Removing the sutures from non-incisional double eyelid surgery can be done through micro-punctures, without an incision.
This article explains the difference between suture removal and releasing natural adhesions, the results you can expect based on time since surgery, and the procedure itself.
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■ The Bottom Line
A double eyelid created with the non-incisional (buried suture) method can be reversed by removing the sutures placed inside the eyelid,
and this can be done without an incision, by retrieving the sutures through tiny micro-punctures alone.
A very small puncture is made at the same sites where the sutures were placed during the original non-incisional surgery,
so the sutures can be precisely located and removed with minimal tissue trauma.
In most cases, the double eyelid crease disappears once the sutures are removed.
However, the longer it has been since surgery, the more tissue adhesions form,
so part of the crease may persist even after suture removal,
and results can vary depending on time since surgery and the individual's tissue characteristics.
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■ What You Need to Know First: Three Situations to Tell Apart
If you search for non-incisional suture removal, you will find three similar-sounding terms used interchangeably.
These three differ in both the clinical situation and the treatment approach.
① Buried Suture Removal
A procedure to retrieve the buried sutures that are still inside the eyelid.
This applies when the sutures are still present in the tissue,
and removing them often makes the crease disappear or fade considerably.
② Release of Natural Adhesions
The sutures have already broken or loosened, but adhesions that formed at the time of surgery
are still holding the double eyelid crease in place.
In this case there are no sutures left to remove, or only suture fragments remain,
so the adhesions themselves need to be addressed.
③ Crease Correction (Revision Surgery)
When suture removal or adhesion release alone is unlikely to achieve the desired result,
the crease height and shape are redesigned through incisional revision surgery.
* Which of these three situations applies to you
must be determined through an in-person examination.
The first step is to confirm whether any sutures are still present.
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■ How to Reverse Non-Incisional Double Eyelid Surgery: Through Micro-Punctures, Without an Incision
Many people assume that removing buried sutures requires an incision.
However, the sutures can be removed through micro-punctures alone, without an incision.
[ What Is the Micro-Puncture Technique? ]
During the original non-incisional surgery, small punctures were made to place the sutures.
A very small puncture is made again at those same suture entry points,
and the sutures are traced and retrieved through that opening.
Because the skin is not incised and opened widely, tissue trauma is minimized.
Because the sutures are drawn out rather than cut or torn out,
recovery is quick, and there is less concern about scarring than with an incisional approach.
[ How It Differs from the Incisional Approach ]
Locating and removing fine buried sutures embedded in the eyelid through punctures alone, without an incision,
demands extensive experience and expertise.
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■ How Is the Procedure Performed?
Below is the typical process for non-incisional suture removal (micro-puncture technique).
[ Step 1 ] Assessment and Suture Localization
We assess the current condition of the eyelid, how long it has been since the non-incisional surgery,
and whether any sutures remain and where they are.
The approach varies with the suture configuration (single-knot, continuous buried, etc.).
[ Step 2 ] Local Anesthesia or Sedation
Anesthesia is given at the treatment site.
Sedation or local anesthesia is chosen based on the patient's condition.
[ Step 3 ] Micro-Puncture and Suture Tracing
A very small puncture is made at the suture entry point.
The position of the fine suture is precisely traced through this opening.
[ Step 4 ] Suture Removal
Once the suture is identified, it is removed without damaging the surrounding tissue.
How difficult the removal is depends on the suture's condition (intact or broken).
[ Step 5 ] Finishing and Documentation
The treated area is cleaned up, and so that removal can be verified,
the removed sutures are photographed and the images are kept on file.
Patients sometimes find it hard to confirm whether the sutures were actually removed,
so photo documentation helps prevent unnecessary misunderstandings.
[ Procedure Summary ]
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■ Results Vary with Time Since Surgery
How closely the eyelid returns to its original appearance after buried suture removal
depends on how much time has passed since the surgery.
[ Short Term: Within 3 Months of Surgery ]
At this stage, adhesions have not yet fully formed,
so much or most of the double eyelid crease often disappears after the sutures are removed.
The sutures are also relatively easy to locate during this period.
[ Mid Term: 3 Months to 1 Year After Surgery ]
Adhesions gradually form during this period.
