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Double Eyelid Revision Surgery

When the double eyelid line is too large, uneven, or has become undone,

this is a surgery that corrects the double eyelid line and restores it to its original

natural yet refreshed double eyelid shape.

The Purpose of General Double Eyelid Surgery

Double eyelid surgery is not simply meant to create a double eyelid line.

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

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

The purpose of double eyelid revision surgery is the same.

Its goal is to correct the eye shape so that it becomes larger, clearer, and more natural.

When Epicanthal Folds Are Present

There are cases in which the double eyelid line does not continue all the way to the end and disappears in the middle.

If the inner line of the double eyelid disappears, it can give a somewhat cramped impression.

Epicanthal fold removal is also called medial canthoplasty. If double eyelid surgery is performed together with medial canthoplasty to create a double eyelid, the line can continue to the end and form a natural line.

Epicanthal Fold Removal (Medial Canthoplasty)

When the space between the eyes appears wide, there are many cases where skin excessively covers the eyeball at the inner corner of the eyes. The skin covering the eyeball on the inner side of the eyes is called an epicanthal fold.

Epicanthal fold removal (medial canthoplasty) is a surgery that removes the inner canthal fold to normalize the distance between the eyes and open up the cramped-looking inner corners of the eyes.

It increases the horizontal length of the eyes and makes the medial part of the eyes look clearer.

An epicanthal fold (inner canthal fold) is diagnosed when the distance between the eyes is 40 mm or more, or when the skin at the inner corners covers the whites of the eyes, creating a cramped feeling.

Eyes with epicanthal folds usually have an inner corner that is not sharp, appears rounded, or has a steeply downward angle.

The Three Principles of Epicanthal Fold Removal (Medial Canthoplasty)

◆ There should be no visible scar.

The incision line should be hidden inside the eyelid border so that scarring is nearly absent.

◆ The shape should be natural.

The inner corner of the eye should be designed horizontally so that the medial canthoplasty looks natural.

◆ It should not recur.

The inner corner should be fixed and sutured to the ligament so that it does not return to its original position.

Why Scarring Does Not Occur in Medial Canthoplasty at Our Clinic

Whenever skin is incised, a scar will inevitably form.

The same is true for epicanthal fold surgery; if it is performed by incision, scarring is an unavoidable issue.

If the surgery is performed in a way that leaves the scar exposed externally, the scar can look unsightly no matter how carefully it is sutured.

However, if the scar line is buried at the very edge of the eye corner and hidden, the scar becomes almost unnoticeable.

Because the scar is not exposed on the surface, it does not show.

Indications for Epicanthal Fold Removal (Medial Canthoplasty)

1. When the space between the eyes appears wide

As a rule, surgery is performed when the distance between the inner corners of the eyes exceeds 40 mm.

The normal distance between the eyes is about 36 to 37 mm, but if the distance is normal and an epicanthal fold is present, it is better not to perform surgery.

If done incorrectly, the distance between the eyes may become too short and the eyes may appear close-set.

2. When you want to create an out-fold double eyelid

If an epicanthal fold is present, an in-fold double eyelid is formed, so epicanthal fold removal is necessary to create an out-fold double eyelid.

Comparison of Externally Exposed Medial Canthoplasty (Epicanthal Fold Removal) Scars and the Medial Canthoplasty at Duhan Plastic Surgery Double Eyelid Clinic

The principle of epicanthal fold removal (medial canthoplasty) is that it should leave minimal scarring, have a low recurrence rate, and be suitable to perform together with double eyelid surgery.

At our clinic, we mainly perform the Furukawa and Y-V methods.

The advantages of the surgery are that the scar is less visible, the result is natural, and when performed together with double eyelid surgery, it can be designed naturally as an extension of the double eyelid line.

Various Epicanthal Fold Surgery Methods and Scar Patterns

Although many methods have been developed, only a few are actually used.

The principle of epicanthal fold removal (medial canthoplasty) is that it should leave minimal scarring, have a low recurrence rate, and be suitable to perform together with double eyelid surgery.

At our clinic, we mainly apply the Furukawa method shown in the lower right and perform the surgery.

Its advantages are that the scar is almost invisible, the shape is natural, and when combined with double eyelid surgery, the epicanthal fold procedure can be performed naturally as an extension of the double eyelid line.

Medial Canthoplasty Procedure

1. The skin is pulled toward the nose to make it taut.

2. With the skin stretched, the design is marked with special ink.

The design shape varies depending on the surgical method, so it is not always the same.

At our clinic, we mainly use the Y-V method to keep the scar from being noticeable.

