one.
Occasionally, though, the suture remains visibly pinched. If the surgery was recent, it is reasonable to wait up to six months.
More often than not, the knot will gradually settle in. But if the pinching persists well past that window, it is usually because the suture failed to embed properly rather than because the fixation itself is too deep.
In that case, I recommend removing the suture and redoing the buried-suture procedure.
The patient I operated on today came in because the lateral portion of her crease appeared pinched when she closed her eyes.
The arrow points to the pinched area at the lateral end.
Ideally we would remove the suture and redo it. The trouble is that her surgery was a year and a half ago, which makes the suture much harder to find.
After identifying the suture through each access point: it appears she had a single-knot continuous technique for the fold itself, with an additional ptosis-correction suture set in the center.
You can see that the lateral portion is now flat.
Compared with the immediate pre-op view, the right side of this image (post-op) shows the in-out fold sitting slightly lower even with swelling still present.
She had a natural double-eyelid crease originally, so this is essentially a return to her native crease line.
I closed the lateral skin to flatten that area, which is why the line appears slightly broken at this stage (sutures still in place).
She told me she had visited several clinics before us trying to have the buried sutures removed. She had been turned away each time and told that only an incisional revision was possible.