[Duhan Plastic Surgery Double Eyelid Surgery] - [An Attractive Double Eyelid]

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Attractive Double Eyelids

The standard for attractive and beautiful double eyelid lines

is not fixed,

but generally from a common perspective,

let’s look at what makes an attractive double eyelid line.

It should not look operated on,

and it should be natural

and beautiful.

That is what can be called an attractive double eyelid.

A double eyelid line that is too large is not good.

In general, when the line is large, it often makes the impression look awkward.

From the viewpoint of beauty, a large and distinct line can create an artificial and awkward impression.

The most ideal line is when the eyes are open

and the line is only slightly visible by about 1–2 mm; this can be considered the most attractive double eyelid line.

It is better if the double eyelid line extends clearly

to the inner edge of the eye.

Depending on the case, East Asian eyes may have an epicanthal fold (medial canthal fold),

and if surgery is performed without considering this,

the inner line of the eye may disappear,

which can create a feeling of heaviness.

Whenever possible, it is better for the line to be visible to the inner part of the eye.

If the line cannot be properly formed because of the epicanthal fold, epicanthoplasty should be performed.

If there is no epicanthal fold, the design should be done well so that the line does not break at the inner side.

Surgical marks should not be visible.

The biggest disadvantage of surgery using the incision method is scarring.

How much scarring remains is determined by differences in the surgeon’s skill and individual physical factors.

In particular, people with thicker skin and orbicularis oculi muscle tend to have relatively more scarring.

Once a scar develops, there is no way to erase it,

but in cases of severe scarring, scar revision surgery can be performed to make the scar less noticeable.

Therefore, during the first surgery, it is important to minimize scarring by removing an appropriate amount of skin and performing precise suturing.

The eyelids should look thin.

Causes of eyelids appearing puffy include thick skin or orbicularis oculi muscle,

or a large amount of orbital fat or pretarsal fat.

It is better to address these issues during double eyelid surgery whenever possible.

The most common cause is a large amount of orbital fat.

This can be removed during double eyelid surgery.

Another method is partial removal of the orbicularis oculi muscle layer when the layer beneath the skin is thick.

The orbicularis oculi muscle below the incision line can be partially removed,

whereas it is difficult to remove the muscle above the incision line.

If there is an epicanthal fold, it is better to remove it.

In East Asians, there are sometimes epicanthal folds (medial canthal folds),

which can cover the skin at the inner edge of the eye and create a heavy appearance.

Removing this makes the horizontal width of the eye look larger and more refreshing, and the double eyelid line becomes clearly visible to the inner side as well.

However, surgery should be performed carefully while considering the shape of the eyes so that unsatisfactory results do not occur.

If the distance between the eyes does not look wide and there is little to no epicanthal fold at the inner corners, performing an epicanthoplasty can instead make the eyes look too close together or make the gaze appear harsher.

Therefore, after an accurate physical examination, it should only be performed when the indication is appropriate.

If there is ptosis, it should be corrected at the same time.

Ptosis refers to a condition in which the upper eyelid droops and covers the pupil because the function of the levator palpebrae superioris muscle that lifts the eyelid is weakened, making the eyes look sleepy.

If this is overlooked during surgery, the double eyelid line may not turn out beautifully.

Before double eyelid surgery, the eyes should look larger and more refreshed for the double eyelids to also look beautiful.

If, depending on the degree of ptosis, it is determined that ptosis correction is also needed,

it is better to correct the ptosis at the same time using the incision method.

Beautiful Quick Double Eyelids

Return to daily life with minimal swelling~

Quick double eyelid surgery is a procedure that uses minimal incision and minimal swelling, allowing immediate return to daily life after surgery.

Our quick double eyelid surgery is performed using a minimal-incision partial incision method,

and because skin suturing is not required, normal daily activities are possible,

there is almost no swelling immediately after surgery,

and it is characterized by a natural result.

It also has the advantage of being less likely to come undone.

