[Duhan Plastic Surgery Double Eyelid Revision] - [Causes of Revision Failure and Common Questions]

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Causes of Revision Failure

Main Symptoms After Revision Failure

1. Surgery was done to make a large line smaller, but the line hardly changed or remained the same.

2. Swelling does not go down easily and looks unnatural. - Thick, sausage-like appearance

3. It feels awkward to open the eyes, and the eyelids feel heavy.

4. There is a pulling sensation and stiffness when opening the eyes.

5. The line is severely asymmetrical.

6. The eyelashes remain everted and do not recover.

7. It is awkward to open the eyes, but they close well.

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

Causes of Revision Failure

The biggest cause of failure is the patient thinking of double eyelid revision too lightly.

After a failed double eyelid surgery, the mindset of “It can just be fixed again” when trying to correct the shape leads to revision failure.

In order to undergo revision, you must recognize the cause of the mistake yourself more than anyone else so that the same failure does not happen again.

The items below are the reasons for revision failure, analyzed through various tests after patients came to our clinic for revision following failed revision surgery at another hospital.

1. When revision is performed together with epicanthoplasty

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

Epicanthoplasty causes the inner corner (medial canthus) line to become thicker.

It is not logical to perform revision surgery to reduce the fold line while, at the same time, performing a surgery that makes the inner line larger in the opposite direction.

This can create various problems due to an entirely unnecessary epicanthoplasty.

Epicanthoplasty should only be applied when necessary for eyes with an epicanthal fold, and unnecessary epicanthoplasty may cause various side effects such as excessive exposure of the inner mucosa, a severe outfold line, eyes that appear too close together, or a harsher look.

An unnecessary epicanthoplasty often ends up ruining the impression, so caution is needed.

2. When the scar tissue is not fully dissected during revision

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

Without this, tissue repositioning cannot be achieved.

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

If the area is sutured without proper dissection, not only will the double eyelid line fail 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

If fat should be repositioned but is neglected, the dissected tissue may stick together again, preventing the eyes from opening fully and even creating a triple double eyelid.

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

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

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

Scar tissue should not form at the inner corner of the eye.

The inner corner plays an important role in opening the eyes widely, and excessive scar tissue in this area can prevent the eyes from opening well.

5. When levator palpebrae superioris shortening is not performed

The levator palpebrae superioris (the muscle that lifts the eyelid) is a key structure that opens the eyes, and most patients undergoing double eyelid revision usually have weakened eyelid-lifting muscles.

Therefore, it is important to perform levator shortening (Step 6) to help the eyes open wider.

If this is not done, the existing sleepy-looking eyes may not improve at all, and the result may even make the eyes look more drowsy.

6. When the sutures are removed too early

The reason sutures are removed late in revision surgery is that most revision patients do not have much excess skin, and because tissue repositioning has been performed, the tissues need to be held firmly by the sutures to keep them fixed.

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

7. When fat grafting and double eyelid revision are done at the same time in cases of sunken eyelids

There are clinics that perform fat grafting and double eyelid revision at the same time when the eyelids are sunken and revision is needed, but this should not be done.

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

When revision is performed, tissues must be dissected, and fat grafting cannot be placed into the dissected tissue space.

If fat grafting and revision are done at the same time, it is like scattering fat into the dissected empty space, so the fat will not properly take, and only the double eyelid line will be ruined.

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

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

▶ With fat grafting, swelling makes it almost impossible to accurately estimate or adjust the double eyelid line.

As a result, the desired line is not created, leading to dissatisfaction 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.

In revision surgery, the dissection must be made between the orbital fat layer and the levator palpebrae superioris layer, but the fat has been grafted into that area.

▶ Conversely, if fat is grafted directly into the orbital fat layer after incision, the grafting will not be accurate or delicate, so proper long-term engraftment may not occur and dissatisfaction such as an uneven appearance may result.

How to Overcome Revision Failure

By carefully analyzing the causes of double eyelid surgery failure,

a proper plan can be made for successful revision.

