When people first start looking into ssangsu (double eyelid surgery), the first question they usually run into is
the difference between the non-incisional and incisional methods.
I've put together an easy guide that covers the terms, compares the methods, and explains how to choose the right one for you.
---
■ The Bottom Line
Double eyelid surgery (ssangsu) falls into two main categories.
Non-incisional (buried suture) method: creates a double eyelid crease by securing the eyelid with sutures, without cutting the skin
Incisional method: creates the crease through a direct incision in the eyelid skin
The biggest difference is whether or not the skin is cut.
The non-incisional method offers a quick recovery and no scar, but how long it lasts can vary depending on the condition of the eyelid,
while the incisional method involves a somewhat longer recovery but lasts longer and can correct a wider range of problems.
Which method is right depends on eyelid thickness, the amount of fat, and the crease shape you want.
---
■ Wait, What Is "Ssangsu"?
"Ssangsu" is the Korean shorthand for double eyelid surgery.
Any surgery that creates a double eyelid crease on an eye without one (a single eyelid, or monolid)
or changes an existing crease is collectively called ssangsu.
Eyes without a crease = monolid / single eyelid / uncreased eyelid
Eyes with a crease = double eyelid / double eyelid crease
When you first look into double eyelid surgery, the terms you'll come across most often are the non-incisional (buried suture) method and the incisional method.
---
■ What Is the Non-Incisional Method?
Here's the simplest way to explain the non-incisional method:
"A method that sets the double eyelid crease by securing the inner eyelid with sutures, without cutting the skin"
Its Korean name, maemol (埋沒), comes from Chinese characters meaning "to bury."
It is called the buried suture method because the suture is buried within the eyelid tissue to hold the crease in place.
[ Features of the Non-Incisional Method ]
- No skin incision is made, so no external scar is left.
- The operation is relatively short, and recovery is quick.
- Swelling is usually mild, so patients tend to return to daily life quickly.
- If you are unhappy with the result, it is easier to reverse by removing the sutures than it is with the incisional method.
- If the eyelid is thick or has a lot of fat, the crease may not hold well or
may loosen over time.
[ Good Candidates for the Non-Incisional Method ]
- Thin eyelid skin with little fat
- When a quick recovery is a priority
- When you want to try out a crease before surgery
- When you want a natural change without an incision
---
■ What Is the Incisional Method?
The incisional method can be explained like this:
"A method that creates the crease by making an incision in the eyelid skin, refining the tissue as needed, and then closing it with sutures"
Much like altering a garment by cutting the fabric and sewing it back together,
the eyelid skin is opened so the underlying tissue can be precisely refined and the crease designed.
[ Features of the Incisional Method ]
- The crease is set by directly removing eyelid skin and, when necessary, fat.
- The incision line sits within the double eyelid crease and becomes naturally concealed over time.
- Results are durable, so once the crease is created, it lasts a long time.
- Recovery takes somewhat longer than with the non-incisional method, and early swelling is more pronounced.
- Even thick eyelids can be treated because the underlying tissue can be refined directly, so it suits a wide range of cases.
- When needed, it can be combined with ptosis correction (correcting the eyelid's opening strength).
[ Good Candidates for the Incisional Method ]
- Thick eyelid skin or a lot of fat
- Sagging or lax eyelid skin (mainly in middle-aged and older patients)
- When you want a long-lasting crease
- When the eyelid's opening strength also needs correction (accompanying ptosis)
---
■ Non-Incisional vs. Incisional at a Glance
---
■ Which Method Is Right for Me?
Follow the steps below to work out which method may suit you.
STEP 1 — Are your eyelids thick, or is there a lot of fullness around your eyes?
→ YES: The incisional method is more likely to be suitable.
→ NO: Move on to the next step.
STEP 2 — Is your eyelid skin sagging or stretched?
(If you are in your 40s or older, or feel that your eyelids are covering your eyes)
→ YES: The incisional method, or incisional surgery combined with ptosis correction, should be considered.
→ NO: Move on to the next step.
STEP 3 — Is a fast recovery important to you, and do you want the option to reverse the result?
→ YES: The non-incisional method is considered first.
