Changes and Causes That Can Occur When the Double Eyelid Line Becomes Weaker

When consulting with patients, there are many people who consider revision double eyelid surgery for a variety of reasons.

As time passes, the double eyelid line may loosen,

a double fold may appear, the line may look asymmetric,

or it may sit too low or too high compared with the height originally desired.

Depending on each person’s eye condition, revision surgery is considered for many different reasons.

Today, among those reasons, I will talk about the surgical approach centered on real cases related to the cause of a 'loosened double eyelid,' which is often mentioned as a reason for revision surgery.

| Changes that can appear when a double eyelid becomes loose | 1) When the line has completely disappeared The double eyelid line disappears from one or both sides, and the eyes may look similar to how they did before surgery.

2. When it has loosened partially The line may look short or interrupted in the middle, and some areas may appear more prominent.

3. When the original line disappears and a new line appears above it As the line shifts upward in an awkward way, asymmetry between the two eyes becomes more noticeable, and the eyes may look blurred or sleepy.

4. When multiple lines appear A double fold forms, making the eyes look unrefined and giving a tired impression.

5. When the line is uneven and fluctuates The line may seem to appear and disappear inconsistently, and sometimes a double fold forms or the line shifts upward. |

If these kinds of changes repeat or continue,

it may be worth considering the possibility that the double eyelid line is weakening or loosening.

There can be several reasons why a double eyelid line does not stay stable.

Typical factors include the following:

1. When the skin is thick or there is a lot of soft tissue

2. When the muscle that opens the eyes is weak (a tendency toward ptosis)

3. When the eyeballs protrude more than average

4. When the adhesion thread loosens or breaks after a non-incisional procedure

First. When the skin is thick or there is a lot of soft tissue

When the skin on the eyelid is thick, the distance between the eyelid skin and the tarsal plate becomes greater,

which may widen the area that needs to be fixed during double eyelid surgery.

As a result, fixation may be relatively difficult or the holding power may be weak,

and over time the double eyelid line may become faint or loosen.

Incisional eye revision surgery + upper eyelid fat repositioning (3 months after surgery)

Incisional eye revision surgery + lower eyelid fat repositioning (1 month after surgery)

→ A method that organizes sagging skin and soft tissue through incisional double eyelid surgery

In this type of case, during revision surgery,

a small incision may be used to organize unnecessary fat, muscle, and other soft tissue

that could affect line retention.

When skin sagging is severe or there is a lot of soft tissue,

planning a more stable double eyelid line using the incisional method

may be an approach suited to the individual’s eye condition. Second. When the strength of opening the eyes is weak

When the strength of the muscle that opens the eyes is weak, the eyelid does not lift well, so the double eyelid line may not appear clearly

or the line may feel blurred over time. In such cases, ptosis correction surgery to adjust the tension of the muscle that opens the eyes is sometimes considered together. By supplementing eyelid movement through ptosis correction,

it may help maintain the double eyelid line and change the overall impression.

Non-incisional eye revision surgery + non-incisional ptosis correction + non-incisional lower canthoplasty (1 month and 2 weeks after surgery)

Incisional eye revision surgery + asymmetric incisional ptosis correction (1 month after surgery) Third. When the degree of eye protrusion is large

When the eyes protrude more than average, the skin covering the protruding eyeball is pulled upward,

which can make the double eyelid line unstable or cause a double fold, making the eyes look less smooth.

In such cases, if the line is set too high during surgery, the protrusion may stand out even more,

so a slightly lower-than-average in-out line is often considered to soften the overall eye impression.

In addition, when fixing the line, it may be planned so that adhesion is created at multiple points at an appropriate height,

enhancing the line’s retention.

Incisional double eyelid surgery + incisional ptosis correction + upper eyelid fat repositioning (19 days after surgery)

Incisional double eyelid surgery + ptosis correction + upper eyelid fat repositioning (3 months after surgery)

Revision incisional double eyelid surgery + ptosis correction + upper eyelid fat repositioning (1 month after surgery)

→ Example of a surgical approach for protruding eyes:

A case in which the double fold was improved, and the sunken area above the eyelid and the protruding impression

were balanced and refined. Fourth. When the adhesion thread becomes loose or comes undone

Non-incisional double eyelid surgery creates adhesion between the eyelid skin and the tarsal plate using thread.

However, if the thread loosens or comes undone before sufficient adhesion is formed,

the line may become blurred or disappear.

Therefore, it is important to form adhesion with an appropriate fixation strength—not too weak and not excessively strong.

Source: TS Plastic Surgery website

In revision surgery for this type,

finding the exact fixation points and increasing stability through double knots, etc. can help,

and considering factors that may affect the eyelid, such as soft tissue and ptosis,

can help secure both line retention and balance.

Sometimes there is no problem with the result of double eyelid surgery,

but the double eyelid line is not clearly visible over the eyelid,

so it feels as if the double eyelid has loosened.

In such cases, sagging tissue in the eyelid, eyebrow, or forehead area may cover the existing double eyelid line.

In this situation, rather than repeating double eyelid surgery, improving sagging in the forehead or eyebrow area through a lifting procedure

may be a more appropriate direction to make the double eyelid line visible again.

Forehead lift + double eyelid revision surgery

Today, I explained the symptoms that can appear when the double eyelid line becomes weaker or loosens,

its causes, and the improvement methods that may be considered accordingly.

If the double eyelid line repeatedly loosens, when planning revision surgery,

it is important to make a precise diagnosis of not only the first surgical method but also the current eye condition, soft tissue, muscles, skin thickness, and other

factors, and then establish a surgical plan that fits them.

In some cases, revision may be possible with a buried suture method or natural adhesion method,

but depending on the individual’s eye condition, an incisional method may be needed or

additional surgical approaches such as ptosis correction may need to be performed together.

※ Since side effects such as inflammation, bleeding, and nerve damage may occur depending on the individual, sufficient consultation with the medical staff is necessary before surgery.

These are example images to help with understanding.