A thorough analysis of the cause and a surgery based on principles and fundamentals

can lead to a more satisfying revision result~

What Revision Surgery Is

It refers to surgery that corrects a double eyelid line that is too large, uneven, or has loosened, restoring it to a natural and refreshed double eyelid shape.

Indications for Revision Surgery

1. A double eyelid line that is too large

2. When the eyes feel tired after double eyelid surgery

3. When the impression looks worse after double eyelid surgery

4. When the eyes look sleepy after double eyelid surgery

5. When the line is asymmetrical

6. When the line has loosened

7. When you want to restore a beautiful and natural eye shape

The Purpose of General Double Eyelid Surgery

Double eyelid surgery is not simply about creating a double eyelid line.

The purpose of double eyelid surgery is to make the eyes larger and brighter and to create clear, lively eyes with a refined appearance.

Surgery performed only to create a double eyelid line can easily lead to unwanted results.

The purpose of double eyelid revision is the same.

It aims to correct the eye shape so it looks larger, brighter, and more natural.

Features of Our Clinic

1. We have accumulated many years of extensive clinical experience and know-how in double eyelid revision.

2. We have a systematic system for revision surgery.

3. Through preoperative consultation, we perform various examinations and tests to predict postoperative results.

4. Surgery is performed only when the tests show there is enough room for improvement.

If it is determined that the patient cannot achieve the desired result, our principle is not to attempt surgery at all.

5. We identify the mistakes of the previous surgery through examinations, provide a thorough and clear explanation, and suggest the best surgical method for the best outcome.

6. We explain the surgical process and recovery clearly so the patient fully understands, and we do not omit explanations of possible postoperative side effects.

7. We provide thorough postoperative care.

We closely observe the recovery process after surgery to confirm that healing is proceeding properly.

8. Our clinic continues to conduct research and make every effort to become the last clinic visited by those who want double eyelid revision, so they will not need any further surgery.

Types of Examinations and Tests During Consultation

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

Because revision surgery requires at least some removal of scar tissue before the operation, the amount of excess skin is an important indicator of surgical prognosis.

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

If surgery is forced under conditions of insufficient skin, the results will be poor and lagophthalmos, in which the eyes do not close properly, may worsen. For that reason, this is the most important test that must be done before revision surgery.

The second most important test for determining revision is levator palpebrae superioris (eyelid-lifting muscle) function.

In severe ptosis, how much levator function remains is a key issue.

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

The degree of function in this muscle helps predict whether revision surgery can succeed.

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 has dropped below a certain threshold.

Other Examination Methods

○ Measurement of eyelid skin thickness

○ Examination for the presence of eyelash eversion

○ Assessment of the scar and degree of adhesion in the existing double eyelid line

○ Selection of the method that can maximize satisfaction and achieve excellent procedural results

○ 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 vertical eyelid opening when looking straight ahead at eye level

○ Measurement of the horizontal length of the eye and the distance between the eyes (to assess the presence of an epicanthal fold)

○ Assessment of the presence of strabismus

Surgical Plan Based on the Above Test Results

1. Setting the height and design shape of the new double eyelid line

2. Setting the width of skin (scar) excision

3. Setting the width of levator shortening

4. Determining whether orbicularis oculi muscle excision is needed

Plan for Revision to Restore a Natural Eye Shape

Based on the test results above,

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

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

If surgery is not possible, we explain why it is not possible,

or explain how far surgical correction is realistically possible.

http://www.doublefold.co.kr

Common Questions and Answers

I want my first double eyelid surgery done by a doctor who specializes in revision surgery. Is that okay?

The first double eyelid surgery should be done well so that you do not end up needing revision, which is unfortunate.

Since the highest level of double eyelid surgery is revision surgery, the first surgery should be done properly so that revision is never needed.

Is double eyelid revision something just anyone can do?

Double eyelid revision requires the highest level of technical skill and experience among cosmetic surgeries.

