[Special Double Eyelid Revision Surgery at Duhan Plastic Surgery] - [Restorative Surgery for Damaged Double Eyelid Eye Shape]

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Conditions for successful reoperation

(Condition of successful reoperation)

For a successful revision surgery,

there are things that you yourself need to understand and work on.

1. For revision surgery, more than anyone else, you need to identify on your own why the double eyelid surgery went wrong. If you do not recognize the cause of the problem, it is not easy to undergo revision surgery.
2. Only when you recognize the cause yourself and the doctor in charge also identifies the cause can the patient and doctor proceed with surgery in trust.
3. To identify the cause of the failed double eyelid surgery, it is essential to seek a detailed consultation with a plastic surgery specialist who has as much experience as possible.

Conditions for successful revision NO. 01: You must be operated on by a board-certified plastic surgeon.

There should not be an undesired result from revision surgery either.

At the very least, you should know whether the surgeon performing the operation holds a board certification in plastic surgery, is a specialist in another field, or is a general physician with only a medical license.

Among plastic surgery clinics, there are many hospitals that only have the sign of a plastic surgery clinic, while in fact non-specialists provide the treatment.

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

Conditions for successful revision NO. 02: There must be plenty of surgical experience in double eyelid revision.

Even among board-certified plastic surgeons, the areas of specialty differ slightly.

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

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

So even among board-certified plastic surgeons, there are those who say they do not have the confidence to perform it.

Undergoing surgery from a specialist with proven know-how and accumulated experience in revision surgery makes it more likely that the eyes can be restored to a more beautiful and natural shape.

Conditions for successful revision NO. 03: You should not think of revision surgery as easy.

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

Revision surgery is several times more delicate and difficult than the first surgery, and it is one of the highest-difficulty cosmetic procedures.

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

Proceeding with surgery based only on vague expectations can lead to another bad result.

Conditions for successful revision NO. 04: You must know the exact 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 first surgery.

To avoid repeating surgical failure, through consultation both the patient and the plastic surgeon must accurately understand, in terms of the exact mechanism, why the first surgery went wrong so that the correct revision surgery can be performed based on that understanding.

Therefore, through consultation, the patient must be able to clearly understand why the first surgery went wrong and by what process the revision will be performed, so that they can proceed with trust and achieve good results.

Conditions for successful revision NO. 05: The surgery time should not be too short.

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

However, a complete-incision double eyelid revision cannot be finished in a short time.

If the revision is finished in less than 1 hour, there is a high possibility that it was not performed properly.

Unlike the first double eyelid surgery, revision surgery involves releasing the original fold, dissecting scar tissue, repositioning tissue, and performing delicate layered suturing, so the operation inevitably takes longer, and all steps must be carried out according to principle for good results.

Saying that revision surgery ends too quickly is like a runner not taking the proper course and instead cutting across to reach the finish line faster.

Revision surgery is the same.

Only when every step is performed without omission and according to principle can good results be obtained.

Conditions for successful revision NO. 06: The eyes must open well immediately after surgery.

A double eyelid line that is too large and eyes that look half-open are called pseudo-ptosis, and most revision cases involve such patients.

The goal of surgery is to make the double eyelid line thinner and to let the eyes open clearly and comfortably.

If the surgery is successful, in most cases the eyes should open clearly as soon as the operation ends.

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

If the appearance immediately after surgery is not awkward, then after the swelling goes down later, the result will usually look natural.

Conditions for successful revision NO. 07: The thick front line should be reduced immediately after surgery.

The highlight of double eyelid revision is naturally converting a severe out-fold line into an in-fold.

If the inner line does not become narrower and remains unnatural, the entire line will not be corrected.

Right after surgery, the inner line, which is the first button, must be formed properly so that the outer line can continue naturally and lead to a good prognosis.

If the line remains thick even immediately after surgery and the inner line is not properly narrowed, the prognosis cannot be considered good.

Conditions for successful revision NO. 08: There should be a slight degree of lagophthalmos for a certain period after surgery.

If the eyes close properly immediately after surgery, that is a poorly performed operation.

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

If surgery is performed in that state and the eyes need to close well, the skin must stretch from somewhere, and in most cases the skin stretches below the incision line.

If that happens, the double eyelid line becomes larger again, making the surgery almost meaningless.

Therefore, a successful revision surgery is one in which the eyes temporarily do not close well 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 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 was excess skin, recovery is faster.

Conditions for successful revision NO. 09: The stitches should be removed a little later.

The stitches should be removed later.

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

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

If stitches are removed too early after revision surgery, the scar may widen and the tissues above the incision may be pulled upward again, resulting in a procedure that is almost meaningless.

Because revision suturing is done in a state where there is not enough tissue, the stitches must hold the tissues in place until they settle into their new position.

If the stitches are removed before the tissues have settled, the tissues that have not yet settled may be pulled upward again, leading to a failed operation.

