Introduction

In Korea, the double eyelid crease is often described as a small detail that changes everything. It opens the gaze, adds definition, and can make the face appear brighter and more awake. At Hugo Plastic Surgery, we see patients every week — both local and international — who are curious about whether they should choose the incisional or the non-incisional method for double eyelid surgery.

To be honest, the question isn’t simply “which is better?” It’s about which technique respects your anatomy, your healing capacity, and your long-term goals. Let’s break down both approaches in a way that’s clear, practical, and true to real surgical experience.

What is Double Eyelid Surgery?

Double eyelid surgery, or blepharoplasty, creates a defined crease in the upper eyelid. In some people, the crease is naturally present; in others, the eyelid skin covers it, resulting in a monolid.

In Korea, this procedure has become almost a cultural language of aesthetics. With the rise of K-pop and Korean drama stars admired worldwide, the “bright, natural eye” has become a beauty standard recognized far beyond Asia. But contrary to stereotypes, it isn’t about erasing ethnicity — it’s about refinement.

Many patients want a crease that enhances, not changes, their identity. The aim is balance: an eye shape that matches their face, their expression, and their personality. At Hugo Plastic Surgery, we view the eyelid like the precision mechanism of a watch: small adjustments bring harmony without disrupting the whole.

The Non-Incisional Method: Subtle, Stitch-Based Refinement

The non-incisional, or suture technique, involves creating the crease by placing fine sutures through the eyelid skin into the underlying tissue. No scalpel is used, and there’s no skin removal.

Who it suits best

• Younger patients with elastic skin

• Those without significant eyelid fat or drooping

• People who want minimal downtime and a reversible option

• Patients seeking a very natural and understated look

Benefits

• Less swelling and faster recovery (often back to work in less than a week)

• No visible external scar

• Natural, subtle results when done with precision

• Option to revise or reverse if the patient wishes to change the crease in the future

Limitations

• The crease may loosen or fade over time, especially if the eyelids are heavy or the skin becomes lax with age

• Not ideal for patients with excess fat, thick eyelids, or asymmetry issues

• Durability depends heavily on both surgical technique and patient anatomy

Think of this technique like tying a delicate ribbon: it holds beautifully as long as the fabric itself is light and supple. When performed on the right candidate, the results can be so natural that even close friends may not realize surgery was done — only that the patient looks more refreshed.

From a surgeon’s perspective, precision is everything here. The sutures must be placed at exactly the right depth and tension. Too loose, and the crease will fade; too tight, and it can look artificial.

The Incisional Method: Lasting Precision with Structural Change

The incisional method is more comprehensive. A small incision is made along the eyelid, allowing the surgeon to remove excess skin, fat, or muscle before creating the crease.

Who it suits best

• Patients with thicker eyelid tissue or excess fat

• Those with drooping skin (ptosis) or asymmetry

• People who want permanent, stable results

• Patients over 30 who are beginning to see signs of skin laxity

Benefits

• Long-lasting, often permanent crease

• Ability to correct functional issues (like sagging skin impairing vision)

• Greater control for the surgeon to fine-tune eye symmetry and contour

• Can be combined with ptosis correction or skin tightening for comprehensive rejuvenation

Limitations

• Longer recovery (two to three weeks of swelling, final results in months)

• Small risk of visible scarring if not performed with skill

• More invasive, which may feel daunting to younger patients

If the non-incisional method is like tying a ribbon, the incisional method is more like tailoring a garment. It allows the surgeon to reshape and refine, ensuring the fit remains beautiful for years.

From a surgical standpoint, the incision method also allows us to address structural problems that the suture technique cannot — such as uneven fat distribution, excess muscle bulk, or significant eyelid drooping. This makes it the preferred option for patients seeking both aesthetic improvement and functional enhancement.

How to Choose: A Surgeon’s Perspective

Patients often ask: “Which method is better for me?” The truth is, the decision comes down to your eyelid anatomy and your lifestyle priorities.

