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When the double eyelid line is too large

In cases where the double eyelid line is large, it is rarely suitable no matter what the case may be.

A natural line is appropriate only when it is slightly visible when the eyes are open.

A large line is a representative example of an unattractive double eyelid and is one of the most common indications for reoperation.

When the area below the line looks swollen, as if puffed up (sausage phenomenon)

The swelling of the area below the double eyelid line is called the so-called sausage phenomenon.

It gives the impression that the person had surgery only a few days ago and makes viewers feel uncomfortable.

The causes of the sausage phenomenon include thick skin and orbicularis oculi muscle, a line designed too high, or a partially loosened line.

Correction is done by partially removing the orbicularis oculi muscle and then pulling the skin taut.

When the double eyelid line is too thick

From a general point of view, a double eyelid line that is only slightly visible is natural and beautiful.

If the line is too thick, the eyes look sleepy, and the other person may perceive the impression as strong and rough.

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■ Causes

• A line designed too high

• Scar adhesion

• Ptosis

• Lack of extra skin, etc.

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■ Correction

The existing high line must be flattened or removed by incision, and a new line must be designed at an appropriate height.

However, the height of the new line varies from person to person, and it is important to design it by finding the most natural height for the individual, taking into account skin laxity and eye size.

Problems that occur during double eyelid reoperation

Problem of dealing with a very high scar line

In many cases, surgery is performed without removing the existing scar line.

In principle, the existing scar line should be removed, but if the scar line is excessively high and cannot be removed at all, there are cases in which surgery must be performed by flattening it without excising the scar.

▶ When the scar line is very high and the scar is dark

The new double eyelid line must be created immediately below the existing scar, and the scar must be removed.

The existing scar line can be removed, but because the line must be set high, it is not possible to reduce it as much as desired.

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▶ When the scar line is very high but faint

Instead of removing the existing scar line, it is dissected and flattened.

Then the existing scar line remains faintly, and a slight scar is visible when the eyes are closed.

However, since a new double eyelid line can be made where desired, there is the advantage of being able to reduce the line sufficiently.

Problem of dealing with excessively wide scars

After scar excision, there is the issue of reducing the line and the issue of preventing distortion in the shape of the double eyelid.

The causes of scar darkening include improper suturing, lack of skin laxity causing the scar line to spread, and frequently rubbing the eyes.

To solve the problem when the scar line is large, the scar must be excised while considering skin laxity, and rather than simple suturing, the tissue must be dissected and precisely layered and sutured in order to reduce scarring.

Also, care must be taken to prevent distortion of the double eyelid due to excision of wide scar tissue, and the more scar tissue that is removed, the greater the limit to how much the line can be reduced.

Problems when the scar tissue becomes very thick after multiple reoperations

There is the problem that it becomes very difficult to create a proper line because of hard, thick scar tissue.

The more times surgery is repeated, the firmer the skin tissue becomes and the thicker the scar tissue becomes.

Flattening thick and firm tissue and recreating the line is not easy.

A proper line may not form because of the firm scar tissue.

The existing firm scar tissue must be excised as cleanly as possible, and the scar tissue under the skin must also be neatly cleared away in order to create a new line.

Problems with an excessively wide outer-fold line

The outer fold must be reduced or changed into an inner fold, and this is the most difficult reoperation technique.

To reduce the line, the inner line must be properly reduced.

When the line is thick and the inner line is also very wide, it becomes an outer fold.

Only by reducing the outer fold into an inner fold can a natural overall line be created.

One of the most difficult techniques in reoperation is turning an outer fold into an inner fold.

If the inner fold is not properly reduced, the desired line cannot be created.

Problems when excessive epicanthoplasty has been done

Excessive epicanthoplasty makes it difficult to change to an inner-fold line or a natural line.

Because of unnecessary excessive epicanthoplasty, severe outer-fold lines may occur, excessive exposure of the mucosa may occur, or the eyes may appear too close together.

In cases of excessive epicanthoplasty, the first step is to make the line as much like an inner fold as possible, and if that is still insufficient, epicanthoplasty restoration should be performed additionally after 6 months.

Problems when there is not enough skin and lagophthalmos occurs

When there is not enough skin, the line cannot be reduced as much as desired, or lagophthalmos may become severe.

In cases where the eyes do not close properly due to multiple reoperations or excessive skin removal during surgery, the eyes must be made to close again, but if there is no extra tissue, correcting lagophthalmos is practically impossible.

Lagophthalmos must be left as is, and only the thickness of the line should be adjusted.