Extreme reoperation to correct a damaged line

(Extreme Reoperation)

In cases where the condition is very severe or where it is said that further surgery is no longer possible,

revision surgery is performed in an extreme state

to restore a normal eye shape.

What is extreme revision surgery?

It refers to surgery that restores an eye shape that is in a very poor state—one that is difficult or nearly impossible to restore to a normal eye shape—so that it approaches normal again.

The goal of extreme revision surgery is to restore eyes with repeated revision operations, foreign substances such as fillers injected into the eyelids, or lump-like fat grafts causing severe contour irregularities, adhesions, and ptosis, back to a normal eye shape.

Examples of extremely damaged double eyelids

Differences between extreme revision and general revision

General revision may simplify or omit certain surgical steps depending on the condition, but in extreme revision, when there is not enough excess skin or the existing scar line is too high and too pronounced, making revision nearly impossible, instead of excising the scar, subcutaneous dissection is performed and a new line is created beneath it.

This refers to concentrating all available techniques for restoring a natural and beautiful double eyelid by combining multi-layer tissue dissection and repositioning to release scar adhesion, insertion of fine fat tissue, upper eyelid levator shortening, and dissection and resection of the orbicularis oculi muscle beneath the incision line.

Plan for extreme revision

1. If tissue or skin is insufficient, measure the limit of how much can be stretched and stretch it.

2. If the upper eyelid levator has almost no function, calculate the limit to which it can be lifted.

3. If the skin is very thick, establish a plan to thin the tissue by resecting the orbicularis oculi muscle.

4. If scar adhesion is very severe and cannot be released, plan micro-fat grafting after scar dissection.

5. If the sausage-like appearance is severe, plan to eliminate it through dissection of the incision line and partial resection of the orbicularis oculi muscle.

6. If the scar line is very high, establish a plan to smooth it rather than excise it.

7. If the scar line is very dark and sunken and cannot be excised, establish a plan to fill in the depressed area.

8. If eyelash ectropion is severe, establish a plan to correct the ectropion by sub-brow dissection at the eyelash root.⁩

http://www.duhans.com

Before-and-after results of extreme revision surgery

Even truly difficult and challenging revision cases

can produce good results

if the surgery is performed according to principle

with a sufficient plan.

However, surgery is not possible in every case.

If there is too little excess skin, or if scar adhesion is very severe, there are limits to surgery,

and sometimes surgery may not be possible at all.

If, based on the preoperative examination, it is judged that revision surgery will be difficult, we make it a principle not to create a surgery plan at all.

Dr. Shin Duhan

When the procedure is very delicate or difficult during consultation, choosing what to do

When a patient visits for consultation and examination, there are cases where, from the surgeon’s perspective, the eye shape is very delicate or it is difficult to feel confident about creating a satisfactory result.

In such cases, the surgeon cannot always say with certainty that the answer to consultation will be positive, but at the same time, saying that it is only somewhat difficult may lower the patient’s trust in the clinic or lead them to mistake the doctor for someone lacking skill.

From the surgeon’s perspective, if they provide honest and principled care and accurately judge the patient’s condition, explaining what is difficult and that the result may be poor, some patients understand this, but more often people take it negatively.

They come to believe that the doctor lacks skill and is less competent.

In the end, to avoid hearing that they are an unskilled doctor, the surgeon may be pushed into giving exaggerated reassurance such as saying that it will definitely go well, and if the patient is swayed by such exaggerated consultation and undergoes surgery, the situation can become even more hopeless.

From the patient’s perspective, it is very important to distinguish consultation content that is exaggerated from a surgeon who is acting with conviction.

There are various possible outcomes after revision surgery.

Some people think that if they meet a highly skilled doctor for revision surgery, they will automatically get good results, but this is a very dangerous way of thinking.

Even the most skilled doctor may see cases where surgery improves the result, cases where improvement is not possible, and sometimes cases where the outcome is insufficient.

Before surgery, you should keep the three cases above in mind and receive a consultation, then make a realistic judgment by checking whether surgery is possible, how much improvement is possible if it is, or whether it is impossible.

Cases where revision surgery is difficult or impossible

There are many cases where revision surgery is impossible or difficult, such as when there is no or insufficient excess skin, when the scar line is too dark and adhesion is hard to release, when the tissue has become hard and thick after multiple revision surgeries, when there is severe sausage-like swelling but surgery is likely to be pushed down again and recur, and when there is severe ptosis.

Just as even when you go to a skilled and capable doctor there are patients who can be saved and patients who cannot, the same applies to double eyelid revision surgery.

In cases where surgery is very delicate and difficult, the patient must understand the limitations, but there are people who do not want to accept those limits.

If you proceed with surgery while only holding a vague hope that somewhere there must be a hospital that can perform it perfectly, you are setting yourself up to fall into a very deep pit.

Therefore, you must carefully judge the limits and prognosis of your current condition and then decide on surgery.

http://www.doublefold.co.kr