3. Under sedation anesthesia, local anesthesia is administered to the designed area.

4. A scalpel is used to make a precise incision along the design line.

5. The skin is lifted away from the muscle.

6. The tissue is rearranged so that the epicanthal fold is pulled toward the nose.

At this point, an appropriate amount of excess skin tissue is removed.

7. The skin is sutured with fine thread.

No bandage is needed immediately after surgery, and the stitches are removed after 5 to 6 days.

Before-and-After Photos of Epicanthal Fold Removal (Medial Canthoplasty)

Postoperative Care After Epicanthal Fold Removal (Medial Canthoplasty)

1. The first follow-up visit is the day after surgery, when the surgical site is disinfected and the progress is observed.

2. Stitches are removed on the 5th day after surgery.

3. Swelling is minimal after surgery, and the full settling period is about 1 to 3 months. During this period, the surgical site should not be rubbed strongly.

4. For about 3 months, a slight scar may be visible at the inner edge of the eye, but this is a normal process, and after 3 months it becomes almost unnoticeable.

5. Be careful not to rub the surgical site when washing your face.

If you rub the surgical site hard, the scar may become unsightly or widen, so be careful.

Precautions for Epicanthal Fold Removal (Medial Canthoplasty)

1. It should only be performed when it suits your own eye shape.

During consultation, you should carefully discuss with the specialist whether epicanthal fold removal is truly necessary before deciding on surgery.

2. No matter which method is used, it is difficult to perform epicanthal fold removal without leaving any scar at all.

It is better to perform the surgery in a way that leaves as little scarring as possible, and it is preferable to hide the scar internally.

Because the scar is not visible externally, there is almost no sign that surgery was performed.

When Epicanthal Fold Removal (Medial Canthoplasty) Should Not Be Performed

1. When the distance between the eyes is less than 40 mm

Usually, 36 to 37 mm is considered normal.

If it is less than 40 mm, the procedure should not be performed.

If medial canthoplasty is performed on eyes with a normal distance, the eyes may appear too close together, so caution is needed.

2. Even if the distance between the eyes is wide, if the inner corner of the eyes already has a sharp shape, epicanthal fold removal should not be performed.

The goal of epicanthal fold surgery is to open up and soften the round inner corner of the eyes.

If the eye shape is already sharply open, surgery may make the eyes look even more severe, so caution is needed.

Double Eyelid Line with Unnecessary Medial Canthoplasty

Various problems can occur due to unnecessary medial canthoplasty.

Medial canthoplasty should only be performed when truly needed in eyes with epicanthal folds, and unnecessary or excessive medial canthoplasty can cause problems such as excessive exposure of the inner mucosa, a very pronounced out-fold line, eyes that appear too close together, or a harsher eye shape.

Unnecessary medial canthoplasty often makes the impression look worse, so caution is needed.

Problems When Medial Canthoplasty Is Excessive

Excessive medial canthoplasty has limits when trying to change it into an in-fold line or a natural line.

Because of unnecessary excessive medial canthoplasty, a severe out-fold line, excessive exposure of the mucosa, or the side effect of eyes appearing too close together may occur.

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

Medial Canthoplasty Restoration Surgery

This refers to a surgery performed to restore the original eye shape because unnecessary medial canthoplasty, which was not even indicated, ended up making the impression worse.

Why Medial Canthoplasty Restoration Surgery Becomes Necessary

If medial canthoplasty was done because it was needed, you should think carefully about why restoration surgery would be necessary again.

The reason medial canthoplasty restoration surgery exists is that some clinics recommend medial canthoplasty unconditionally without considering the post-surgical eye shape.

If medial canthoplasty is performed even when it is not indicated, various problems can arise, so this should be kept in mind.

Problems That Occur After Unnecessary Medial Canthoplasty

1. The distance between the eyes becomes shorter than normal, making the eyes appear close-set.

2. If medial canthoplasty is performed when the inner corner is already sharp, the eye shape becomes too sharp and looks severe.

3. The mucosa on the inner side of the eye is exposed too much, making it look unpleasant.

4. When medial canthoplasty is performed, the inner line becomes thicker, and cases that wanted an in-fold line end up with an unwanted out-fold line.

5. Even after double eyelid revision surgery to reduce the inner line, performing it together with medial canthoplasty may prevent the line from decreasing, or may even make it larger.

Medial Canthoplasty Restoration Method

Restoration is performed by designing the surgery in the opposite direction of medial canthoplasty, using a V-Y advancement flap method or a Z-plasty method.

The method varies depending on the individual eye shape and available tissue.

Example of Medial Canthoplasty Restoration Surgery

Before medial canthoplasty restoration surgery, we should avoid creating a situation that requires restoration in the first place.

It means spending money on unnecessary medial canthoplasty, making the impression worse, and then spending even more money to restore it.

You should carefully decide whether the surgery is truly necessary for you.

