Background <p>Buried suture double eyelid blepharoplasty (BSB) is among the most frequently performed cosmetic procedures in East Asia. We previously reported that concurrent upper eyelid lipectomy (UEL) reduced early postoperative complications after BSB; however, the mean follow-up was only 7.5 months, leaving the mid-term effect on the persistence of the double eyelid crease unknown. This study extended follow-up and used survival analysis to assess whether concurrent UEL reduces buried suture–related events.</p> Methods <p>This single-centre, single-surgeon retrospective cohort study included 102 consecutive patients who underwent BSB between January and December 2024, followed until February 2026. Patients were grouped as BSB alone (monotherapy, <i>n</i> = 61) or BSB with concurrent UEL (combination, <i>n</i> = 41). The primary endpoint was a buried suture–related event, defined as reoperation or suture removal for loss or loosening of the double eyelid line. Event-free survival was estimated using the Kaplan–Meier method, compared by the log-rank test.</p> Results <p>The median follow-up was 19 months (interquartile range 16–22). Buried suture–related events occurred in 17 patients (16.7%): 14 (23.0%) in the monotherapy group versus 3 (7.3%) in the combination group (<i>P</i> = 0.056). Event-free survival was significantly longer in the combination group (log-rank <i>P</i> = 0.037). All three events in the combination group were requests for cosmetic revision, with no mechanical suture-related complications.</p> Conclusions <p>Concurrent UEL was associated with significantly longer event-free survival over mid-term follow-up, suggesting improved persistence of the double eyelid crease.</p> Level of Evidence <p>Level III, therapeutic study.</p>