[DuHan Plastic Surgery Double Eyelid Revision Surgery] - [Causes of Revision Surgery Failure]

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Causes of revision surgery failure

Main symptoms that appear after revision surgery failure

1. Surgery was performed to make a large line smaller, but the line hardly became smaller or stayed the same.

2. Swelling does not go down easily and looks awkward. - sausage phenomenon

3. Opening the eyes feels uncomfortable and the eyelids feel heavy.

4. There is a pulling sensation when opening the eyes, and they feel stiff.

5. The line is severely asymmetric.

6. After eyelash eversion, it does not recover.

7. Opening the eyes is uncomfortable, but the eyes close well.

8. The scar line at the incision site is too dark.

Causes of revision surgery failure

If you had double eyelid revision surgery but got an undesired result, there are various causes.

The biggest cause of failure is the patient’s own tendency to think of double eyelid revision surgery as something simple.

After a failed double eyelid surgery, the thought that “It can just be corrected again.” is what leads to failed double eyelid revision surgery.

To undergo revision surgery, more than anyone else, you yourself must understand the cause of the failed surgery so that failure does not happen again.

The following items are an analysis of the causes of revision surgery failure in cases where patients came to our clinic for revision after failing revision surgery at another hospital, based on various examinations.

1. Cases where revision surgery is performed together with epicanthoplasty

There are hospitals that perform revision surgery to reduce the line together with epicanthoplasty.

Epicanthoplasty tends to make the inner (medial canthus) line thicker.

It does not make sense to perform revision surgery intended to reduce the line while, on the contrary, doing a procedure that makes the inner line larger.

In addition, unnecessary epicanthoplasty can cause various problems.

Epicanthoplasty should only be applied when needed for eyes with an epicanthic fold, and unnecessary epicanthoplasty can cause side effects such as excessive exposure of the inner mucosa, a severely outfolded line, eyes that look too close together, or a harsh appearance.

Unnecessary epicanthoplasty often ruins the overall impression, so this should be noted.

2. When scar tissue is not clearly dissected during revision surgery

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

Without this, tissue repositioning cannot occur.

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

If the incision is sutured without proper dissection, the double eyelid line will not narrow at all; instead, the skin below the incision line will be pulled upward, causing eyelash eversion.

3. When orbital fat is not repositioned

If the fat that should be repositioned is neglected, the dissected tissues stick together again, preventing the eyes from opening fully and even causing a triple double eyelid.

Along with dissection of scar tissue, orbital fat repositioning is one of the important steps in surgery because it acts like a lubricant to prevent tissues from sticking together.

4. When fat is not repositioned at the medial canthus (inner corner of the eye)

If orbital fat is not positioned at the medial canthus, scar tissue can form on the inner side of the eye and interfere with opening the eyes wide.

Scar tissue should not form on the inner side of the eye.

The inner side of the eye plays an important role in helping the eyes open widely, and if excessive scar tissue develops in this area, the eyes will not be able to open wide.

5. When levator palpebrae superioris shortening is not performed

The levator palpebrae superioris (the muscle that lifts the eyelid) is an important structure that helps open the eyes, and in most patients undergoing the procedure, this muscle is usually weakened.

It is important to perform levator palpebrae superioris shortening (Step 6) to help the eyes open wider.

If this is not done, the existing sleepy-looking eye shape will not be corrected and may even make the eyes look more sleepy.

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 tissue has been repositioned, the tissues must be held firmly with the strength of the sutures to keep them in place.

Repositioned tissues tend to return to their original state, like a spring, so they must be held in place by the sutures. But if the sutures are removed before the tissues have stabilized in their new position, the tissues return to their original location and lead to poor surgical results.

7. Cases where fat grafting and double eyelid revision surgery are performed at the same time when the eyelids are sunken

There are hospitals that perform fat grafting and double eyelid revision surgery at the same time when the eyelids are sunken and revision surgery is needed.

First, fat grafting should be performed, and double eyelid revision surgery can be done 3 to 6 months later.

During revision surgery, tissue must be dissected, but fat grafting cannot be done into dissected tissue.

If fat grafting and revision surgery are performed at the same time, it is like scattering fat into an already dissected empty space, so the fat does not properly take, and only the double eyelid line becomes damaged.

Therefore, performing the two surgeries at the same time is not reasonable.

8. Problems that occur when fat grafting and revision surgery are done together

● If fat grafting is performed, the swelling makes it almost impossible to accurately judge or adjust the double eyelid line.

As a result, the desired line is not created and the patient becomes dissatisfied with the surgery.

● If an incision is made immediately after fat grafting for double eyelid surgery, the grafted fat will spill out through the incision site.

This is because, during revision surgery, one must dissect and enter between the orbital fat layer and the levator palpebrae superioris layer, and fat has been grafted into that area.

● Conversely, if fat is directly grafted into the orbital fat layer after the incision, the grafting cannot be done accurately or precisely, and later the fat may not take properly or may result in an uneven appearance, leading to dissatisfaction.

A proper analysis of the causes of failed double eyelid surgery

is necessary to make a good plan and perform a proper revision surgery.

By carefully analyzing the causes and performing surgery according to principles,

it becomes possible to achieve satisfactory revision results.

Director Shin Duhan

Common questions and answers

I want to have my first double eyelid surgery. Can I go to a doctor who specializes in revision surgery?

The first double eyelid surgery must be done well to avoid the unfortunate need for revision surgery.

The highest level of double eyelid surgery is double eyelid revision surgery, so the first surgery should be done properly so that revision surgery is not needed.