Medial Canthoplasty Restoration Method at Duhan Plastic Surgery Double Eyelid Revision Clinic

At Duhan Plastic Surgery Double Eyelid Revision Clinic, if medial canthoplasty has been done too extensively and restoration is desired, the current double eyelid may be natural and there may be enough excess skin at the front, in which case treatment may be possible in one stage. However, if there is not enough excess skin, the double eyelid looks awkward, and the fold is large, staged reconstructive surgery may be necessary.

In general, if the thickness (width) of the double eyelid is around 6 mm as a reference and is much larger than that, or if the fixation point of the double eyelid is very high, it may take a long time before it becomes natural.

It can be reconstructed to match the shape of your own eyes.

Even if epicanthal fold reconstruction is performed, it will not be exactly the same as the old eyes, and during reconstruction the skin around the eyes must be brought together toward the eye corner, so care must be taken to prevent the scar from spreading below the inner corner of the eye.

The scar does not form because it is sutured inside the skin.

Double Eyelid Line with Lateral Canthoplasty

This is one of the surgeries that should absolutely not be performed in plastic surgery.

It is a surgery that even plastic surgery textbooks say is better not to do.

Lateral canthoplasty is a procedure that can cause various side effects such as mucosal exposure, eyelid ectropion, a severe eye shape, and significant scarring.

The side effect rate of lateral canthoplasty is over 90%, and because it can cause irreversible, serious side effects, caution is needed.

Lateral Canthoplasty Surgery

These days, side effects from lateral canthoplasty performed at other clinics are frequently reported.

Lateral canthoplasty refers to surgery that opens the outer corner of the eye, opposite to medial canthoplasty.

Types of Lateral Canthoplasty Side Effects

○ Eyelid ectropion and lifting

○ Distorted scar at the outer corner of the eye

○ Mucosal exposure and eyelid drooping

○ Excessive exposure of the lower white part of the eye

○ Deformation of the eye shape and twisting of the lateral canthus

○ Dry eye syndrome and tearing

Examples of Lateral Canthoplasty Side-Effect Cases from Other Clinics

In plastic surgery, there are procedures that are good to have, and there are procedures that should not be done.

Even if the most skilled specialist performs the surgery, if the probability of serious side effects exceeds 10%, it is considered a risky procedure and one that should not be done.

Lateral Canthoplasty Restoration Method at Duhan Plastic Surgery Double Eyelid Revision Clinic

Based on more than 20 years of extensive clinical experience and know-how, if the outer eye corner is raised and the horizontal length of the eye is short, performing lateral canthoplasty together with lower canthoplasty can create a larger and softer impression.

However, in the case of lower-lateral canthoplasty, some eyes benefit significantly depending on the eye shape and eyeball structure, while others do not.

In lower-lateral canthoplasty, tissue that tends to reattach is sufficiently removed through skin dissection, so it does not reattach.

From the inner conjunctiva of the eye, the procedure involves delicate suturing according to the anatomical structure, from the ligament-fascial layer to the muscle layer and skin layer.

This surgical method compensates for the drawback of reattachment, which is a side effect of conventional lateral canthoplasty.

Because the skin and mucosa are sutured separately, it does not form a D-shape, and there is no need to worry about reattachment.

Also, unlike at other clinics, it is not done by skin incision alone; it is firmly fixed to the periosteum, so it does not come undone,

and it is a safe surgery that can also be restored later.

The sutured area is naturally hidden along the eye corner line to minimize visible scarring, and thanks to years of experience in double eyelid revision surgery, delicate and precise suturing leaves almost no scar.

Through numerous surgical cases, patient safety and satisfaction have been improved.

Our clinic does not perform one uniform eye shape for everyone.

With 1:1 customized design, we tailor the design to the patient's eyes and create a natural eye shape that harmonizes with the existing double eyelid line.

http://www.doublefold.co.kr

Before surgery, you should consider three things during consultation:

whether the surgery is possible,

if possible, how much improvement can be achieved,

or whether it is impossible.

For revision surgery, sufficient clinical experience and the surgeon's technical skill must support the procedure.

Revision surgery is performed at many clinics, but in most cases the results are not very good.

Revision surgery is a procedure that can only be done when extensive experience and know-how have accumulated, so it is not a surgery just anyone can perform.

Please note that there are not many people in our country who can perform revision surgery and consistently produce results that satisfy patients.

To achieve good results, one must accurately understand what went wrong with the first surgery and how it should be improved.

As long as there is enough excess skin, revision surgery is fully possible.

The purpose of revision surgery is largely twofold.

Restoring large, clear eye shape and

restoring a natural double eyelid line.

Dr. Shin Duhan, Duhan Plastic Surgery

http://www.doublefold.co.kr