"Should I get suture (non-incisional) or incisional double eyelid surgery?"

This is the most frequently asked question during consultations. Many patients arrive having already decided which method they want. It's natural — after hours of online research, you form a preference.

But I don't answer that question right away.

Because the method shouldn't come first — your eyes should. The same suture technique works beautifully on some eyes, yet is the worst possible choice for others. The same goes for incisional. You need to understand your own eye conditions first, then determine the right approach.

This article covers what I explain to every patient in my consultation room: what crease suits your eyes, which conditions favor suture vs incisional, what happens when the wrong method is chosen — and how RESPECT approaches this decision with 1mm precision.

First, Read Your Own Eyes

Four factors that determine everything — from crease height to surgical method

Before deciding on a crease line, I check the following factors. These conditions determine crease height, shape, and even the surgical method.

Eyelid Thickness & Elasticity: Patients with thin, elastic eyelid skin get fine, natural-looking creases. These eyes respond well to the suture method. Conversely, thicker skin or reduced elasticity can cause puffiness at the same crease height, or the fold may gradually fade. In these cases, the incisional method delivers more stable, lasting results.

Fat Volume: When there's significant upper eyelid fat, the crease line gets buried and appears indistinct. The suture method alone can't adequately remove fat, so for fattier eyelids, the incisional approach — removing an appropriate amount of fat before securing the crease — produces a more natural result.

Eye-Opening Strength (Levator Muscle): Some people have weak levator muscle function. If only a double eyelid is created without addressing this, the eyes can look tired, or the patient unconsciously raises their forehead to open their eyes — deepening forehead wrinkles. Ptosis correction should be considered simultaneously, which typically requires the incisional approach.

Natural Eye Shape: Horizontal eye length, inner corner structure (presence of epicanthal fold), outer corner angle, and the distance between brow and eye — all of these influence the ideal crease height and shape. Beyond that, overall facial proportions and pupil size are also factors that must be considered.

Suture vs Incisional: What's the Difference?

Two methods, two principles — choosing depends entirely on your eye conditions

Once the crease design is determined, the next step is choosing the method. Suture and incisional techniques create double eyelids through fundamentally different mechanisms.

Who Is Each Method Best For?

A clearer breakdown to help you understand where you might fit

To make the distinction even clearer, here's a side-by-side look at the ideal candidate profiles:

What Happens When the Wrong Crease Is Chosen?

Why saying "no" is sometimes the most important part of a consultation

During consultations, some patients bring reference photos of their desired crease. But sometimes, that particular crease isn't suited to their eyes. When that's the case, I explain honestly — because an ill-suited crease doesn't just look "less ideal." It can produce results that differ significantly from expectations.

This is why I take extra time during consultations. The goal isn't finding "which crease looks pretty" — it's finding "which crease is right for these eyes." That's the most important step before any surgery.

Double Eyelid Surgery at RESPECT

1mm precision design, starting from "seeing your eyes again"

At RESPECT, the first step of double eyelid surgery isn't choosing between suture and incisional — it's "seeing."

RE:SPECT — in Latin, it means "to look again." We believe that to design a crease that truly suits someone, you must first see their eyes thoroughly. Not decide after one glance, but look repeatedly — the skin condition, the fat distribution, the muscle function, and the potential these eyes carry.

Crease Design — Finding Your 1mm

Crease height, starting point, tail angle — each parameter is fine-tuned in increments of 1mm. The design is confirmed with the patient sitting upright (not lying down), because gravity changes how the eyelid falls. This step alone can take longer than the surgery itself.

Natural Is the Highest Standard

RESPECT believes the best surgical result is one where no one notices you had surgery. The goal isn't dramatic transformation — it's that quiet moment when someone says "you look refreshed" without being able to explain why.

Safety System — Respecting the Weight of Every Surgery

Surgery is a significant decision. RESPECT never recommends surgery lightly, nor suggests more invasive approaches when simpler options suffice. Every procedure follows a four-phase protocol:

International Patients Can Feel at Ease

Complete care from abroad to Seoul

For international patients, seeking medical care in a foreign country requires attentive support. RESPECT offers multilingual consultation — from online preliminary assessments to in-person consultations upon arrival in Seoul, there's always a communicator available throughout.

Airport pickup, partner accommodation arrangements, post-op follow-up scheduling — no detail is overlooked. For us, respecting your time is just as important as respecting your eyes.

What You Should Know Before Double Eyelid Surgery

Read the Eyes First, Then Choose the Method

"Suture or incisional?" We started this article with that question. If you've read this far, you understand why the question was in the wrong order all along.

The best surgery isn't the most expensive one, or the trendiest technique, or the method your friend recommended. It's the one that was designed specifically for your eyes — by a surgeon who took the time to read them carefully.

And sometimes, that means the surgeon telling you: "Actually, for your eyes, the simpler option is the better one." That honesty is where real precision begins.

At RESPECT, that's exactly what we do. We look at your eyes — again. And we find the crease that was always meant to be there.