Background <p>Continuous buried suture double-eyelid surgery is widely performed in Asia because of its minimally invasive nature and short recovery. However, age-specific outcomes remain underexplored.</p> Methods <p>We retrospectively reviewed 788 patients who underwent continuous buried suture double-eyelid surgery at a single institution between March 2023 and June 2024. Patients were classified into a younger group (18–39&#xa0;years, n = 530) and an older group (≥ 45 years, n = 288). Cases performed by surgeons with fewer than 300 procedures, interrupted suture methods, and concomitant brow excision were excluded. The primary endpoint was any reoperation or suture removal within 12&#xa0;months. Cumulative incidence was calculated using the Gray test, and Fine–Gray regression was applied to estimate subhazard ratios.</p> Results <p>Event incidence was higher in the older group (16.3%) than in the younger group (7.0%). Cumulative incidence rose sharply between 30 and 90&#xa0;days postoperatively in older patients, while it increased linearly over time in younger patients. Fine–Gray regression showed that older age independently increased the event risk (subhazard ratio 2.49, 95% CI 1.55–4.00). Most events were due to dissatisfaction with eyelid shape rather than crease loss or infection.</p> Conclusions <p>Older patients undergoing buried suture blepharoplasty demonstrated a higher risk of reoperation or suture removal, especially within the early postoperative period. Despite being a palliative technique, the buried method remains a valuable option for older patients due to its minimally invasive nature and reversibility.</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>