[Duhan Plastic Surgery Double Eyelid Revision Surgery] - [Information on Candidates for Double Eyelid Revision Surgery]

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Revision Surgery Information

Revision double eyelid surgery refers to surgery that corrects the double eyelid line when the line is too thick, uneven, or has loosened, and restores it to a natural yet clear double eyelid shape.

Indications for revision surgery

◎ A double eyelid line that is too large

◎ Feeling eye fatigue after double eyelid surgery

◎ Looking less attractive after double eyelid surgery

◎ Eyes appearing sleepy after double eyelid surgery

◎ An asymmetric line

◎ A line that has loosened

◎ Wanting to restore beautiful, natural-looking eyes

The purpose of general double eyelid surgery

Double eyelid surgery is

not simply meant to create a double eyelid line.

The purpose of double eyelid surgery is

to make the eyes look bigger and clearer,

and to create bright, sparkling eyes

and a refined eye shape.

Surgery done only to make a double eyelid line can easily lead to undesired results.

The same applies to the purpose of double eyelid revision surgery.

Its purpose is to correct the eye shape so that it becomes larger, clearer, and more natural.

Features of our clinic

1. We have accumulated over 20 years of extensive clinical experience and expertise in double eyelid revision surgery.
2. We have a systematic system for revision surgery.
3. Through preoperative consultation, we perform various examinations and tests to predict postoperative results.
4. We perform surgery only when the examinations and tests show that there is sufficient room for improvement. If we determine that we cannot produce the result the patient wants, we make it a rule not to attempt surgery at all.
5. Through examinations, we identify the problems with the previous surgery, provide a thorough and clear explanation, and suggest the surgical method best suited to achieve the best result.
6. We explain the surgical process and course of recovery in a way that ensures a clear understanding, and we do not omit explanations of possible side effects that may occur after surgery.
7. We provide thorough postoperative care. We closely monitor the postoperative course to confirm that recovery is progressing properly.
8. Our clinic continually devotes research and effort to become the last hospital a person visits, so that those who want double eyelid revision surgery will not need further surgery.

Types of examinations and tests during consultation

The most important test for determining whether revision surgery is possible is the amount of excess skin.

Because revision surgery must involve removing at least a small portion of the scar tissue before operating,

the amount of excess skin is an important indicator for judging surgical prognosis.

If there is no excess skin, surgery may not be possible.

If surgery is performed forcefully when there is insufficient excess skin,

the result will not be good and lagophthalmos, in which the eyes do not close properly, will worsen,

so this is the most important test that must be done before revision surgery.

The second most important test for determining whether revision surgery is possible is

the levator palpebrae superioris (eyelid-lifting muscle) function test.

In cases of severe ptosis,

how much levator function remains is the key issue.

The levator palpebrae superioris is the muscle that lifts the eyelid upward.

A certain degree of function in this muscle is needed to predict the success of revision surgery.

In patients with ptosis,

if levator function is significantly reduced,

surgery may not be possible.

As a rule, surgery should not be performed when levator function is below a certain threshold.

Other examination methods

Measurement of the thickness of the eyelid skin
Examination for the presence of ectropion of the eyelashes
Examination of the scar and degree of scar adhesion along the existing double eyelid line
Degree of looseness and presence of a double eyelid line
Measurement of the height and symmetry of the existing double eyelid line (scar line)
Measurement of the amount and presence of orbital fat, and the thickness and presence of the orbicularis oculi muscle
Measurement of the degree of ptosis by measuring the palpebral fissure height (the vertical size when looking naturally straight ahead at eye level)
Measurement of the horizontal length of the eyes and the distance between the eyes (to determine the presence of an epicanthal fold)
Measurement for the presence of strabismus

Surgical plan based on the above test results

Setting the height and design shape of the new double eyelid line
Setting the width of skin (scar) excision
Setting the width of levator palpebrae superioris shortening
Determining whether orbicularis oculi muscle excision is needed

Based on the above test results,

we predict the postoperative result and the likelihood of surgical success.

We recommend surgery only when it is judged to be possible.

If surgery is not possible, we explain the reasons why,

or explain how far surgery can realistically be performed.

Candidates for revision surgery

"Please check whether you fall into any of the following candidates for double eyelid revision surgery."

First candidate for revision surgery:

The line is too large!

From a general standpoint, a double eyelid line

is most natural and beautiful when it is just slightly visible.

If the line is too thick, the eyes appear sleepy,

and it gives others a strong, rough impression.

♥ Causes

• A line designed too high

• Scar adhesion

• Ptosis

• Lack of excess skin, etc.

♥ Correction

The existing high line must be smoothed out or removed by incision,

and a new line should be designed at an appropriate level.

