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Requirements for successful double eyelid revision surgery

| For revision surgery, more than anyone else, you yourself need to understand the cause of what went wrong with the original double eyelid surgery. If you do not recognize the cause of the problem, revision surgery is not easy. Only when you understand the cause and the doctor in charge also understands it can you and the doctor proceed with surgery with trust. In order to figure out the cause of the failed double eyelid surgery, it is essential to receive a detailed consultation from a plastic surgery specialist with as much experience as possible. |

♥ Success requirement for revision surgery NO. 01: Surgery must be performed by a plastic surgery specialist.

Even revision surgery should not produce an undesirable result.

At the very least, you should know whether the surgeon has a board-certified plastic surgery specialist license, is a specialist in another field, or is a general doctor with only a medical license.

Among plastic surgery clinics, there are many that are plastic surgery clinics in name only, while in reality non-specialists provide treatment.

It is important to distinguish this carefully and avoid surgery by non-specialists whenever possible.

♥ Success requirement for revision surgery NO. 02: There must be extensive 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 can achieve better results by consulting a specialist who focuses on double eyelid revision surgery.

Double eyelid revision surgery is one of the more difficult, high-level procedures among plastic surgeries.

That is why even some plastic surgery specialists say they are not confident enough to do it.

Receiving surgery from a specialist with solid know-how and accumulated experience in revision surgery can restore a more beautiful and natural eye shape.

♥ Success requirement for revision surgery NO. 03: You should not think of revision surgery as easy.

If you think revision surgery is easy, the chance of failure again is very high.

Revision surgery is several times more complicated and difficult than the first surgery, and it is one of the highest-difficulty plastic surgeries.

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

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

♥ Success requirement for revision surgery NO. 04: You must accurately know the cause of the failed double eyelid surgery.

For revision surgery to succeed, the first priority is for the patient to understand why the eye shape became unattractive after the initial surgery.

To avoid repeating a failed surgery, both the patient and the plastic surgeon must understand the exact mechanism of why the first surgery went wrong through consultation, so that the proper revision surgery can be performed based on that understanding.

Therefore, through consultation, the patient must be able to clearly understand why the first surgery failed and what process will be used for the revision surgery, so that surgery can proceed with confidence and produce good results.

Process of double eyelid revision surgery

Full incision method

Full incision method is possible for correcting ptosis with a thick line.

The full-incision revision process is very difficult and requires extensive experience, high-level skill, and know-how.

It usually takes about 2 to 3 hours and proceeds in roughly 10 steps, and if even one step is omitted, the result may fall below expectations.

Therefore, even if it takes some time, good results can be achieved only by checking every step and performing the surgery with care.

Two goals of the surgery

The goals for correcting a thick line and ptosis are broadly divided into two.

First: to reduce a large and unattractive double eyelid line and make it into a natural, thin double eyelid

Second: to make sleepy-looking, drowsy-looking eyes open wider and look brighter and more refreshed

▶ With these two major goals, double eyelid revision surgery proceeds as follows.

Step 1: Design the planned incision line, including the existing scar tissue.

Before surgery, the design is made to create a new double eyelid line below the scar line and determine the width of skin to be removed up to the scar line.

For example, if the existing scar line is 10 mm above the eyelashes and the new double eyelid line is set at 7 mm, the skin excision width becomes 3 mm.

The new double eyelid line is determined by considering how much the line should be reduced and how much spare skin is available.

The average height of the revision line is 5 to 7 mm.

Step 2: Remove the skin and scar tissue.

The scar tissue is excised along the design line.

The incision is made precisely with a scalpel, and then the tissue is removed with surgical scissors.

The lower excision line becomes the new double eyelid line, and the upper line should naturally be pulled downward after tissue dissection so that it can be sutured.

Step 3: Dissect the orbicularis oculi muscle, orbital fat, and skin that are adherent to the levator palpebrae superioris.

Because the skin above the incision line must be pulled downward, the hard scar tissue that has adhered tightly must be dissected.

