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Surgical Methods for Revision Surgery

Correcting a Thick Line

A double eyelid line that is excessively thick looks artificial and awkward, and gives the impression that the surgery was done not long ago.

When the eyes are open, a line that is only slightly visible is the most natural and appropriate height.

A thick double eyelid is one of the most common indications for revision surgery.

Causes of a Thick Double Eyelid Line

1. The initial surgery was designed too high.

2. The skin is thick.

3. Ptosis is present.

4. Protruding eyes.

5. Adhesion of the scar line.

6. Excessive skin removal.

Surgical Method for a Thick Double Eyelid Line

1. The scar is excised.

2. The area between the levator aponeurosis and the orbital fat is carefully dissected so that tissue repositioning can be performed.

3. After dissection, fat is advanced to prevent adhesion of scar tissue.

4. To prevent the skin below the excision line from being pulled upward, the skin below the excision line is firmly fixed to the tarsal plate.

5. A levator shortening procedure is performed so that the eyes open somewhat larger. As the eyes open more widely, the double eyelid line becomes narrower.

6. The tissue is securely sutured in layers through the tissue to complete the repositioning and prevent the tissue from being pulled upward.

7. The sutures are removed a little later so that the scar does not widen and the repositioned tissue can stabilize.

Correcting Asymmetric Lines

Double eyelids with lines that differ too much look awkward and create a poor impression.

In cases of asymmetry, the general rule is to correct the side that is unsatisfactory based on the side whose double eyelid is preferred. If neither side is satisfactory, both sides need correction.

Causes of Asymmetric Lines

1. The height of the double eyelid crease is different.

2. Ptosis is present in one eye.

3. One double eyelid line has loosened.

4. The skin on one side has sagged.

5. Due to insufficient orbital fat, the eyelid becomes sunken and the line is pulled upward.

6. The line has been pulled upward due to scar adhesion.

Surgical Method for Asymmetric Lines

If there is a difference in the height of the original double eyelid crease, the heights need to be matched. If the original surgery was done with buried sutures, the height of the line on the other side is adjusted to match the desired side using the same buried suture method or a partial incision method.

If the newly created line has stronger tension, the line created by the original buried suture method usually loses tension and disappears on its own.

Correcting a Loosened Line

This refers to a line that has become blurred, thinned out, or disappeared.

When the line has loosened, the goal is to restore the original line.

If the original line is unsatisfactory, a new line is recreated.

Causes of a Loosened Line

1. Thick skin.

2. Excess orbital fat.

3. A thick orbicularis oculi muscle.

4. Scar tissue does not form properly.

5. Frequently rubbing the eyes out of habit.

6. Undergoing the buried suture method despite it not being an appropriate indication.

Surgical Method for a Loosened Line

If the line has loosened, the correction method must differ depending on whether it loosened after the incision method or after the buried suture method.

If it loosened after the buried suture method, the primary option is usually correction with a partial incision method. If it is judged that correction with a partial incision method will not work well, the line is recreated with a full incision method.

To prevent loosening, scar tissue and fatty tissue beneath the line must be completely removed, and the sutures must be firmly fixed to the tarsal plate.

Creating an In-fold from a Severe Out-fold Line

An out-fold refers to a line where the inner line is visible all the way to the end. A thin out-fold line may suit some people depending on the individual, but a severe out-fold creates an awkward eye shape and should be changed to an in-fold line.

This is the highlight and core of double eyelid revision surgery, and the peak of technique is transforming an out-fold into an in-fold.

If the inner line cannot be adjusted as desired, the overall line becomes awkward and it is difficult to achieve the desired result.

Transforming an out-fold line into an in-fold line when there is no excess skin and scarring is severe can be considered one of the most difficult procedures among double eyelid revision methods.

Causes of an Out-fold

◇ The double eyelid line was designed too high overall.

◇ The inner design line was set too high.

◇ Unnecessary epicanthoplasty or excessive epicanthoplasty was performed.

◇ Excessive skin removal.

Surgical Method

In most cases, only a full incision method is possible.

There are cases where the buried suture method or partial incision method can be used, but this is only possible when adhesion is weak and the line has loosened partially.

When adhesion is strong or the scar line is pronounced, correction with the buried suture method or partial incision method is almost impossible.

The method involves a full incision, carefully dissecting between the orbital fat and the levator aponeurosis, then repositioning the inner orbital fat and also dissecting and flattening the inner scar line.

This is a procedure that requires highly advanced skill and accumulated experience.

A Thick, Sausage-Like Area Below the Incision Line

This refers to a swollen, pouch-like appearance below the double eyelid line, as if the surgery had been done only a few days ago.

Causes

◇ The line was made too high.

◇ The skin and orbicularis oculi muscle are thick.

◇ The buried suture for the double eyelid line was placed below the height of the incision line.

◇ The suture area loosened, causing the double eyelid line to be pushed downward.

