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5-Point Non-Incisional Blepharoplasty with Threads for Double Eyelid and Minor Ptosis Correction - [

Due to the imprinted misconception that the eye-lid is the most important area of the eye that determines the overall aesthetics of a person, when it comes to blepharoplasty, patients seeking help for a pair of attractive eyes often request for the correction their eyelids. Over the years, it has become one of the most highly sought-after and performed surgery for the eyes.


Medically, the term ‘blepharoptosis’ refers to eyelids that are partially or extensively covering the iris. Blepharoptosis may also be attributed to many various factors, but there are 5 main categories in which it can be classified under - namely, congenital, traumatic, neurological, involutional and idiopathic. Other factors may include, but not limited to, genetic abnormality, conjunctivitis, trauma, neurological disorder, and prolonged constant wearing of contact lenses.

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Aside from the factors mentioned above, muscle laxity that comes with ageing and bad habits such as excessive rubbing or tugging, together with genetics and congenital factors also play part to blepharoptosis; although in some case, people born with smaller eyes can also suffer from droopy eyelids, or experience difficulty in opening their eyes later as they age.

Blepharotosis not only impairs a patient’s facial features, presenting a sleepy appearance and making them appear to have indifferent personalities, it also induces functional disorders such as headache, eyestrain and increased tearing.

Correction of blepharoptosis is recommended as soon as possible because it can affect the person’s vision and interfere with their daily activities. Aside from the obvious aesthetic reasons, if left untreated for a long period of time, it can potentially have a negative impact on one’s eyesight including lazy eye or astigmatism. Correction by surgical intervention is usually required to not only improve a patient’s overall facial aesthetics, but also the quality of life.

Blepharoplasty: Incisional vs Non-Incisional

Blepharoplasty as a form cosmetic surgery procedure is common and is performed on the skin around the eye to reshape and form a crease in the upper eye-lids to create a “double eye-lid”. There are generally two methods which are commonly used: the Incisional and Non-Incisional technique.

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Traditionally, the Incisional technique is more appropriate to address droopy eye lids that have more fat and thicker skin by cutting on the line of the eyelid to remove the required amount of tissue (skin, muscle, fat, connective tissue) while connecting the dermis to the tarsi allowing the scar between the two tissues to make a deep and natural double eyelid. In addition, a procedure to remove the epicanthal fold (i.e. an epicanthoplasty) is often performed in conjunction with an Double Eyelid Surgery

This technique is the most common and popular double eyelid fold surgery type. In the long term, it produces the most natural look and is widely considered the best technique for the permanent reshaping of the eyes. The Incisional method produces the most satisfaction in terms of results. However, the downside of this technique, is that it takes a longer time for patients to heal and results are often non-reversible.

With the increasing demand for fast and effective procedures as alternatives, the Non-Incisional technique can not only offer a shorter procedural and recovery time, but scarring is more inconspicuous as compared to the Incisional technique. Furthermore, it can be easily revised, causes less edema, and should complications occur, is reversible. The Non-Incisional technique, however is not suitable for everyone, and potentially has a higher likelihood of asymmetry as compared to the Incisional technique.

Blepharoptosis Correction with Threads

In a recent study published in 2010, using the non-incisional method, the authors initially expected relapse to occur at speculated percentages between 30-40% even for mild cases. Yet, esults turned out to be much better than the initial expectation, with lasting elevation achieved for 97.5% of mild cases and 88.9% of moderate cases. The stability of suspension could be attributed to the formation of scar tissues around the suspension sutures.

The same study also notes that, to correct moderate blepharoptosis, the ptotic eyelids need to be elevated by greater distances than in the correction for mild ptosis. Hence, more tissue needs to be included in the suspension sutures. Accordingly, the likelihood that the sutures loosen or tear the tissue increases. It is also recommended to address relapse as a possible complication in preoperative explanation for patients with moderate ptosis.

It is also reported that all cases that developed complications was within a 2-month time period post-operation; with no cases developing relapse more than 2-months after. Consequently, the authors hypothesised that scar formation around the suspension sutures is completed within 2-months, stabilising the suspension effect. Therefore, it is recommended to use materials that do not disintegrate for at least for 2-months as the suspension sutures. This means that although absorbable sutures may reduce frequency of corneal itching, it is not recommended as they are likely to begin decomposing within 2-months.

The study also notes that there is a significantly shorter downtime, along with another merits of the using non-incisional thread technique, leaving no visible scars by forming folds on the slits in which the knots are enfolded. Since the shape of the double fold is affected by positioning, and personal preference varies as to the shape of the double fold, care must to be taken in deciding the position at which the suspension sutures are applied.

5-point Non-Incisional Blepharoplasty

By using the right Non-incisional Blepharoplasty technique, one can not just effectively create the effects of double eye-lid achieved by the incisional technique, but also potentially correct minor ptosis. This week, IFAAS faculty, Dr. Choi, shares his exclusive 5-point Non-Incisional Blepharoplasty with Threads Technique for Double Eyelid and Minor Ptosis Correction:

Hope you have enjoyed the article & video! Stay tuned for our future posts about more techniques and information related to our advanced aesthetic and cosmetic training courses!



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