Scar tissue dissection proceeds by separating the area between the orbital fat layer and the levator palpebrae superioris, and in some cases dissection is also performed between the muscle and the fat to allow the fat to be moved forward.

Through this dissection process, the tissue can be advanced and repositioned downward, and it is an important preparatory step for obtaining a natural double eyelid line.

Step 4: If there is contracture of the orbicularis oculi muscle, the muscle is incised or resected to relieve it.

In rare cases where scar tissue adhesion is too severe, a vertical 1 to 2 mm incision may be made in the orbicularis oculi muscle to release the contracture.

Step 5: To prevent re-adhesion, the orbital fat is repositioned to the incision line.

Advancing the orbital fat is part of the process to prevent tissues from re-adhering.

If the fat is not repositioned, the tissues can stick together again, which can lead to ptosis and make the eyes look sleepy and half-closed.

In some cases, a triple double eyelid fold may form, which can damage the eyelid line.

Another effect of repositioning orbital fat is that, if the eyelid is sunken, it can help correct the hollowing to some extent. In some cases, if fat grafting would otherwise be needed in the future, the surgery itself may improve the condition enough that fat grafting is no longer necessary.

Step 6: Shorten the levator palpebrae superioris to strengthen its function.

Levator palpebrae superioris shortening is one method of correcting ptosis. It is simple, effective, and has the advantage of being able to correct the condition with almost no tissue damage.

This method does not cut out the levator palpebrae superioris; it simply advances it and ties it to the tarsal plate (cartilage plate).

During revision surgery, the effect of levator palpebrae superioris shortening is twofold: it helps the eyes open wider so they look brighter and more refreshed, and by opening the eyes more widely, it also reduces the double eyelid line.

Step 7: After incising the orbicularis oculi muscle at the inner canthus, orbital fat is inserted between the muscles to prevent re-adhesion.

Along with advancing the fat, fat is inserted into the inner canthus of the eye to prevent adhesion of the orbicularis oculi muscle.

The inner part of the eye is the area where scar tissue is most likely to adhere, and adhesion in this area can make the eyes appear sleepy and prevent them from opening well, causing discomfort when opening the eyes.

To prevent this, orbital fat, which can act like a lubricant, is placed between the orbicularis oculi muscle and the tarsal plate and secured with sutures.

Step 8: During suturing, layered sutures are used so that the repositioned structures do not shift.

The suturing method for revision surgery is not simple.

The purpose of suturing is to close the open wound and create the double eyelid line.

Therefore, in order to achieve the double eyelid line that was originally designed, the skin below the incision line must not be pulled upward.

To do that, the skin below the incision line must be firmly fixed to the tarsal plate (cartilage plate), and the repositioned fat must also be secured with sutures so it is not pulled upward.

In addition, the orbicularis oculi muscle and skin above the incision line must all be passed through by the sutures and firmly layered together to obtain the desired double eyelid line.

Step 9: A small amount of swelling-reducing agent (hyaluronidase) is administered to the surgical site to prevent hematoma and inflammation.

Hyaluronidase, a swelling-reducing agent, is a medicine with a fluid-dispersing effect, and it can quickly reduce swelling as soon as it is administered.

However, if too much is used, it can instead cause more bruising, so it is used only in a limited way for swelling reduction.

Step 10: Sutures are removed in two sessions on day 7.

Stitches are usually removed around 7 days after surgery.

The reason stitches are removed later is that in revision surgery, most cases do not have enough excess skin, and because the tissues have been advanced and repositioned during surgery, the suture line is under considerable tension.

If stitches are removed on day 3 or 4, the tense suture line may open up or the scar line may widen, causing a larger scar. The tissue may gradually be pulled upward, which can enlarge the double eyelid line as well.

Therefore, until the tissue stabilizes, the stitches need to hold the tissue in place, so it is better to leave them in longer.

To prevent the stitch marks from making the scar look messy, most of the stitches are removed on day 4 and only the remaining 3 to 4 stitches are left, so there is almost no visible stitch marking.