If you hastily undergo surgery at a clinic without experience or skill, not only will there be no improvement, but the impression may actually be ruined.

Therefore, revision should be decided carefully and performed only by an experienced specialist.

Should double eyelid revision and epicanthoplasty be done together?

If a clinic recommends doing revision and epicanthoplasty at the same time, it is often a clinic that does not understand double eyelids well, so this should be kept in mind very carefully.

Epicanthoplasty (medial epicanthus correction) has the effect of making the inner line thicker.

It should not, in principle, be done together with double eyelid revision intended to reduce the line.

If a surgery intended to reduce the line is combined with epicanthoplasty, which does the exact opposite by thickening the line, the inner eye line may become distorted or thicker, making it impossible to achieve the desired result.

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

Epicanthoplasty is a procedure performed only when it is clearly indicated, and if epicanthoplasty is truly needed, it should be decided only after the revision has fully settled and several months have passed.

One should not carelessly make the mistake of performing revision and epicanthoplasty at the same time and causing a poor result.

My eyelids are sunken. Can fat grafting be done together with double eyelid revision?

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

Only after fat grafting restores a flatter eye shape should revision be done.

When revision is performed, tissues must be dissected, and fat grafting cannot be placed into the dissected tissue space. If fat grafting and revision are done at the same time, it is like scattering fat into the dissected empty space, so the fat will not properly take, and only the double eyelid line will be ruined.

Therefore, doing the two surgeries at the same time is not reasonable, and if a clinic suggests doing them together, it is likely inexperienced or lacking sound judgment, so please keep this in mind.

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

There is so-called surgery to loosen or remove a double eyelid, but such surgery should not be done.

Once more than a week has passed after surgery, whether it was a buried method or an incision method, in principle there is no surgery that can truly “undo” the operated eye shape.

This is because the incision line remains visible whether the eyes are open or closed, which is not only very unattractive but also often causes folds or sagging of the eyelid.

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

Sometimes people try to loosen the fold because the eye shape has become more awkward, and then later try to make the line again, but once a loosening procedure has been done, it is almost impossible to make a line again through revision, so this should be kept in mind.

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

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

The reason is that scar tissue must heal and settle completely for the revision result to be good.

If red erythema or bumpy hypertrophic scars remain in the scar tissue, 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 degree, but some people may take longer depending on their constitution, so revision is possible once all redness in the scar area has disappeared.

I’m afraid of having revision surgery.

Doing double eyelid surgery again after one failure is several times more frightening than having it done for the first time.

That is because of the fear of what will happen if it fails again.

However, if you receive sufficient consultation and entrust yourself to a revision specialist, you can obtain the desired result.

I had revision surgery at another place, and it did not improve at all. Is further revision still possible?

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

But if there is enough room for improvement through preoperative consultation, it can be restored to a natural eye shape.

What if revision fails again?

If preoperative examination and testing show no possibility of success, our principle is not to attempt surgery at all.

However, if the procedure is clearly possible, we can restore a beautiful eye shape along with surgical success.

When can I return to daily life after double eyelid revision?

After surgery, no bandage or tape is applied.

Therefore, you can return to daily life right away.

There will be some swelling and bruising, but generally less than with the first surgery.

Even about a week after surgery, the eye shape does not look particularly awkward.

Also, not using tape 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?

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

However, if the clinic is very far from home, visiting only on the day the stitches are removed is also acceptable.

The final stitches are usually removed around day 7.

Compared with the first surgery, how much swelling and bruising occurs after double eyelid revision?

Compared with the first double eyelid surgery using the incision method, revision surgery generally causes less swelling.

Revision surgery does not necessarily mean more swelling or bruising.

In fact, swelling and bruising are often milder than in first-time surgery, so there is no need to worry too much about them.

What happens to the scar after double eyelid revision?

One of the goals of revision surgery is to improve the dirty-looking, dark scar from the first surgery as much as possible.

