To investigate the clinical efficacy of the small-incision two-stage fat-removal suture embedding method for double eyelid surgery in patients with puffy upper eyelids and provide evidence for selecting the optimal surgical approach. A total of 160 patients with puffy upper eyelids who underwent double eyelid surgery at the Department of Medical Aesthetic Plastic Surgery and Burns, Affiliated Hospital of Inner Mongolia Medical University, from October 2020 to October 2024,were enrolled. These patients were divided into four groups: the small-incision two-stage suture embedding group (experimental group, n = 45), traditional incisional group (n = 42), continuous buried suture group (n = 32), and three-point small-incision group (n = 36). A retrospective analysis was conducted to evaluate clinical outcomes. Follow-up assessments were performed at 6 days, 1 month, 3 months, and 6 months postoperatively. Visual Analog Scale (VAS) scores for postoperative swelling, VAS scores for scar severity, and patient satisfaction scores were compared among the four groups, with intra-group score changes recorded. At 6 days postoperatively, the experimental group exhibited significantly lower VAS swelling scores than the traditional incisional group (P < 0.05). At 1 month postoperatively, the experimental group showed lower VAS swelling and VAS scar scores than the traditional incisional group but higher scores than the continuous buried suture group (statistically significant differences). No significant difference was observed compared to the three-point small-incision group. At 1 month, there was no significant difference in satisfaction scores among the four groups. By 3 months postoperatively, the experimental group maintained lower VAS swelling and VAS scar scores than the traditional incisional group (P < 0.05) but higher scores than the continuous buried suture group (P < 0.05). The experimental group's satisfaction scores surpassed those of the continuous buried suture and three-point small-incision groups (P < 0.05), with no significant difference compared to the traditional incisional group. At 6 months postoperatively, the experimental group demonstrated lower VAS scar scores than the traditional incisional group (P < 0.05), with no significant difference compared to the other two groups. Satisfaction scores remained higher in the experimental group than in the continuous buried suture and three-point small-incision groups (P < 0.05), but no significant difference was observed compared to the traditional incisional group. The small-incision two-stage suture embedding method for double eyelid surgery achieves favorable outcomes in patients with puffy upper eyelids. This technique combines the advantages of traditional incisional and minimally invasive approaches. By removing fat via small incisions and employing a two-loop suture design at the highest point of the eyelid, it achieves stability comparable to traditional incisional methods. The two-stage sutures are embedded medially and laterally, avoiding knots at the highest point, thereby minimizing disruption to small veins and local lymphatic drainage. This results in shorter swelling recovery periods, rare suture reactions or infections, rapid recovery, minimal scarring, and high patient satisfaction. This method is a recommended surgical approach.
He et al. (Wed,) studied this question.