→ NO: The choice between the two depends on your eyelid condition.
* This guide is for reference only; an accurate assessment requires an in-person examination of your eyelids.
In particular, eyelid thickness and fat volume are often hard to judge on your own,
so it is important to have them checked during a consultation.
---
■ 3 Common Misconceptions
Misconception ① "Non-incisional looks natural; incisional looks artificial"
Not true. How natural a crease looks depends more on its design than on the surgical method.
When designed as a low, natural crease, the incisional method can also produce natural results,
and even the non-incisional method can produce an unnatural result if the design is poor.
Misconception ② "Non-incisional leaves no scar, so it's always better"
It's true that the non-incisional method leaves no scar,
but if the eyelids are thick or have a lot of fat, the crease may not hold well or may loosen.
In such cases, patients who chose the non-incisional method sometimes end up needing incisional revision surgery later.
Misconception ③ "Once you have incisional surgery, it can never be changed"
Revision after the incisional method is more complex, but it is not impossible.
That said, revision surgery is more difficult than the first operation, so
it is important to plan the first surgery carefully after a thorough consultation.
---
■ Frequently Asked Questions (FAQ)
Q1. What is the biggest difference between the non-incisional and incisional methods?
A. The biggest difference is whether or not the skin is cut.
The non-incisional method creates the crease by securing the inner eyelid with sutures, without an incision,
while the incisional method creates the crease by opening the eyelid skin directly.
This difference affects recovery speed, how long the result lasts, whether there is a scar, and which eyelids are suitable.
Q2. Does a non-incisional crease really loosen over time?
A. It can.
The risk is higher when the eyelids are thick or have a lot of fat, when you rub your eyes often,
or when the sutures were not secured firmly enough in the first place.
When the eyelids are thin with little fat, results from the non-incisional method often last a long time.
Q3. How can I tell whether my eyelids are thick or thin?
A. The most accurate way is to have them examined in person at a plastic surgery consultation.
Generally, when you gently lift the upper part of the eyelid,
if you see a lot of fat or the skin feels thick,
you may have thick eyelids.
However, this is often hard to judge on your own, so it's best to have it checked during a consultation.
Q4. Does the incisional method leave a noticeable scar?
A. Because the incision is placed where the double eyelid crease folds,
it is hidden within the fold when your eyes are open.
Over time (3–6 months), the scar fades until it closely matches the surrounding skin tone,
so in many cases it is hard to notice at an ordinary conversational distance.
Q5. If I don't like the result of the non-incisional method, can it be reversed?
A. Yes.
With the non-incisional method, it is easier to restore the original eyelid by removing the sutures than it is with the incisional method.
However, the more time has passed since surgery, the more adhesions form,
which can make a complete return to the original eyelid difficult.
If you want to reverse it, it's best to seek a consultation as early as possible.
Q6. If it's my first surgery, should I start with the non-incisional method?
A. If your eyelids are thin with little fat, the non-incisional method can be a good choice.
However, if your eyelids are thick, a "let's just try non-incisional first" approach
can end up requiring incisional revision surgery later.
Even for a first surgery, it is important to assess your eyelid condition before deciding on a method.
Q7. What is ptosis correction? Is it different from double eyelid surgery?
A. Double eyelid surgery creates a crease (fold) in the eyelid.
Ptosis correction (blepharoptosis repair) is for cases where the eyelid's opening strength itself is weak;
it strengthens levator muscle function so the eyes open wider.
Some patients need both procedures at once, in which case ptosis correction can be performed together with the incisional method.
If you use your forehead or eyebrows to help open your eyes, you may need ptosis correction.
Q8. What questions should I ask during a consultation?
A. If it's your first consultation, ask these three questions:
"Based on the thickness of my eyelids, is the non-incisional or incisional method more suitable?"
"If I tell you the crease height I want, is that achievable?"
"What happens if I'm not happy with the result after surgery?"
It's a good idea to check whether the medical team gives you specific answers to these three questions.
---
* This article provides general information for people looking into double eyelid surgery for the first time.
Whether the non-incisional or incisional method is right for you
depends on the condition of your eyelids,
so be sure to make the decision after an in-person consultation with a specialist.
---
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.