For about 3 to 6 months after surgery, redness may remain and the scar line may be slightly noticeable.

This is a normal recovery process that everyone experiences after incision-based double eyelid surgery.

Usually, at least 3 to 6 months must pass before the scar line gradually fades and settles.

After 6 months, the scar line usually becomes less noticeable and, in most cases, fainter than the original surgical scar.

I was told that eyelid fat grafting has many side effects and should not be done at another clinic. Is that true?

That does not mean all other clinics are like that.

The area requiring the highest level of experience and skill in fat grafting is the upper eyelid and the under-eye dark circle area.

These are areas that cannot be treated carelessly without accumulated experience and skill.

We always explain this in consultations: fat grafting is absolutely not a procedure that just anyone can do.

As with all surgeries, results vary depending on how much experience and know-how the surgeon has.

There are many clinics that perform fat grafting, but only a handful do it properly.

Fat grafting is easy to perform, but difficult to make the results proper.

In principle, fat grafting can produce good results only when performed precisely.

Different clinics use different methods, and results can vary greatly depending on experience.

You may have heard of or experienced poor fat grafting and developed a bad impression, but when done properly, satisfying results can be achieved in a single treatment.

In particular, the upper eyelid (sunken eyelid, hollow eyelid) is an area that requires extensive experience, skill, delicacy, and precision, so it cannot be done by just anyone.

I had eyelid fat grafting at another clinic, but almost everything has gone down and there is little left. Can it be treated again?

Even after a procedure at another clinic, if the graft has mostly subsided due to a low engraftment rate, a repeat procedure is possible.

However, it should be done at least 3 months later.

Fat graft engraftment takes a minimum of 3 months, so another procedure can be done once 3 months have passed since the last one.

Even if repeat treatment is performed at our clinic, the results are almost the same as with the first treatment.

I had eyelid fat grafting at another clinic, and it looks bumpy and feels uncomfortable when opening my eyes. Is this a side effect?

The goal of eyelid fat grafting is to restore sunken eyelids and improve the function of opening the eyes so that eye fatigue is reduced.

To achieve this goal, the procedure must be precise and delicate.

With fat grafting performed by someone with limited experience, fat may be placed into the orbicularis oculi muscle layer instead of the orbital fat layer, causing irregularity, or it may be placed near the deep levator palpebrae superioris layer, making it more uncomfortable to open the eyes than before the procedure.

If such side effects occur, the fat must be removed again, which is quite difficult.

To prevent side effects, it is better not to receive treatment from someone with limited experience or from a non-specialist in plastic surgery.

What if filler, instead of fat, is injected into the eyelids?

Because the eyelids are constantly moving structures, procedures that interfere with eyelid movement should not be done.

Fat grafting can act as a cushion and lubricant, helping the eyelids move more smoothly, but if a foreign material such as filler is injected, it can cause serious problems with the function of opening the eyes, regardless of eyelid shape. In severe cases, swelling may not go down or the eye shape may become distorted.

It can even cause inflammation, so filler should absolutely not be injected into the eyelids.

Is eyelid fat grafting dangerous because it is close to the eyeball?

Not at all.

The risk is higher only when performed by a doctor with limited experience or a non-specialist in plastic surgery; if it is done accurately by an experienced specialist, there is no need to worry.

Eyelid fat grafting should be performed by someone with precise anatomical knowledge and know-how gained through extensive experience with double eyelid surgery, and when done correctly according to principle, it is one of the safe procedures.

Question) I developed a bulging side effect after eyelid fat grafting at another clinic. Can it be corrected?

Answer) Sometimes patients visit our clinic for correction because excessive fat injection at another clinic has made the eyelids heavier and bulging.

Depending on the condition, the fat must be removed by suction. If the fat can be grasped by hand as a lump, it can be corrected by inserting a microcannula and suctioning it out.

However, 100% removal is impossible, and usually about 50–80% can be removed and corrected.