Surgical Method

1. Sausage-like swelling after the full incision method

Usually, surgery can only be performed with a full incision, and part of the orbicularis oculi muscle below the incision line should be removed to reduce muscle thickness. The sagging skin is pulled upward, tightened, and fixed in place.

2. Sausage-like swelling after the buried suture method

This occurs because the line was designed too high and partially drooped after surgery. If the partially loosened line is pulled upward and firmly re-fixed in a tight manner, it can be corrected.

Surgery is performed with a partial incision method or a full incision method.

Triple Double Eyelid Line

This refers to a case where three lines appear, and it should be organized into a single line.

Usually, of the two lines, the upper line is removed and the correction is made to match the lower single line.

Causes

◇ As the line loosens, it loses its center of tension and another line appears above the incision line.

◇ Excessive fat removal causes another line above the incision line due to scar adhesion.

◇ Skin slides downward below the scar line and a new line is formed.

◇ Excessive scar formation at the suture site creates a line above the scar.

Surgical Method

1. If scar adhesion is not severe

In cases of a triple line caused by line loosening, the existing line is firmly fixed with a partial incision method so that the line above the incision line naturally loosens.

2. If scar adhesion is severe

A full incision method is used.

The correction is performed by making a full incision, removing scar tissue, dissecting it, and repositioning the orbicularis oculi muscle and orbital fat.

Eyelash Eversion

This refers to a condition in which the skin below the incision line is pulled tightly upward and the mucosa under the eyelashes becomes visible.

If the mucosa is excessively exposed, it creates a poor impression.

Causes

◇ Excessive skin removal

◇ During suturing, the tissue was pulled too far upward and sutured under excessive tension

◇ There was no excess skin, so the skin below the incision line was pulled upward

◇ Severe adhesion of the scar line

Surgical Method

Correction is possible only through a full incision, and if surgery is delayed, the everted eyelash shape may become fixed and correction may no longer be possible.

In cases of eyelash eversion, surgery should be performed as soon as possible for correction to be effective, but if correction is done months or years later, it may not be corrected properly.

In other words, surgery must be performed before the shape becomes fixed for any meaningful correction to be possible.

The scar line is incised, the skin below the incision line is lifted, and dissection is performed downward to relieve the tension of the skin that had been pulled tightly upward.

Usually, dissection is carried out up to near the eyelashes, and in some cases part of the orbicularis oculi muscle is also removed.

After adjusting the relaxed skin to an appropriate height, it is fixed with sutures so it does not move, and then the skin is closed.

When the Scar Line Is Pronounced

When surgery is performed with the incision method, scars inevitably form at the surgical site.

If the scar line is faint and light, there is no problem. But if the scar line is dark and deeply indented, it can be bothersome even when the eyes are closed.

In such cases, the scar line needs to be made lighter so that it is not easily visible even when the eyes are closed.

Causes

◇ The scar widens due to excessive skin removal.

◇ The skin becomes darker because excess skin is not removed and the skin covers the incision line.

◇ Sunken scars occur due to excessive removal of the orbicularis oculi muscle beneath the skin.

◇ When there is no excess skin, the scar line gradually widens or becomes deformed.

◇ The habit of rubbing the eyes frequently after surgery

◇ A constitutional tendency to form scars easily

Surgical Method

The edge of the scar line is designed precisely, and only the scar portion is excised and removed. Then normal skin is meticulously sutured together with the orbicularis oculi muscle beneath the skin.

If there is no excess skin, it may be necessary to delay suture removal, so it is also important to remove the sutures only after confirming that the area has healed sufficiently without the scar widening.

If there is a thick so-called sausage-like swelling below the incision line, part of the orbicularis oculi muscle beneath the skin is removed and the skin is pulled upward and flattened for correction.

Postoperative Precautions

◇ After suture removal, continue disinfecting for a few more days until the holes along the suture line have closed.

◇ Wipe the scar area well with antiseptic so that foreign substances or dead skin do not settle there.

◇ Do not rub your eyes with your hands just because your eyes feel tired or there is discharge. It is better to wipe them with a cotton swab.

◇ Rubbing the eyes can deform the double eyelid line or make the scar untidy, so absolutely do not rub them.

Requirements for Successful Revision Surgery

1. For revision surgery, you must first understand the cause of the failed double eyelid surgery better than anyone else.

It is not easy to undergo revision surgery without recognizing the cause yourself.

2. If you understand the cause of the failure and the doctor also identifies it correctly, the patient and doctor can proceed with trust.

3. In order to identify the cause of the failed double eyelid surgery, it is essential to receive a detailed consultation from an experienced plastic surgery specialist whenever possible.

You must receive surgery from a plastic surgery specialist.

It should not be the case that the revision surgery also produces an undesirable result.

At the very least, you should confirm whether the surgeon holds a board certification in plastic surgery, and if not, determine whether they are a specialist in another field or simply a general doctor with only a medical license before proceeding.