Is double eyelid revision surgery something anyone can do?

Double eyelid revision surgery requires the highest level of skill and experience among plastic surgeries.

If you hastily undergo surgery at a clinic without experience or skill, not only will there be no improvement, but it may also ruin your appearance.

Therefore, revision surgery should be decided carefully, and you should definitely receive surgery from an experienced specialist.

Should double eyelid revision surgery and epicanthoplasty be done together?

If a clinic recommends doing revision surgery and epicanthoplasty at the same time, it is likely a clinic that does not understand the concept of double eyelids, so please be extremely careful.

Epicanthoplasty (epicanthic fold removal) has the effect of making the inner line thicker.

It should not, in principle, be combined with double eyelid revision surgery, which aims to reduce the line.

If you perform epicanthoplasty, which makes the line thicker, together with surgery intended to reduce the line, the inner line of the eye may become distorted or thicker, making it impossible to achieve the desired result.

This is like having two boatmen on one boat, with one rowing east and the other rowing west.

Epicanthoplasty is a procedure that should only be done when there is a clear indication. If epicanthoplasty is truly necessary for the eye shape, the decision should be made only several months after the revision surgery, once everything has fully settled.

One should not recklessly make the mistake of doing revision surgery and epicanthoplasty at the same time, thereby creating a poor result.

If the eyelids are sunken, should fat grafting be done together with double eyelid revision surgery?

When the eyelids are sunken and the double eyelid line looks awkward, making double eyelid revision surgery necessary, fat grafting should be done first, and then double eyelid revision surgery can be performed 3 to 6 months later.

After fat grafting, revision surgery should be done only after the eye shape has been restored to a flatter appearance.

During revision surgery, tissue must be dissected, but fat grafting cannot be done into dissected tissue, and if fat grafting and revision surgery are performed at the same time, it is like scattering fat into an already dissected empty space, so the fat does not properly take and the double eyelid line is damaged.

Therefore, doing the two surgeries at the same time is not reasonable, and if a clinic suggests doing them together, it is likely a clinic with somewhat limited experience.

I dislike my existing double eyelid line and want to completely undo it. Is that possible?

There is a so-called double eyelid release surgery, but such a procedure should not be done.

Once more than a week has passed after surgery, whether it was done with the burial method or the incision method, a procedure to “release” the operated eye shape is, in principle, not possible.

That is because the incision line remains visible whether the eyes are open or closed, which is really unattractive, and the eyelid often becomes uneven or appears saggy.

Instead, the double eyelid should be made into an internal double eyelid so that the line is barely visible when the eyes are open.

Some people who undergo release surgery find that the eye shape becomes even more awkward and want to recreate the line, but if release surgery has already been done, it is almost impossible to perform revision surgery to create a line again, so this should be kept in mind.

I had surgery at another clinic. When can revision surgery be performed?

In general, revision surgery is possible about 6 months after the last surgery.

The reason is that the scar tissue must heal and settle completely for revision surgery to produce good results.

If the scar tissue still has redness or bumpy hypertrophic scarring, surgery is difficult.

The time it takes for scars to settle varies from person to person. Usually, after about 6 months the scar has settled to some extent, but depending on the body type, some people take longer to settle, so revision surgery is possible once all redness at the scar site has disappeared.

I am afraid to have revision surgery.

Having to repeat a double eyelid surgery that already failed is several times more frightening than having the first surgery.

It is because of the feeling of wondering what if it fails again.

However, if you have a thorough consultation and entrust yourself to a revision surgery specialist, you can achieve the desired result.

I had revision surgery at another place, but it did not improve at all. Can it still be revised?

Depending on the condition, there are cases where it is truly impossible.

But if the consultation before surgery shows there is enough room for improvement, it can be restored to the original natural-looking eyes.

What if revision surgery fails again?

In principle, if examinations and tests before surgery show that there is no possibility, we do not attempt surgery at all.

However, if it is sufficiently possible, surgery can succeed and restore a beautiful eye shape.

How soon can I return to daily life after double eyelid revision surgery?

After surgery, no bandage or tape is applied.

Therefore, daily life is possible immediately.

There may be some swelling and bruising, but in general there is less swelling and bruising than with the first surgery.

Even about a week after surgery, the eye shape is not very awkward.

Also, not applying bandages helps the swelling go down faster and allows the line to settle a little sooner.

How many times do I need to visit the clinic after double eyelid revision surgery?

After surgery, you will usually visit about three times: the day after surgery, on day 4 when stitches are removed, and on day 7.

However, if the clinic and your home are very far apart, it is fine to visit only on the day the stitches are removed.

The final stitches are usually removed around 7 days after surgery.

After double eyelid revision surgery, how much swelling and bruising should I expect compared with the first surgery?

Compared with having the first double eyelid surgery done with the incision method, revision surgery generally tends to cause less swelling.

It is not the case that revision surgery always causes more swelling and bruising.

In fact, swelling and bruising often appear more mildly than in the first surgery, so there is no need to worry too much about them.

What happens to the scar after double eyelid revision surgery?

One of the goals of revision surgery is to improve the messy and dark scar from the first surgery as much as possible.

For about 3 to 6 months after surgery, there is a redness phase, so the scar line may be slightly noticeable.

This is a normal healing process that anyone who has had double eyelid surgery by the incision method goes through.

Usually, only after at least 3 to 6 months have passed does the scar line gradually fade and settle.

After 6 months, the scar line fades in most cases and becomes less noticeable than the original surgery scar.

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