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"Tissue threads" replace sutures in double eyelid surgery. But are they better?

Reporting in the Annals of Plastic Surgery, two South Korean surgeons have described an alternative to using suture during crease formation in "non-incisional" double eyelid surgery (more accurately termed the "suture technique").

eyelid surgery suture

Drs. Choi and Eo of Seoul have eliminated the use of commercial suture from the operation by replacing it with "tissue threads" harvested from the patient's own body or from allogeneic human dermis (skin taken from another human, usually a cadaver).


The tissue threads consist of thin strands obtained from diverse locations including the temple, around the belly-button, and from inside the lower eyelid.

The tissue threads are employed in the same manner as commercial suture in performing the steps of the conventional operation. Insertion is undertaken using a proprietary device.

The authors reported no instances of infection or reaction in 78 cases and concluded that tissue thread is safe for use in double eyelid surgery.

APSG Comment: While this work may sound interesting for its novelty, one has to wonder why it was undertaken. Tissue alternatives to commercial suture have been around for almost a century for use on the eyelids and elsewhere but are cumbersome and time-consuming to use and unpredictable in effect due to widely variable rates of weakening.

Modern surgical suture material is, on the other hand, not only affordable and convenient, but also extremely versatile, strong, non-reactive, available in countless materials and thicknesses, and attached to beautifully-shaped, razor-sharp needles that constitute marvels of modern engineering, all features developed over decades to best limit tissue damage, promote rapid healing, and minimize wound failure, infection, inflammation, and scarring. Commercial surgical suture saves on valuable operating time while allowing for high levels of success otherwise unattainable before its introduction.

To replace such modern technology with a comparatively crude substitute seems a questionable step backwards undertaken to address no identifiable need or problem.

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New material for use in Asian double eyelid surgery