While incisional double eyelid surgery is indeed the "gold standard" when it comes to creating or better defining a crease in the Asian upper eyelid, this procedure is often compared to the older non-incisional technique, also called the suture method.
• The incisional technique allows the surgeon to directly address any anatomical impediments to crease formation by altering and rearranging internal eyelid tissue layers. Such changes replicate as closely as possible the natural conditions that exist in any Asian or non-Asian patient born with a crease.
• The new crease is there to stay because the internal anatomy is changed. There is no dependence on retained sutures for effect.
• The incisional technique allows for more variation in the final height and shape of the crease (for instance, higher or lower, tapered or parallel, etc.).
• If indicated, skin and/or fat may be trimmed. This is especially important in the patient past his or her twenties or in a patient who wishes to alter crease height or shape.
• The crease is "dynamic," which means simply: When the eye is opened, the crease appears. When the eye is closed, it disappears.
• The time between the operation and final healing is much longer with the incisional technique. The more you do, the more there is to heal.
• Performing the operation skillfully is more challenging for the practitioner who doesn't do much eyelid surgery. Especially under such circumstances, the chance of functional or aesthetic problems is increased.
In the hands of an experienced eyelid surgeon, the pros seem to far outweigh the cons.