Objective: Fold loss and suture extrusion are fairly common in double-eyelid surgeries. We hereby explore a new composite suture technique that aims to reduce such complications and to improve the long-term aesthetic outcome. Methods: Based on the conventional external incision procedure, the suture procedure in our technique involves three stitches that fixate the orbicularis oculi, the levator aponeurosis, and the tarsal plate. This modified upper-eyelid blepharoplasty was performed in 98 patients (91 female and seven male, 196 eyes) with either congenital absence of the upper-eyelid folds (n = 84) or loss of fold from previous procedures (n = 14). The patients were followed up for 6-30 months. The complications were documented, and the overall outcomes of upper-eyelid folds were evaluated by both surgeons and patients as excellent, good, fair, or poor. Results: Among 98 patients, 89 (91%) had excellent results and nine (9%) had good results; no patient had fair or poor results. Four patients had scar formation at postoperative week 2, all resolved without particular treatments at 6 months. The buried sutures could not be seen or felt through the skin. In addition, no suture extrusion was noted. There was no case of faded or disappeared folds during the follow-up. All patients were satisfied with the outcome. Conclusions: The composite suture technique ensures a firmer fixation and improves the aesthetic outcomes. It is a highly applicable and reliable approach for upper-eyelid blepharoplasty. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.