Background <p>Buried suture double-eyelid surgery is a popular minimally invasive technique used in East Asia. However, suture loosening and crease loss remain the common reasons for reoperation. The impact of patient age on surgical stability remains unclear. This study aimed to evaluate the age-related risk of reoperation due to suture loosening in patients undergoing two-point buried suture double-eyelid surgery.</p> Methods <p>This retrospective cohort study was conducted using 600 randomly selected cases (100 per age group:  &lt; 20, 20–29, 30–39, 40–49, 50–59,  ≥ 60&#xa0;years) from a national dataset of 52,281 procedures. The primary outcome was reoperation due to suture loosening. Analyses performed included chi-square tests, Kaplan–Meier curves, and multivariable Cox regression.</p> Results <p>Reoperation occurred in 134 patients (22.3%), with the highest rate in the &lt; 20 age group (41%) and the lowest rate in the 30–39 age group (12%) (<i>p </i>&lt; 0.001). Cox analysis showed significantly increased hazard ratios (HR) in the &lt; 20 group (HR: 1.91, 95% CI: 1.13–3.23), while the ≥ 60 group showed a non-significant trend (HR: 1.34, <i>p</i> = 0.327). All-cause reoperations followed a similar pattern.</p> Conclusions <p>Reoperation risk varied significantly with age, with younger and older patients being more prone to crease failure. Age-specific surgical planning and consideration of anatomical factors are essential to improving long-term outcomes.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>