• If you’re in your early 20s, with thin skin and little excess tissue, the non-incisional method may give you the crease you want with minimal disruption.

• If you’re in your 30s or beyond, or if you have puffiness, sagging, or asymmetry, the incisional method provides a stable, tailored outcome.

• If you value reversibility, or are trying surgery for the first time, the non-incisional approach offers flexibility.

• If you want a “once-and-done” solution with minimal risk of the crease fading, the incisional method is usually recommended.

And sometimes, the best results come from combining techniques, such as partial incisions with suture reinforcement — a nuance that only comes with an experienced surgeon’s eye.

At Hugo Plastic Surgery, Dr. Seonghyeok Yang often tells patients: “Your eyelid is not just skin — it’s a layered structure. Choosing the right method means respecting every layer.”

Recovery and Results: What to Expect

Both methods share one common factor: patience.

Non-incisional recovery

• Swelling usually resolves in 5–7 days, with most patients resuming daily life quickly.

• Minimal bruising compared to incisional methods.

• The crease may look sharper at first, then soften into a natural line over weeks.

Incisional recovery

• Swelling and bruising are more pronounced, often taking 2–3 weeks to fade enough for social comfort.

• Final results can take 3–6 months to fully settle as tissues heal and scars mature.

• Some tightness or numbness is common early on but improves steadily.

It’s also important to understand that every pair of eyes heals differently. What people often overlook is that symmetry comes not just from the surgeon’s hands, but from how each eyelid tissue responds during healing. This is why follow-up appointments are so critical — adjustments and careful monitoring ensure the final result looks natural and balanced.

Why Precision Matters

South Korea is the global capital of eyelid surgery, with thousands of procedures performed every year. But not every clinic approaches it with the same philosophy.

At Hugo Plastic Surgery, we avoid a “one-size-fits-all” approach. A high fold may look striking on one patient, but artificial on another. The goal isn’t a Western eye — it’s a harmonious eye that feels like it was always yours.

We’ve seen patients who had surgery elsewhere come to us saying their eyes look “too done.” Often, the issue isn’t the technique itself, but the lack of personalization. A crease set too high, or sutures placed without accounting for tissue thickness, can create results that don’t match the rest of the face.

That’s why consultations are so critical. In our clinic, we spend as much time evaluating and planning as we do performing the procedure. We use high-resolution imaging to simulate outcomes and discuss fold height, shape, and symmetry with patients in detail. To us, eyelid surgery is not just cutting or stitching — it’s reading the unique language of each patient’s anatomy.

Revision Surgery: When Things Don’t Go as Planned

One topic rarely discussed openly is revision surgery. Unfortunately, because eyelid surgery is so common in Korea, patients sometimes undergo the procedure in clinics that prioritize speed or cost over precision.

Revision may be needed if:

• The crease has loosened or disappeared (common after poorly performed suture methods)

• The eyelids look asymmetrical

• Scarring or tethering creates an unnatural fold

• The crease is set too high, making the eyes appear hollow or unnatural

Revision surgery is more complex than primary surgery. Scar tissue, altered anatomy, and previous suture placements must be carefully managed. At Hugo Plastic Surgery, Dr. Yang specializes in difficult revision cases, often combining incisional and corrective techniques to restore a natural crease.

Final Thoughts: Incisional vs. Non-Incisional

Neither method is inherently superior. The real question is: Which approach will give you a crease that enhances your features naturally, and lasts in a way that fits your life?

If you’re considering double eyelid surgery, seek a clinic that doesn’t just perform the procedure, but studies your anatomy with the care of a watchmaker examining gears. At Hugo Plastic Surgery, Dr. Seonghyeok Yang and our team specialize in tailored eyelid surgery, ensuring that every crease is designed with precision, balance, and your unique beauty in mind.

✨ Ready to explore your options? Visit Hugo Plastic Surgery in Gangnam and consult with Dr. Yang — where expert care meets natural aesthetics.