The 4 Principles of Double Eyelid Surgery

1. Swelling must be minimized

Quick double eyelid surgery is one method that produces less swelling than any other technique.

2. The line must not come undone

By removing orbicularis oculi muscle and orbital fat, the line almost never comes undone.

3. Scarring must be minimized

With a minimal 2 mm incision, scarring is almost nonexistent.

4. The line must look natural

By creating the line in advance while seated, we find the most natural line and perform the surgery accordingly.

Why quick double eyelid surgery does not cause swelling

Swelling occurs when exudate produced by surgery accumulates within the tissue.

The reason quick double eyelid surgery causes almost no swelling is that the swelling-producing tissue, the orbicularis oculi muscle and fatty tissue, is removed through a microincision, and the exudate generated by the surgery is immediately drained through the microincision, leaving no room for swelling to develop.

For example, it is like how a bruise without a cut swells, while a cut wound barely swells.

A bruise without a cut swells because exudate forms inside and is not drained, so it accumulates. A cut wound does not swell because the exudate drains out immediately.

Surgical method of quick double eyelid surgery

1. Design the desired double eyelid line.

The design is made according to the height and shape the patient wants, or the surgeon determines the most suitable line and designs it.

The height of the line is usually designed at 5–8 mm above the eyelashes, and the direction of the design line changes depending on whether an out-fold or an in-fold is chosen.

2. Mark the positions for incision at three points with design ink.

The locations are lightly marked on the inner side, center, and outer side.

3. Under sedation, local anesthetic is injected into the three marked points while the patient is asleep for about 5 minutes.

The local anesthetic is administered in minimal amounts so that swelling does not occur as much as possible.

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

If the incision is made too large, more scarring will remain, so surgery is performed with minimal incisions to leave almost no scar.

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

The orbicularis oculi muscle is the muscle layer covering the eyelid, and because it interferes with double eyelid formation, it must be removed so that the double eyelid line does not come undone.

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

6. If there is a lot of orbital fat, pull it out through the outer incision site and expose it outside.

Fat removal is mainly done from the outer side.

7. Grasp the fat with a hemostatic forceps and cut off the base of the protruding fat with a scalpel.

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

8. After fat excision, use an electrocautery device to stop bleeding so that no bleeding occurs.

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

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

10. After burying the sutures, apply ophthalmic ointment and the surgery is finished.

Washing and makeup are possible from the next day.

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

If cold compresses are continued for more than 3 days, swelling will not go down as well, so it is best to do them only for exactly 3 days.

Postoperative care after quick double eyelid surgery (partial incision method)

1. Apply cold compresses with the cool pack provided by the hospital.

Do this for 2 hours a day for only 3 days.

The time for cold compresses can be done continuously for 2 hours, or divided into 20–30 minute sessions.

Usually, it is convenient to do this before going to sleep.

2. Postoperative visit: come to the hospital once the day after surgery to disinfect the surgical site and observe the progress.

3. Makeup and face washing are possible from the next day.

4. Postoperative swelling varies from person to person, and in most cases it subsides almost completely in about 7 days, but it takes 1–3 months for the result to fully settle.

Before-and-after photos of quick double eyelid surgery (partial incision method)

http://www.duhans.com

Comparison of quick double eyelid surgery (partial incision method) and buried suture method

​	Quick double eyelid surgery (partial incision method)	Buried suture method
Use of sutures	Absorbable sutures	Non-absorbable sutures
Degree of incision	About 2 mm, 3 incision points	About 2 mm, 3 incision points
Postoperative swelling	Slight	Slight
Likelihood of loosening	Almost never loosens	Tends to loosen or become thinner more often.
Line definition	Maintains the same definition as incisional surgery	Often loosens or is not clearly defined.
Fat removal	Possible	Impossible
Removal of sutures	Not necessary. Can be removed if desired	Removal is impossible or very difficult
Scarring	Almost none	Almost none

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