Reducing a thick line when there is not enough skin is a very high-level, difficult procedure that is only possible by stretching and repositioning the tissue as much as possible.

Problems with wrinkled eyelids that lack elasticity

If there are many skin wrinkles, the line may not come out smoothly.

Unlike younger people, older individuals develop wrinkles on the eyelids and skin texture changes, making it very difficult to create a natural and smooth line.

The key is to create the line while minimizing wrinkle lines as much as possible, but because wrinkles cannot always be fully smoothed out, surgery must be performed with a certain degree of limitation.

Problems when ptosis correction is not possible

In the case of a nonfunctional levator palpebrae superioris muscle, no further ptosis correction is possible, or lagophthalmos may occur.

Even after multiple ptosis corrections, there are cases where the eyes still look sleepy.

If the levator palpebrae superioris muscle has almost no function even after ptosis correction is attempted again, correction may be impossible.

In such cases, ptosis correction is not performed, and only the line is corrected.

If an excessive ptosis correction is attempted, lagophthalmos only becomes more severe, and ptosis is hardly corrected at all.

Problems when eye correction has been done too much

Reducing an overcorrected eye to a normal size is much more delicate than ptosis correction.

If the eyes are exposed because ptosis correction or eye correction has been overdone, the levator palpebrae superioris relaxation procedure must be performed to reduce the eye size again, but if the levator palpebrae superioris is relaxed carelessly, ptosis may develop a few months later and the eyes may open less.

Reversing overcorrection is much more delicate than ptosis correction, and it is difficult to predict the later outcome.

The degree of levator palpebrae superioris relaxation must be carefully controlled based on extensive experience and know-how.

Problems when the patient comes in after having surgery to loosen the double eyelids

In cases where a patient visits after having loosening surgery at another clinic, recreating the line is often difficult or impossible.

One of the most difficult problems to overcome in double eyelid reoperation is when the patient comes in after having loosening surgery at another clinic.

In 9 out of 10 cases, reoperation is not possible.

The reason is that, in order to loosen the line, the incision is made very low and thick tissue is placed on the incision line so that no line forms there.

Because this tissue later turns into thick scar tissue, it is almost impossible to remove that thick scar tissue again and create a natural line.

Even for the future, loosening surgery is a procedure that should be avoided as much as possible.

Indications for double eyelid reoperation

When the double eyelid line is too large
When the double eyelid line has loosened
When the line is asymmetrical
When the eyes feel tired after double eyelid surgery
When there is a sausage-like swelling below the incision line
When the impression looks worse after double eyelid surgery
When you want to restore beautiful, natural-looking eyes

Double eyelid reoperation

This refers to surgery that revises the double eyelid line and restores the original natural and refreshing double eyelid shape when the line is too large, uneven, or loosened.

Purpose of double eyelid surgery

The purpose of double eyelid surgery is not simply to create a double eyelid line.

The purpose of double eyelid surgery is to make the eyes larger and more refreshing, and to create bright eyes and a refined eye shape.

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

The purpose of double eyelid reoperation is the same.

The goal is to correct the eye shape so that it becomes larger, more refreshing, and more natural. �a0

Features of the Duhan Plastic Surgery double eyelid reoperation clinic

1. We have accumulated more than 20 years of extensive experience and know-how in double eyelid reoperation.

2. We have a systematic system for reoperation.

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

4. We only perform surgery when examinations and tests show there is sufficient room for improvement.

If we judge that the patient cannot achieve the desired result, we make it a rule not to attempt surgery.

5. Through examinations, we identify the problems with the previous surgery, provide sufficient and clear explanations, and suggest the surgical method for the best result.

6. We explain the surgical process and course clearly so that patients fully understand, and we do not omit explanations of possible postoperative side effects.

7. We provide thorough postoperative care.

We closely observe the postoperative course to confirm that recovery is proceeding properly.

8. The Duhan Plastic Surgery double eyelid reoperation clinic is making every effort and conducting research to become the final hospital people visit so that those who want double eyelid reoperation do not need further surgery.

Types of examinations and tests during consultation

The most important test for deciding whether reoperation is possible is the amount of skin laxity.

Because reoperation must be performed after removing at least a small amount of scar tissue, skin laxity is an important indicator for predicting the prognosis of surgery.

If there is no skin laxity, surgery may be impossible.

If surgery is performed recklessly when there is insufficient skin laxity, the result will not be good and lagophthalmos, in which the eyes do not close properly, will worsen. Therefore, this is the most important test that must be done before reoperation.�a0�a0

The second important test for deciding whether reoperation is possible is the levator palpebrae superioris (eyelid-raising muscle) function test.