There are many hospitals that only display a plastic surgery signboard while in reality non-specialists provide the treatment.

It is important to distinguish this well and not undergo surgery by a non-specialist.

There must be extensive surgical experience in double eyelid revision surgery.

Even among plastic surgery specialists, areas of expertise differ slightly.

Therefore, if you are considering double eyelid revision surgery, you may obtain better results by consulting a specialist who focuses on double eyelid revision surgery.

Double eyelid revision surgery is one of the more difficult procedures in plastic surgery.

Receiving surgery from a specialist with solid expertise and accumulated experience in double eyelid revision surgery makes it more likely that the eyes can be restored to a more beautiful and natural shape.

Double eyelid revision surgery should not be taken lightly.

If revision surgery is considered too casually, the probability of failing again is very high.

Revision surgery is one of the most difficult plastic surgery procedures, several times more complicated and difficult than the first surgery.

Therefore, it is better to consider it more carefully and decide on surgery with caution.

Surgery based only on vague expectations can once again lead to poor results.

The cause of double eyelid surgery failure must be understood accurately.

To succeed in revision surgery, the first priority is for the patient to understand for themselves why the eyes did not turn out beautifully after the first surgery.

To avoid experiencing surgical failure again, through consultation, both the patient and the plastic surgeon must accurately understand the mechanism behind why the first surgery went wrong. Only then can the correct revision surgery be performed based on that understanding.

Through consultation, you should be able to understand clearly why the initial surgery was wrong and by what process the double eyelid revision surgery will be performed. Only then can you proceed with trust and achieve good results.

The surgery time should not be too short.

A typical double eyelid surgery usually takes about 30 minutes to 1 hour.

However, double eyelid revision surgery with the full incision method is not a procedure that can be finished in a short time.

If the revision surgery is completed in less than an hour, there is a high chance that something was insufficient.

Unlike the initial double eyelid surgery, revision surgery involves loosening the original double eyelid, dissecting scar tissue, repositioning tissue, and performing meticulous layered suturing, so the operation inevitably takes longer. Good results can only be achieved when every step follows the proper principles.

If double eyelid revision surgery ends too quickly, it is like a runner not taking the proper course and instead cutting straight across to the finish line.

The same applies to revision surgery.

Only when every step is carried out without omission can better results be achieved.

It is good if the eyes open widely immediately after surgery.

A double eyelid line that is large and makes the eyes look drowsy is called pseudoptosis, and most revision patients fall into this category.

The goal of surgery is to make the double eyelid line as thin as possible and to allow the drowsy-looking eyes to open clearly.

If the surgery goes smoothly, in most cases the eyes should open clearly as soon as the operation is finished, and that is considered a successful surgery.

If, even after revision surgery, the appearance immediately after surgery is not much different from before surgery, the operation is likely to have failed.

For the appearance right after surgery not to look awkward is usually a sign that, after the swelling goes down later, the result will look natural.

There should be slight lagophthalmos for a certain period after surgery.

If the eyes close perfectly well immediately after surgery, the operation is considered incorrect.

In most double eyelid revision cases, there is not enough excess skin.

In such a state, if surgery is performed and the eyes need to close well, the skin has to stretch from somewhere, and in most cases it stretches below the incision line.

If that happens, the double eyelid line becomes larger again, making the surgery essentially pointless.

Therefore, a successful revision surgery is one in which the eyes do not close very well for a while after surgery.

However, during the adaptation period, the skin above the incision line gradually stretches, and after some time the eyes close naturally.

The duration of lagophthalmos after surgery varies somewhat depending on the degree of ptosis correction and the amount of excess skin.

If there was not enough excess skin, recovery from lagophthalmos is slower. Conversely, if there is excess skin, recovery is faster.

The sutures should be removed a little later.

The sutures should be removed later.

Usually, the sutures are removed in two stages, on day 4 and day 7, depending on the amount of excess skin.

Unlike the first double eyelid surgery, where all sutures are usually removed around 3 to 4 days after surgery, in double eyelid revision surgery the final suture is removed around day 7.

If sutures are removed too early after revision surgery, the scar may widen and the tissues above the incision line may be pulled upward again, resulting in a surgery that is effectively no better than no surgery at all.

Because revision suturing is performed when there is insufficient tissue, the sutures must hold the tissues in place until they settle into their new position.

If the sutures are removed before the tissues have settled, the tissues that have not yet stabilized may be pulled upward again, leading to failure.

http://www.duhans.com

http://www.duhans.com

Double eyelid revision surgery

requires the highest level of skill and experience among plastic surgeries.

If you undergo surgery carelessly at a hospital without experience or skill,

not only may there be no improvement at all, but your impression can actually be worsened.

Therefore, revision surgery should be decided carefully,

and you must be sure to receive surgery from an experienced specialist.

http://www.doublefold.co.kr