However, the height of the new line varies from person to person,

and it is important to find and design the height that is most natural for the individual,

taking into account excess skin, eye size, and other factors.

Second candidate for revision surgery:

Eyes appearing sleepy

If the eyes do not open naturally after double eyelid surgery

and appear sleepy, they should be corrected

so that the eyes can open naturally and clearly again.

A sleepy appearance can easily leave a bad impression on anyone.

♥ Causes

• Congenital ptosis

• Pseudoptosis

• Scar adhesion, etc.

♥ Correction

In cases of ptosis, shortening or resection of the levator palpebrae superioris is the most common surgical method for correction.

Third candidate for revision surgery:

When the lines are uneven

Everyone has a slight degree of asymmetry,

but noticeable asymmetry must be corrected.

♥ Causes

• Incorrect design

• Loosening of the line

• Scar adhesion

• Ptosis on one side, etc.

♥ Correction

If the double eyelid lines on both sides are uneven,

surgery must be performed again to match the desired side.

However, if revision surgery is performed on only one side,

the eyes will not be completely symmetrical immediately after surgery,

so even with proper surgery, you must be patient for at least 1 to 2 months

and observe the correction of the asymmetry;

therefore, when operating on only one side in this way, it must be decided carefully.

Fourth candidate for revision surgery:

When the scar from the incision line is too severe

If the scar is highly visible when the eyes are closed after incisional double eyelid surgery,

it should also be corrected with the incision method so that almost no scar remains.

♥ Causes

• Improper suturing of the incision line

• The stitches were removed too early, widening the scar gap

• The stitches were removed too late, leaving the shape of the stitches behind

• Individual constitutional differences

♥ Correction

The existing scar must be excised, and the muscle and skin must each be sutured in separate layers

with very precise alignment so they do not shift out of place.

It is also important to remove the stitches at an appropriate time

so they do not affect the scar.

Fifth candidate for revision surgery:

When the double eyelid has loosened

After surgery it looks good, but over time

the line becomes narrower or loosens again.

In such cases, this often occurs after buried-suture surgery,

with the line gradually loosening and descending.

♥ Causes

• Surgery done with the buried-suture method despite thick skin

• Incorrect double eyelid surgical technique

• A large amount of fat

• In some individuals, thick skin or orbicularis oculi muscle

• Constitutional factors that make line adhesion less likely, etc.

♥ Correction

Considering the patient’s eye condition,

the eyelid is corrected through the incisional or partial-incision method so that it will not loosen again

and can form a clear line.

Sixth candidate for revision surgery:

When there is scar adhesion

After a previous double eyelid surgery,

scar tissue above the incision line may adhere, and a second line can form above the original line,

creating a double line.

If another line appears above the incision line,

it means the previous surgical method was incorrect and it is a target for correction.

♥ Causes

• When orbital fat was not repositioned

• Atrophy of orbital fat

• Excessive fat removal, etc.

♥ Correction

In such cases, the adhered incision line must be released and made into a single line.

In all cases of double eyelid surgery, the incision line should become the double eyelid line.

Seventh candidate for revision surgery:

When there are three double eyelid folds

This is when a double eyelid line forms in addition to the existing incision line.

It may form below the incision line, or above it.

♥ Causes​

• Scar adhesion

• Sagging skin

• Eyelid hollowing

• Loosening of the line, etc.

♥ Correction​

Depending on the cause,

the other line, excluding the incision line that serves as the reference, must be excised and corrected.

Eighth candidate for revision surgery:

When the outer line is thicker than the inner line

Ideally, the double eyelid line should naturally become wider from the inner corner to the outer corner of the eye.

However, if the inner line is wider than the outer line, this is an abnormal shape and should be corrected.

♥ Causes

• Unnecessary epicanthoplasty

• Incorrect design line

• Excessive skin excision, etc.

♥ Correction

A new design should be made to smooth the existing scar line,

making the inner line as close as possible to an infold line,

and correcting it so the line widens naturally from the inner side to the outer side.

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In cases of revision surgery,

sufficient clinical experience and the operating surgeon’s technical skill must support the procedure.

Revision surgery is being performed at many hospitals, but in most cases the results are not that good.

Revision surgery is a procedure that can only be performed when a great deal of experience and know-how have been accumulated, so it is not something just anyone can do.

Please note that there are not many people in our country who can consistently produce results that leave patients satisfied after revision surgery.

To achieve a good result, it is necessary to accurately understand what went wrong with the first surgery

and how it should be improved.

If there is sufficient excess skin, revision surgery is entirely possible.

The purpose of revision surgery is broadly twofold.

Restoring larger, clearer eye shape and restoring a natural double eyelid line.

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