Effect of Upper Eyelid Fat Removal on Reoperation Rate and Long-Term Stability in Buried Suture Double Eyelid Surgery: A 4.5-Year Retrospective Cohort Study.

[BACKGROUND] Buried suture double eyelid surgery is widely performed in East Asia due to its minimally invasive nature and natural outcomes. However, crease stability can vary over time, and reoperation is needed in some cases. Upper eyelid fat, particularly retro-orbicularis oculi and orbital fat, can hinder crease retention, but quantitative evidence is limited. Therefore, this study aimed to evaluate the impact of fat removal on reoperation rates and long-term crease stability.

[METHODS] In this multicenter retrospective cohort study, 188 cases involving upper eyelid fat removal and 188 randomly selected cases without fat removal were extracted from a database of 2,934 two-point buried suture procedures performed between October and December 2020. The primary endpoint was reoperation due to crease loss. Follow-up continued until June 2025.

[RESULTS] The fat removal group had a significantly lower reoperation rate (17.0%) than the non-fat removal group (33.5%; p < 0.001). Multivariate logistic regression identified fat removal as an independent protective factor (adjusted odds ratio = 0.390, p < 0.001). Kaplan-Meier analysis showed improved long-term crease retention (log-rank p = 0.0208). Cox regression analysis indicated a significantly reduced risk of reoperation in the fat removal group (hazard ratio = 0.449, p < 0.001), supporting its long-term protective effect.

[CONCLUSIONS] Upper eyelid fat removal significantly improved the long-term durability of buried suture double eyelid surgery and reduced reoperation risk. These findings support fat removal as a beneficial adjunct in anatomically suitable cases and may guide surgical decision-making and patient counseling.

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