The incisional method carries a far lower risk of the fold loosening than the non-incisional (buried suture) method.
However, even an incisional fold can loosen depending on how it is sutured.
At Gangnam Seoyon Plastic Surgery, we explain why this happens and how dynamic fixation suturing makes a difference.
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■ The Short Answer
There are two main reasons an incisional double eyelid fold comes undone.
First, the wrong surgical method was chosen in the first place.
Second, the incisional approach was appropriate, but the suturing technique was unfavorable for maintaining the fold.
Unlike the non-incisional method, the incisional method creates the fold by addressing the tissue itself,
so it is true that the risk of the fold loosening is very low.
However, even with an incision, if dynamic fixation is not used during suturing,
the fold can weaken or become unstable over time.
At Gangnam Seoyon Plastic Surgery, we always apply dynamic fixation suturing after the incision
to ensure the fold lasts.
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■ Non-Incisional vs. Incisional: Why Is the Risk of Loosening Different?
To understand why a double eyelid fold loosens, you first need to understand the principle
by which each of the two methods creates the fold.
[ How the Non-Incisional Method Forms the Fold ]
The non-incisional method secures the fold by tying the eyelid tissue with sutures, without a skin incision.
Because the fold is held in place only by the sutures,
if the sutures loosen or break, the fold comes undone as well.
In particular, when the eyelid is thick or has a lot of fat,
the sutures are more likely to give way under the weight of the tissue, causing the fold to loosen.
[ How the Incisional Method Forms the Fold ]
In the incisional method, the eyelid skin is opened and the excess thick skin, fat, and fascia are removed,
after which the tissue itself folds to create the crease.
Because the fold is formed by the tissue structure itself rather than depending on a single suture,
the risk of loosening is significantly lower than with the non-incisional method.
This is why, even among procedures all called the "incisional method," how precisely the eyelid tissue is handled
and which suturing technique is used determine the outcome.
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■ 3 Reasons an Incisional Double Eyelid Fold Comes Undone
If the fold loosens or weakens even after choosing the incisional method,
it is most likely due to one of the following three reasons.
[ Reason ① Ptosis Was Not Corrected ]
When the eye-opening force (levator function) is weak — in other words, when ptosis is present —
creating only a double eyelid fold means the eyelid keeps pulling on the fold.
When an eyelid without sufficient opening strength places continuous load on the fold,
the fold can weaken or appear to have come undone over time.
In such cases, double eyelid surgery must be performed together with ptosis correction (eye-opening correction)
for the fold to remain stable.
[ Reason ② Insufficient Tissue Debulking ]
Even with an incision, if the thick skin, fat, and fascia of the eyelid
are not adequately removed,
the weight of the tissue continuously pulls on the fold,
and the fold may become faint or appear to have come undone.
This is why "how precisely the tissue was handled" matters more than the mere fact that "an incision was made."
[ Reason ③ Dynamic Fixation Suturing Was Not Used ]
How well an incisional double eyelid fold holds also depends on the suturing technique.
Conventional static suturing can cause the incision line to sink in when the eyes are closed,
producing an unnatural result,
and carries a risk of the sutured area loosening over time.
In contrast, dynamic fixation suturing is designed to improve the longevity of the fold,
and whether or not it is used can affect how well the fold holds over the long term.
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■ What Is Dynamic Fixation? — Gangnam Seoyon Plastic Surgery's Core Technique
Dynamic Fixation is a suturing technique designed so that, both when the eyes open and when they close,
the fold is maintained naturally.
How it differs from conventional double eyelid suturing (static fixation):
In incisional double eyelid surgery, Director Choi Dong-il of Gangnam Seoyon Plastic Surgery
uses dynamic fixation suturing.
"Unlike the non-incisional method, the incisional method creates the fold by addressing the tissue itself,
so the risk of loosening is very low.
At Gangnam Seoyon, we additionally apply dynamic fixation suturing to ensure the fold lasts."
— From a Q&A answer by Chief Director Choi Dong-il
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■ Preserving the Orbicularis Oculi — Gangnam Seoyon's Core Principle Alongside Dynamic Fixation
Another key element of incisional double eyelid surgery at Gangnam Seoyon Plastic Surgery is preservation of the orbicularis oculi muscle.
The orbicularis oculi is the muscle responsible for closing the eyes.
If this muscle is damaged during incisional surgery, the following problems can occur:
- Incomplete eye closure
- Lacrimal pump dysfunction (tears do not drain properly)
- Worsening dry eye
- Increasing asymmetry over the long term
At many clinics, the orbicularis oculi is damaged during the incision process.
At Gangnam Seoyon Plastic Surgery, performing the incision while preserving the orbicularis oculi
is one of our core techniques.
It is an approach that considers both a natural-looking fold and preserved eye function.
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■ The Misconception That Incisional Double Eyelids Look Unnatural
There are several misconceptions about incisional double eyelid surgery.
Here are answers to the questions we are asked most often at Gangnam Seoyon Plastic Surgery.
"An incision always leaves a scar" → Not true.
With precise design, orbicularis oculi preservation, and accurate suturing,
the scar sits naturally hidden within the double eyelid fold
and becomes nearly invisible over time.
"Swelling lasts a long time after incisional surgery" → It does not.
Major swelling subsides within 1–2 weeks, and most patients return to daily activities after 3–7 days.
"Incisional surgery makes the fold thick" → Not if tissue debulking is done precisely.
When excess thick skin and fat are appropriately removed and the orbicularis oculi is preserved,
the result is actually a thin, natural fold.