After suture removal the crease may fade considerably or disappear,
but depending on the degree of adhesion, part of the crease may remain.
[ Long Term: 1 Year or More After Surgery ]
Adhesions are well established at this stage.
Even after suture removal, a substantial part of the crease often remains.
In these cases, regular massage after suture removal
can sometimes help the crease fade further.
When adhesions are severe, incisional revision surgery may also be considered.
Time Since Surgery | Degree of Adhesion | Likelihood of Crease Disappearing After Suture Removal
-------------- | --------- | ----------------------------
Within 3 months | Low | High (often disappears almost entirely)
3 months to 1 year | Moderate | Moderate (partial to substantial fading)
1 year or more | High | Low (part to much of the crease remains)
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■ What Happens After Suture Removal?
Outcomes after suture removal fall into three categories.
Returning to the original eyelid:
When the sutures are removed while adhesions are minimal, the double eyelid crease disappears
and the eyelid often returns close to how it looked before surgery.
The crease fades but partly remains:
If some adhesions have formed, the crease may not disappear completely after suture removal.
Regular massage alongside this can sometimes help the crease fade further.
Considering incisional revision after suture removal:
If the result after suture removal is still not what you want,
or if you would like a new crease,
incisional revision surgery may be considered.
Revision is generally performed once the tissue has stabilized after suture removal.
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■ Frequently Asked Questions (FAQ)
Q1. Does removing buried sutures require an incision?
A. No, it can be done without an incision.
At the sites where the sutures were placed during the original non-incisional surgery,
a very small puncture is made to locate and retrieve the sutures,
and because the tissue is not incised, tissue trauma is minimized.
However, precisely tracing and removing fine sutures without an incision
depends heavily on experience and expertise.
Q2. Will the double eyelid crease disappear if the sutures are simply removed?
A. In most cases, the crease disappears or fades considerably after suture removal.
However, if a long time has passed since surgery and adhesions have formed,
part of the crease may remain even after the sutures are removed.
Regular massage after suture removal can help the crease fade further.
Q3. Can all of the sutures be removed?
A. With precise tracing through micro-punctures, most sutures can be removed.
However, if a suture has broken or separated into several fragments,
some fragments may remain, and a further procedure may be needed in that case.
Q4. How does recovery after suture removal compare with standard non-incisional double eyelid surgery?
A. With the micro-puncture technique, which involves no incision, recovery is often similar to
or slightly shorter than that of standard non-incisional double eyelid surgery.
Stitches are typically removed after 3–5 days, and patients generally return to daily activities after 3–7 days.
Q5. Can I have revision surgery (a new double eyelid) right after suture removal?
A. If you want a new crease, suture removal and revision surgery can also be performed at the same time.
However, whether and when to have revision surgery depends on the current condition of your eyelids,
so it is important to decide only after a thorough consultation with your surgeon.
Q6. How can I confirm that the sutures were successfully removed?
A. After the procedure, you cannot easily see for yourself whether the sutures are gone from inside the eyelid,
so reputable clinics photograph the suture removal process and keep the images on record.
This lets you confirm that the sutures were actually removed
and helps prevent unnecessary misunderstandings.
Q7. How is buried suture removal different from releasing natural adhesions?
A. Buried suture removal is used when sutures remain inside the eyelid
and involves retrieving the sutures themselves.
Releasing natural adhesions applies when the sutures have already broken or loosened
but adhesions formed at the time of surgery are maintaining the crease.
In that case there are no sutures to remove, or only fragments remain, so the approach is different.
Some patients need both.
Q8. Will the foreign-body sensation or discomfort go away after suture removal?
A. If the sutures are causing the foreign-body sensation, symptoms often improve once they are removed.
However, if adhesions or other causes are also involved,
the foreign-body sensation may persist even after suture removal,
so identifying the exact cause comes first.
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* This article is intended to provide general information,
and suture removal methods and results may differ depending on each individual's post-operative course and eyelid condition.
Whether and how to remove buried sutures should always be decided through an in-person consultation with a board-certified specialist.
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The photographs in this post were taken under identical conditions with the patient's prior consent.
In addition, side effects such as bleeding, infection, and inflammation may occur after plastic surgery or procedures depending on the individual, so caution is required.