To quickly reduce early inflammation and swelling, steroid medication is given for about 1 to 2 days.

After surgery, artificial tears are used for about 1 to 3 months to prevent dry eye.

If all of the above principles are followed with skilled technique, satisfactory results can be achieved.

http://www.doublefold.co.kr

Partial incision method

The partial incision method is a surgical method used to restore the original clear line when the crease line becomes smaller, loosens, or becomes faint.

It is also a method that can make a small line slightly larger.

1. Design the desired double eyelid line.

In most cases, the design is made along the existing scar line.

Sometimes the design is adjusted to match the height and shape the patient wants, or the surgeon decides on the line that best suits the face.

The direction of the design line also changes depending on whether an out-fold or an in-fold is intended.

2. Mark three incision points with design ink.

The locations are lightly marked at the inner, middle, and outer parts.

3. Under sedation anesthesia, after sleeping for about 5 minutes, local anesthetic is injected into the three marked points.

Local anesthetic is administered in the smallest necessary amount to minimize swelling as much as possible.

4. Make very small incisions of about 2 mm at the three marked points.

If the incision is too large, more scarring remains, so the surgery is performed with the minimum incision to leave almost no scar.

5. Through the incision, first pull the orbicularis oculi muscle and remove it with scissors.

The orbicularis oculi muscle is the muscle layer covering the eyelid and is a tissue that interferes with double eyelid formation, so it must be removed to prevent the double eyelid line from loosening.

Along with removal of the orbicularis oculi muscle, pre-tarsal fat beneath the muscle layer is also removed.

6. If there is a lot of orbital fat, the fat is pulled out through the outer incision.

Fat removal is mainly performed from the outer side.

7. Grasp the fat with a hemostat and cut the base of the protruding fat with a scalpel.

Excessive removal of fat can cause the eyelid to become sunken, so it is better to remove only the amount that protrudes.

8. After removing the fat, cauterize with an electrocautery device to prevent bleeding.

If hemostasis is not done properly, orbital bleeding can occur and bruising and swelling can become severe, so it is important to control bleeding well.

9. Through the three incision sites, use very fine dissolvable sutures to connect the levator palpebrae superioris and the skin to create the double eyelid line.

10. After burying the sutures and applying eye ointment, the surgery is finished.

From the next day, washing the face and wearing makeup are allowed.

Use the cold pack provided by the hospital for cold compresses for 3 days.

If cold compresses are continued for more than 3 days, the swelling may not go down any further, so it is best to do them for exactly 3 days only.

Causes of revision surgery failure

If you underwent double eyelid revision surgery and still did not get the desired result,

there are various reasons.

The biggest cause of failure is that the patient thinks of double eyelid revision surgery too simply.

After a failed double eyelid surgery, the careless idea of “just fix it again” to correct the shape is what causes revision surgery to fail.

In order to receive revision surgery, the patient must first understand the cause of the original double eyelid surgery failure; otherwise, another failure is likely to occur.

The content below explains cases where revision surgery was performed at another hospital, failed, and then revision surgery was requested at our clinic, along with the results of analyzing the causes of the failure through various examinations. T_T

1. When revision surgery is performed together with epicanthoplasty

Some clinics perform revision surgery to reduce the line together with epicanthoplasty.

Epicanthoplasty is a factor that can make the inner line (inner canthus) thicker.

Performing surgery to reduce the line while, in contrast, making the inner line larger is not logical.

In addition, various problems can arise from an entirely unnecessary epicanthoplasty.

Epicanthoplasty should only be performed when necessary in eyes with an epicanthal fold, and unnecessary epicanthoplasty can cause several side effects such as excessive exposure of the inner mucosa, a severe out-fold line, eyes appearing too close together, or a sharper eye appearance.

Unnecessary epicanthoplasty often ends up damaging the impression rather than improving it, so caution is needed.

2. When scar tissue is not sufficiently dissected

During revision surgery, the existing scar must be removed or carefully dissected to release adhesions between the tissues that have stuck together.

