Background: Crease loss after non-incisional double eyelid surgery remains a major cause of dissatisfaction, yet the relative influence of surgical technique, anatomy, and surgeon experience is unclear. Methods: This retrospective study analyzed 513 consecutive cases of transcutaneous non-incisional double eyelid surgery performed between July 2021 and July 2022. Patients were stratified by surgeon experience (<100 vs ≥100 cases). Baseline variables included age, sex, crease design, fixation method, puffy eyelid status, and surgeon experience. Crease loss was defined as revision due to fading or disappearance of the crease. Kaplan–Meier and Cox regression analyses were performed, including interaction terms. Results: Among 513 patients, 264 were operated on by beginners and 249 by experienced surgeons. Experienced surgeons more frequently used continuous fixation (p < 0.001). Continuous fixation and non-puffy eyelids demonstrated significantly superior crease survival (log-rank p < 0.001 for both), whereas surgeon experience showed no significant effect (p = 0.441). In multivariable analysis, continuous fixation (HR = 0.29, 95% CI 0.19–0.44) and non-puffy eyelids (HR = 2.47, 95% CI 1.62–3.78) independently predicted crease retention. A significant interaction indicated that the benefit of continuous fixation was especially strong in puffy eyelids. Conclusions: Fixation method and eyelid puffiness were the primary determinants of crease retention, while surgeon experience was not independently influential. Continuous fixation offered superior durability, particularly in puffy eyelids. These results highlight the importance of standardized technique and individualized anatomy rather than case volume in achieving stable outcomes.
Inoguchi et al. (Thu,) studied this question.