The so-called "non-incisional" or suture method for creating a crease in the Asian eyelid was described during the first decade of the last century. While it has gone through a host of refinements since, the operation still possesses significant limitations.
• The operation can be performed quickly, sometimes in just fifteen minutes.
• Healing time is short. While swelling and bruising may be noticeable for a week or two, the final result is generally in place by about a month or sooner.
• Suture techniques are easier to perform for the inexperienced eyelid surgeon.
• Costs are less, usually by about one-half.
• In most cases, the new crease weakens or disappears within a matter of years (or even months).
• The new crease is not created by a true anatomical rearrangement but rather by crushing the internal tissues into place. Once the sutures weaken (which is almost inevitable), the crease will fade.
• There is little room for adjustability. Most often, the new crease is subtle.
• The technique is not truly "non-incisional." Two or even three smaller incisions are made across the eyelid. In many cases, the resulting external scar is just as visible as with a full incisional technique.
• In the slightly older patient who may also benefit from trimming of excess skin or fat, he or she is simply out of luck.
• The new crease does not come and go with blinking. For the part, it's always there, even when the eyes are closed.
• Most significantly, the operation is not as kind to the internal tissues as many patients assume. Once multiple entry points are made into the lid, sutures are woven this way and that and then looped and tied, scar tissue is created that makes future double eyelid surgery (incisional or non-incisional) more difficult, less predictable, and more expensive.
Speed and less (initial) expense do not seem like good reasons to select a less effective operation on your face.