Otherwise, the tissues cannot be repositioned.

If the muscle layer and fat layer are not clearly dissected while releasing adhesions, tissue repositioning becomes impossible, making it difficult to narrow the double eyelid line.

If suturing is done without proper dissection, the double eyelid line not only fails to narrow at all, but the skin below the incision line may be pulled upward, causing eyelash eversion.

3. When orbital fat is not repositioned

As in step 5 above, the fat should be repositioned, but if this is neglected, the dissected tissue can stick together again, the eyes may not open widely, and even a triple eyelid fold may form.

Along with scar tissue dissection, orbital fat repositioning is an important structure that acts like a lubricant to prevent tissues from sticking together again.

4. When fat is not repositioned to the inner canthus (inner part of the eye)

If orbital fat, corresponding to step 7 above, is not placed in the inner canthus, scar tissue can form in the inner part of the eye and interfere with opening the eyes widely.

Scar tissue should not form in the inner part of the eye.

The inner part of the eye plays an important role in helping the eyes open widely. If excessive scar tissue forms in this area, the eyes may not be able to open widely or a natural line may not be created.

5. When levator palpebrae superioris shortening is not performed

The levator palpebrae superioris (the muscle that lifts the eyelid) is an important structure that allows the eyes to open, and most patients undergoing revision surgery have weakened eyelid-lifting muscles.

Therefore, it is important to 반드시 perform levator palpebrae superioris shortening (step 6 above) to make the eyes open widely.

If this is not done, the existing sleepy-looking eye shape will not be corrected at all and may even result in an even drowsier appearance.

6. When stitches are removed too early

The reason stitches are removed later in revision surgery is that most revision patients do not have much excess skin, and because the tissues have been repositioned, they need to be held firmly in place by the force of the stitches.

The repositioned tissues tend to return to their original position like a spring, so they need to be held by the strength of the sutures. If the stitches are removed before the tissues have stabilized in their new position, the tissues may return to their original location, leading to poor surgical results.

A proper revision surgery can only be performed by carefully analyzing the cause of the failed double eyelid surgery and making a plan accordingly.

By analyzing the cause well and performing surgery according to principle, satisfactory results can be achieved.

http://www.duhans.com

Double eyelid revision surgery accounts for a large share of plastic surgery procedures.

Since double eyelid surgery is one of the most commonly performed procedures in plastic surgery, there is inevitably a high potential for problems.

As plastic surgery is performed not only by plastic surgery specialists but also by non-specialists, concerns about side effects naturally grow.

These issues are also problems with the medical system itself.

It is wrong from the start to allow people without specialist qualifications to treat patients, and another reason is that each specialty does not have a clearly defined domain of its own and partially overlaps with the domains of other departments.

For example, double eyelid surgery being performed in ophthalmology and rhinoplasty to raise the nose being performed in otolaryngology.

The principle is that plastic surgery should be performed in plastic surgery.

If that happens, surgical side effects will also be greatly reduced.

Because many plastic surgeries are performed by unqualified doctors, many victims appear, and patients who experience side effects cannot trust the doctor who performed the first surgery. They end up seeking another plastic surgery specialist and suffering through the burden of having unsatisfactory plastic surgery corrected again.

Before undergoing plastic surgery, rather than first focusing on the cost, you should first check whether the doctor is a board-certified plastic surgery specialist and then proceed with surgery.

Most people assume that if a clinic has a plastic surgery sign, the doctor must be a plastic surgery specialist, which is why dissatisfaction and side effects continue to increase.

For those who need revision surgery, it is painful, and from the specialist’s perspective, there are times when correcting someone else’s damaged double eyelid line can be difficult as well.

Even as a specialist who must perform revision surgery, there are sometimes cases where it is truly something I do not want to do.

That is because there are cases where the condition of the eyes is so severe that it is difficult to even attempt treatment.

Rather than receiving revision surgery, it is more important that the patient does not create the situation that requires revision surgery in the first place.

http://www.doublefold.co.kr