[Column] Why Is Revision Eye Surgery More Difficult?

Hello, this is AB Plastic Surgery!

Today, I’d like to explain why revision eye surgery can be more difficult.

The basic anatomical structure is the same for everyone. There may be differences in the length and thickness of these structures depending on race and constitution, but the basic structures are the same.

If you look at the eye from the outermost structures inward, the skin is on the outside, beneath the skin is the orbicularis oculi muscle, and

beneath that is the septum, followed by orbital fat, then the levator aponeurosis,

and after that the Muller muscle and the conjunctiva.

Using double eyelid surgery as an example, there are broadly incision methods and non-incision methods. In the case of the incision method, the skin is incised,

some of the inner muscle can also be removed, orbital fat may be removed, and if eye correction is performed, the levator aponeurosis

and Muller muscle are partially cut or adjusted.

In the case of a first surgery, these structures are intact, so if the procedure is carried out as planned, the surgery can proceed without major difficulty. However, if the first surgery was performed using an incision method, the amount of skin removed, the amount of fat removed, and the amount of aponeurosis and muscle resected during the first operation

all vary depending on the surgeon and the patient’s eye anatomy, so changes occur from the original basic anatomical structure. In addition, adhesions form after surgery.

(In the case of double eyelid surgery, this principle of adhesion formation is sometimes used to help make the double eyelid more stable.)

In such cases, if revision surgery is performed, the surgery becomes more difficult than the first surgery because the surgeon must dissect the adhesions and proceed while checking the newly changed structures.

There may be cases where too much skin was removed in the first surgery, making it difficult to remove more skin,

or where too much orbital fat was removed so that there is little or no orbital fat left, or where too much of the levator aponeurosis was removed, making further correction difficult.

In other words, because of the many variables involved in the first surgery, revision surgery becomes more difficult.

Relatively speaking, if the first surgery was performed with a non-incision buried suture method, there are fewer changes to the basic structures other than the passage of the suture inducing adhesion,

so it may be less difficult than eyes that underwent an incision method.

To summarize, in revision surgery, the basic anatomical structures of the eye will have changed due to previous operations,

and because the surgery must be performed while predicting these changes and releasing adhesions, it can be said to be more difficult than the first surgery. Even in revision surgery, if existing adhesions are carefully released and, in cases where the previous scars were severe, those scars are also properly removed,

better results can be achieved. Therefore, through a consultation, we recommend having your current eye condition evaluated and finding the appropriate revision method.

Thank you.