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Background:In double-eyelid surgery, the dynamic connection of the levator aponeurosis and skin or derma is reconstructed with the formed scar or the ligated suture.The non incision method can shape a natural and vivid crease with short recovery time.However, the duration of the supratarsal crease formed by the ligated suture in the non-incision method is not long.Methods: Atranscutaneous, subcutaneous, and intratarsal suturing technique was adopted.Five stab incisions were made in the designed double eye line.A needle pass was made with a 7-0 nylon suture from the tarsal plane deeply and the dermis superficially.After tightening the suture and burying the four ligations under the skin, the supratarsal crease was formed.Results:Between October 2003 and November 2008, we used the transcutaneous, subcutaneous, and intratarsal suturing technique for 118 patients with a single-eyelid appearance.One hundred and-six of these patients underwent follow-up ranging from 3 months to 36 months.Most of these patients (95/106 patients, 89.6%) were satisfied with the outcome; 11 patients (10.4%) expressed dissatisfaction.Of the latter, the unilateral double eyelid of 3 patients (2.8%) regressed; 5 patients (4.8%) expressed dissatisfaction with the shape and height of the formed double eyelid line; and mild asymmetry of the formed eyelid appeared in 3 patients (2.8%).Conclnsions:We found that the transcutaneous, subdermal, and intratarsal suturing technique was successful in producing a natural supratarsal crease shape which permitted easy control.We also observed that even though one single knot may be loose or tight, it does not influence the final result.