Non-incisional double eyelids, who tends to have reversal? Zetith eyes and how to choose between non-incisional and incisional methods

Whether non-incisional double eyelids (Zetith eyes) tend to revert depends greatly on age, eyelid thickness, and fat volume[1][2]. In research on the two-point non-incisional method, the rate of revision due to thread loosening was 41% in those under age 20 and 12% in those in their 30s[1]. In patients with thick eyelids or abundant fat, adding fat-removal procedures, or comparing with the incisional method, may result in greater stability in some cases[3][4].

Non-incisional versus incisional — what is the difference?

The non-incisional method creates the line with thread without cutting the skin. It is preferred for minimal swelling, natural appearance, and reversibility.[3] On the other hand, the line becoming shallower or disappearing is a common reason for revision.[1][3].

With the incisional method, it is easier to combine procedures to remove excess skin and fat, and the line can be supported without relying on thread alone.[1] It has been noted that the non-incisional method may not adequately address fat or thick skin.[4] Note that research directly comparing the durability of non-incisional and incisional methods under the same conditions is not included in the materials for this article.

Who tends to have reversal?

Age shows a clear difference. There is research based on over 50,000 records of patients who underwent the two-point non-incisional method, from which 600 people total were selected — 100 each by age group — for study.[1] The overall rate of revision due to thread loosening was 22.3%, with those under age 20 at the highest rate of 41% and those in their 30s at the lowest rate of 12%.[1] Those aged 60 and over also had higher rates of revision.[1].

In a study of 788 patients undergoing the continuous-suture non-incisional method, revision or suture removal within one year occurred in 7.0% of those aged 18–39 and 16.3% of those aged 45 and over.[5]. In those aged 45 and over, the rate of increase accelerated between days 30–90 after surgery.[5].

In addition to age, thick eyelid skin, rapid weight gain over a short period, and mild ptosis (weak eyelid-lifting strength) are also cited as factors that make the line more likely to disappear.[6]Eyelids with thinner skin tend to recover quickly and show good results.[2].

How does eyelid fat affect the outcome?

When fat is abundant, the thread-sutured line adheres less easily. The layer of fat deep within the eyelid muscle and the fat around the eye are thought to interfere with adhesion between the skin and underlying tissues.[3].

In a study followed for up to 4.5 years, combining fat removal with a two-point non-incisional technique reduced the need for revision.[3]However, fat removal is not appropriate for everyone—it applies only when the eyelid shape is suitable.[3].

What changes with different suturing methods?

Evidence to determine superiority based on suturing method differences is still incomplete. The two studies above differed in suturing technique, age grouping, and study duration.[1][5]Because numbers cannot establish that 'continuous suturing resists reversal better,' it is more important to assess your own eyelid condition first before considering suturing method.

What complications should you watch for with non-incisional technique?

The most common complaint is asymmetry between the eyes. In a 7-year review of complaints about double-eyelid surgery, 41.7% of initial complaints involved asymmetry.[6]Complaints about shallow or disappeared lines accounted for 13.3%.[6].

Rarely, the thread may touch the eye surface and damage the cornea.[7]In 12 reported cases, symptoms included eye redness, foreign-body sensation, light sensitivity, pain, tearing, and blurred vision.[7]If such symptoms persist, seek medical attention promptly.

Which should you choose? Guidelines for deciding

Here are guidelines based on eyelid characteristics.

Thin eyelids with little fat: Non-incisional technique is often suitable.[2]

Thick eyelids with abundant fat: Consider fat removal or surgical incision.[3][4]

Under 20 or 60 and older: Ask about revision possibilities beforehand.[1]

45 and older: Watch for line changes during the first 1–3 months after surgery.[5]

Eyelid thickness, fat volume, and levator strength cannot be determined from an article alone. During consultation, have your eyelid condition examined to confirm whether non-incisional technique alone is sufficient or whether fat removal or surgical incision is more appropriate.