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■ Dynamic Fixation Incisional Double Eyelid Surgery at Gangnam Seoyon Plastic Surgery
At Gangnam Seoyon Plastic Surgery, Chief Director Choi Dong-il, with 23 years of experience,
personally handles everything from consultation to surgery.
The 5 steps of our incisional double eyelid surgery:
① Precise design — the plan is defined in a one-on-one consultation based on the patient's condition and desired outcome
② Precise incision below the brow — an accurate incision along the fold line
③ Removal of excess skin, fat, and fascia — eliminating tissue weight as a cause of loosening
④ Orbicularis oculi preservation + dynamic fixation suturing — our core technique, securing a natural fold and lasting results
⑤ Precise suturing within the fold — so the scar is naturally hidden inside the fold
Real post-operative videos of dynamic fixation incisional double eyelid surgery + ptosis correction
can be viewed on the Gangnam Seoyon TV YouTube channel.
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■ Procedure Information
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■ Frequently Asked Questions (FAQ)
Q1. Do incisional double eyelids never come undone?
A. Unlike the non-incisional method, the incisional method creates the fold by addressing the tissue itself,
so the risk of loosening is very low.
However, if ptosis was not corrected, tissue debulking was insufficient,
or dynamic fixation suturing was not used, the fold can weaken even after an incision.
Q2. What is dynamic fixation?
A. Dynamic fixation is a suturing technique designed so that, whether the eyes are open or closed,
the fold is maintained naturally.
Unlike conventional static suturing, the incision line does not sink in when the eyes are closed,
the scar is naturally hidden within the fold,
and the fold holds better over the long term.
Q3. If I have ptosis, will my fold come undone even with incisional double eyelid surgery?
A. If only a double eyelid fold is created while ptosis (weak eye-opening strength) is present,
the eyelid continuously pulls on the fold, which can make it unstable.
In such cases, incisional double eyelid surgery should be performed together with ptosis correction (eye-opening correction)
so that the fold can remain stable.
Q4. My incisional fold came undone. Is revision surgery possible?
A. Yes. If the fold has weakened or come undone after incisional surgery,
it can be corrected with incisional double eyelid revision surgery.
After assessing the previous surgical method, the time elapsed since surgery, and the current tissue condition,
we determine the corrective approach based on the cause.
Bringing your previous surgical records to your revision consultation is helpful.
Q5. My fold came undone after the non-incisional method. Will switching to the incisional method keep it from loosening?
A. Converting to incisional revision surgery after a non-incisional procedure often improves how well the fold holds.
However, the outcome of incisional revision can vary depending on how long it has been since the previous non-incisional surgery,
the current condition of the eyelid, and whether ptosis is also present,
so it is important to decide after a thorough diagnosis.
Q6. Does incisional double eyelid surgery really leave no scar?
A. An incision does not automatically mean a scar will remain.
When precise design, orbicularis oculi preservation, and dynamic fixation suturing are combined,
the scar is naturally hidden within the double eyelid fold
and in many cases becomes nearly invisible over time (3–6 months).
Q7. What is the orbicularis oculi? Why should it be preserved?
A. The orbicularis oculi is the muscle responsible for closing the eyes.
If this muscle is damaged during incisional surgery, the eyes may not close properly
or lacrimal pump dysfunction may develop.
At Gangnam Seoyon Plastic Surgery, preserving the orbicularis oculi during surgery
is one of our core principles.
Q8. How can I get an incisional double eyelid consultation at Gangnam Seoyon Plastic Surgery?
A. You can book a consultation by phone (02-535-8889) or through our KakaoTalk channel.
Clinic hours are 09:30–18:30 on weekdays and 09:30–16:30 on Saturdays.
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* Side effects such as bleeding, infection, and inflammation may occur after surgery depending on the individual,
and subjective satisfaction may vary from person to person.
Accurate diagnosis and surgical planning should always be determined through an in-person consultation with a board-certified specialist.
Director Choi Dong-il
Board-Certified Plastic Surgeon
Current: Chief Director, Gangnam Seoyon Plastic Surgery (2015–present)
Former: Director, BK Plastic Surgery (2011–2013)
Former: Director, Regen Plastic Surgery (2013–2015)
Adjunct Professor of Plastic Surgery, Korea University College of Medicine
Chair of Academic Affairs, Eye Plastic Surgery Research Society, Korean Society of Plastic and Reconstructive Surgeons
Adjunct Professor of Plastic Surgery, Kangdong Sacred Heart Hospital
Regular Member, Korean Society of Plastic and Reconstructive Surgeons
Regular Member, Korean Society for Aesthetic Plastic Surgery
Regular Member, Korean Society of Craniofacial Surgery
Member, International Confederation for Plastic, Reconstructive and Aesthetic Surgery (IPRAS)
Regular Member, Korean Society for Surgery of the Hand
Regular Member, Korean Association of Plastic Surgeons
Member, Academic Committee, Korean Society of Plastic and Reconstructive Surgeons
Expert Reviewer, Editorial Board, Korean Society for Aesthetic Plastic Surgery
Former Director of Finance and Current Director of Information, Korean Association of Plastic Surgeons
Information and Communications Committee Member and Public Relations Committee Member, Korean Society for Aesthetic Plastic Surgery
Regular Member, Eye Plastic Surgery Research Society, Korean Society of Plastic and Reconstructive Surgeons
Former Director of General Affairs, Eye Plastic Surgery Research Society, Korean Society of Plastic and Reconstructive Surgeons
Regular Member, Rhinoplasty Research Society, Korean Society of Plastic and Reconstructive Surgeons
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.