Advantages and Pride of Duhan Plastic Surgery Eye Clinic

Medical staff with extensive experience and safety

Dr. Shin Duhan, who has focused on more than a thousand double eyelid revision cases over the years, works as a team with experienced nurses.

1:1 Customized Surgical Planning

Based on each individual’s double eyelid condition, we consider sex, overall facial harmony, and the patient’s own wishes.

The proportion of correction from outfold to infold and performing epicanthoplasty or lateral canthoplasty at the same time as double eyelid surgery is steadily increasing.

If epicanthoplasty or lateral canthoplasty is appropriate for the eyes and is combined with double eyelid revision, the effect is doubled.

The height of the double eyelid line and the line shape (infold, in-out fold, outfold, etc.) reflect the patient’s preference, and the trend in double eyelid lines these days is “naturalness.”

Double Eyelid Revision Without Side Effects

People who undergo double eyelid surgery worry whether the line will loosen or whether scars will remain.

Side effects are reduced by Dr. Shin Duhan’s analysis and his ability to accurately create the line exactly as analyzed.

In addition, delicate incision and suturing reduce concerns about asymmetry.

Results That Are Hard to Imitate

There are many clinics that perform double eyelid revision, but having the same surgery name and method does not mean the results will be the same.

With more than 20 years of experience, we provide the optimal beautiful line for each patient.

Double eyelid surgery is often thought of as a simple procedure, but revision is quite demanding.

Double eyelid revision includes the delicate process of redesigning the line and completely separating and dissecting the previously adhered double eyelid tissue.

Thanks to the careful dissection process, side effects such as a bumpy line or adhesion that causes the line to roll upward later do not occur.

With the ability to neatly organize not only the skin layer but also all tissues in the fat and muscle layers one by one, we can produce surgical results that are hard to imitate even in the most difficult revisions.

Double Eyelid Revision and Ptosis Correction at the Same Time

At Duhan Plastic Surgery’s double eyelid revision clinic, ptosis correction is included in double eyelid surgery, helping correct sleepy eyes or eyes with the pupil obscured and looking dull.

By tightening and shortening the levator palpebrae superioris that opens the eyes, we adjust how much of the pupil is visible and make the eye shape look clearer.

Research, Lectures, and Educational Activities on Double Eyelid Revision

The most reliable answers come from abundant clinical experience.

Double eyelid revision is like a luxury item perfected through years of experience.

Through this accumulated experience, we also engage in research and educational activities.

An Increase in Revision Consultations

As new clinics spring up and perform double eyelid surgery indiscriminately, revision requests are also increasing, which is truly unfortunate.

If revision is performed multiple times and then fails, the amount of excess skin decreases, making later revisions even more difficult and extreme.

Double eyelid surgery is important from the very first choice, and when considering revision, it should be approached carefully with the mindset that it may be the last chance.

Craftsmanship for a High-Quality Beautiful Face

A doctor who performs double eyelid surgery among cosmetic procedures must have the sensibility of both a doctor and a designer.

If one insists only on a standardized double eyelid line without understanding what makes a beautiful line, the perfect line for each individual patient cannot be achieved.

If you do not have an eye for it, or even if you do but lack the skill to reproduce it, a masterpiece will not emerge.

We do our utmost down to the last stitch to bring beauty and satisfaction to each and every patient.

Honest Surgery with Sincerity

We recommend surgery when it is expected to achieve over 80% satisfaction, but we do not proceed with unnecessary surgery even if requested.

We aim to be a clinic that treats patients honestly through skill and results.

A Reliable Premium Clinic

There is a reason why a craftsman’s work is expensive.

It is because they create beautiful and valuable works.

Duhan Plastic Surgery’s double eyelid revision clinic takes pride and confidence in its surgery.

Proper surgery will become a turning point that gives confidence throughout one’s life.

We aim to be a clinic that delivers satisfying results, even if it is more expensive than clinics that advertise low prices and have several doctors taking turns performing surgery.

http://www.duhans.com