Background <p>Double eyelid surgery is a minimally invasive cosmetic procedure characterized by a short downtime. Continuous and two-point methods are widely utilized buried suture techniques; however, direct comparisons of their long-term stabilities are scarce. This study aimed to compare the long-term stability and reoperation rates between the continuous and two-point buried suture methods.</p> Methods <p>We analyzed reoperation rates, time to reoperation, and reasons for reoperation in 1,000 cases (500 cases for each technique). Multivariate analysis was performed using Kaplan–Meier survival curves and Cox proportional hazards models.</p> Results <p>Reoperation rates were significantly lower with the continuous method (13.4%) than with the two-point method (26.2%; <i>p</i> &lt; 0.001). Cox model analysis revealed that the two-point method significantly increased the risk of reoperation (hazard ratio = 2.1, <i>p</i> &lt; 0.001). The primary reason for reoperation was suture loosening (81.87%).</p> Conclusion <p>The continuous method resulted in lower reoperation rates and superior long-term stability. These findings provide evidence-based guidance for selecting surgical techniques for double eyelid surgery.</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>