In severe ptosis, the key issue is how much function remains in the levator palpebrae superioris.

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

A certain degree of function in this muscle is necessary to predict the success of reoperation.

In patients with ptosis, if the levator palpebrae superioris function is greatly reduced, surgery may be impossible.

As a rule, surgery should not be performed when the function of the levator palpebrae superioris is reduced beyond a certain threshold.

Other examinations and tests

• Measurement of eyelid skin thickness

• Examination for the presence of eyelash eversion

• Examination of scarring and the degree of scar adhesion in the existing double eyelid line

• Selection of the method that can produce excellent effects and maximize satisfaction

• 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 palpebral fissure height (vertical size when the eyes are naturally looking straight ahead at eye level)

• Measurement of the horizontal eye length and the distance between the eyes (determination of the presence of an epicanthic fold)

• Measurement for the presence of strabismus

Surgical plan based on the above test results

�a01. Set the height and design shape of the new double eyelid line

2. Set the width of skin (scar) excision

3. Set the width of levator palpebrae superioris shortening

4. Determine whether orbicularis oculi muscle excision is necessary

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● Based on the above test results, we predict the postoperative outcome and the likelihood of surgical success.

Surgery is recommended only when it is judged to be possible.

If surgery is not possible, we explain the reason it cannot be done, or explain how far surgery can realistically be performed.

Reoperation to change a thick outer-fold line into an inner-fold line

What is an outer fold

It refers to a line in which the inner line is visible all the way to the end.

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A thin outer-fold line may suit some people depending on the individual, but in severe outer folds,

it causes an unnatural eye shape, so it must be corrected to an inner-fold line.

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Surgery to change an outer-fold line into an inner-fold line

is the core of double eyelid reoperation and the peak of the surgeon's skill.

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If the inner line cannot be properly adjusted as desired,

the overall line becomes unnatural and it is difficult to obtain the desired line.

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When there is no skin laxity or scarring is severe, changing an outer-fold line into an inner-fold line

is the most difficult procedure among double eyelid reoperation methods.

Causes of a thick outer fold

When the overall double eyelid line is designed too high
When the inner design line is set too high
When unnecessary or excessive epicanthoplasty has been performed
Excessive skin removal

How to reoperate a thick outer-fold line into an inner-fold line

In most cases, it can be done with full incision surgery.

It may also be possible with buried suture or partial incision methods, but this is only possible when adhesion is weak or has loosened partially.

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

The method is to use full incision surgery to precisely dissect between the orbital fat and the levator palpebrae superioris, then reposition the inner orbital fat and also dissect and flatten the inner scar line.

This is a surgical method that requires very advanced skill and accumulated experience.�a0�a0

Examples of reoperating a thick outer-fold line into an inner-fold line

What makes reoperation difficult is that turning an outer fold into an inner fold is the hardest part.

Reoperations are being performed at many clinics, but the results are generally not very good.

Please understand that there are not many people in Korea who can always produce results that satisfy patients after reoperation.

Only by accurately understanding what went wrong with the original surgery and how it should be improved can good results be obtained.

At the Duhan Plastic Surgery double eyelid reoperation clinic, with more than 20 years of extensive experience and know-how, we perform various examinations and tests during consultation to predict postoperative results, and we only perform surgery when there is sufficient possibility of improvement after surgery.

The greatest key point in reoperation is the amount of skin laxity and the location and darkness of the scar line.

The purpose of reoperation is largely twofold.

Restoring larger, more refreshing eyes and restoring a natural double eyelid line.

After reoperation, the double eyelid line is made thinner and more natural.

Swelling-like sausage phenomenon below the incision line and eye correction

The area below the double eyelid line swells into a pouch-like shape,

looking as if the surgery was done only a few days ago,

which refers to a swollen-looking phenomenon.

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In most cases, surgery is only possible with full incision,

and part of the orbicularis oculi muscle below the incision line must be removed to reduce the thickness of the muscle.

The sagging skin is pulled upward, tightened, and fixed in place.�a0

Causes of a thick sausage double eyelid below the incision line

When the line is made too high
When the skin and orbicularis oculi muscle are thick
When the buried suture for the double eyelid line is placed below the height of the incision line
When the sutured area loosens and the double eyelid line is pushed downward

Sausage phenomenon after buried suture surgery

This is caused by designing the line too high and the line partially sagging downward after surgery, so you simply pull the partially loosened line upward and firmly and tautly re-fix the line.

Surgery is performed with partial incision or full incision methods.

If there is a sausage phenomenon, it can be corrected through double eyelid reoperation.

First, good results can only be obtained by accurately understanding what went wrong with the original surgery and how it should be improved.

At the Duhan Plastic Surgery double eyelid reoperation clinic, based on more than 18 years of extensive clinical experience and know-how, surgery is planned after various examinations and tests during consultation to predict postoperative results, and surgery is performed only when there is sufficient possibility of improvement after surgery.

If there is enough skin laxity, reoperation is fully possible.

The purpose of reoperation is largely twofold.

Restoring larger, more refreshing eyes and restoring a natural double eyelid line.

After reoperation, the double eyelid line is made thinner and more natural.

A thick sausage-like line occurs when the skin is thick and the line is designed too high, causing the skin to push downward.

The surgery must remove the existing scar line and create a new line below it.

Part of the orbicularis oculi muscle under the skin, which causes the sausage-like appearance, must be removed to make it thinner.

If ptosis is present, reoperation will also make the eyes open wider and correct sleepy-looking eyes.

The surgery takes about 2-3 hours, the recovery period is about one week, and the stitches are usually removed about one week after surgery.

Correction of a thick line

A double eyelid that is excessively thick looks artificial and unnatural,

and gives the impression that the surgery was done not long ago.

It also often causes ptosis, making the eyes look sleepy.

Causes of a thick double eyelid line

• When the line was designed too high at the time of the first surgery

The average natural double eyelid height in Koreans is about 6 to 8 mm.

However, because the size and shape of each person's eyes differ, the height of the double eyelid line must also be adjusted accordingly.

The design criterion is to first make a temporary line while sitting and find the line that best suits the individual's eyes.

However, a design made while lying down makes it difficult to find a fitting line, and because it is designed based on the tarsal plate, there is a greater possibility of designing a large double eyelid line.

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• When the skin is thick

Even if the line is set at the same height as other people, thick skin can make the line look thick and unnatural.

In cases of thick skin, it often needs to be set slightly lower than the average height.

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• When ptosis is present

If ptosis makes the eyes look sleepy, the line may appear larger even if it is at the same height as other people.

The reason is that the eyes cannot open widely.

In cases of ptosis, the line should be set lower, or ptosis correction should be performed together.

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• Protruding eyes

If the eyes protrude, the line height should be set slightly lower than in normal cases.

This is because eye protrusion makes the line appear larger.

It is important to make a temporary line while sitting and find the line that is most natural for the individual's eye shape.

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• Sunken eyelids

When the eyes are sunken, the double eyelid line gets pulled upward and becomes higher.

This happens because the line is pulled up along with the skin as the eye becomes sunken.

In cases of sunken eyes, the line should be set lower than in normal cases, or fat grafting should be done first to create a normal eye shape before double eyelid surgery is performed a few months later in order to achieve a satisfying result.

Why it is difficult to reduce the double eyelid line using ordinary methods

In the case of a high line, the height of the incision line is usually 8 mm or more from the eyelashes.

This must usually be reduced to a line of about 5 to 6 mm, and to do this, it is common to excise about 2 to 3 mm of skin, including the existing scar line.

You must understand what will happen if the skin is excised and simply sutured.

If only excision and suturing are done, the skin below the excision line will pull up and adhere to the skin above the excision line, resulting in a large line of more than 8 mm again, so the surgery will fail 100%.

Therefore, the key to the surgery is to pull the skin above the excision line downward.

For this, tissue must be repositioned, and to reposition the tissue, precise dissection between the levator palpebrae superioris and orbital fat is necessary so that the tissue can be rearranged and the line reduced.

How to reduce a thick double eyelid line

Method using full incision surgery

1. Excise the scar.

2. Precisely dissect between the levator palpebrae superioris and the orbital fat so that tissue repositioning can occur.

3. After dissecting the tissue, advance and place fat to prevent scar tissue adhesion.

4. To prevent the skin below the excision line from pulling upward, firmly fix the skin below the excision line to the tarsal plate.

�a05. Perform levator palpebrae superioris shortening so that the eyes open slightly wider.

The more widely the eyes open, the more the double eyelid line can be reduced.

�a06. Complete tissue repositioning by tightly layered suturing through the tissue, and prevent the tissue from pulling upward.

7. Remove the stitches a little later so that the scar does not widen and the repositioned tissue can stabilize.

Examples of thick double eyelid line correction with full incision surgery

www.doublefold.co.kr

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