[Duhan Plastic Surgery Double Eyelid Surgery] - [Double Eyelid Revision Surgery Process, Causes of Failure]

#Ptosis #Eye Correction #Double Eyelid #Double Eyelid Surgery #Double Eyelid #Double Eyelid Surgery #Epicanthoplasty #Epicanthoplasty Revision Surgery #Ptosis Surgery #Ptosis Revision Surgery #Eye Correction Revision Surgery #Double Eyelid Revision Surgery

#Double Eyelid Revision #Double Eyelid Revision Review #Double Eyelid Surgery Review #Double Eyelid Revision Surgery #Double Eyelid Swelling #How to Make Eyes Bigger #Lateral Canthoplasty #Uneven Eyes #Partial Incision #Full Incision #Double Eyelid Surgery #Eye Revision Surgery #Eye Plastic Surgery #Eye Plastic Surgery Clinic

#Best Place for Eye Plastic Surgery #In-line Double Eyelid #Partial Incision Double Eyelid Surgery #Eye Correction Surgery #Eye Correction Double Eyelid Surgery #Eye Correction Double Eyelid Revision #Double Eyelid Revision Incision #Double Eyelid Incision #Best Place for Double Eyelid Surgery #Best Place for Double Eyelid Revision

#In-out Line #Eye Plastic Surgery Clinic #Before and After Double Eyelid Surgery #Double Eyelid Revision Surgery #Pretty Eyes #Best Place for Eye Revision Surgery #Gangnam Double Eyelid Surgery #Gangnam Double Eyelid Revision #Best Place for Double Eyelid Surgery #Double Eyelid Surgery #Types of Double Eyelids

#Double Eyelid Line #Double Eyelid Line #Double Eyelid Incision #Double Eyelid Revision Incision Surgery #Removing Double Eyelids #Outer Line Double Eyelid #Sleepy Eyes #Sleepy Eye Shape #Triple Double Eyelids #Best Hospital for Double Eyelid Revision Surgery

#Uneven Eye Double Eyelid Surgery #Uneven Eye Double Eyelid Revision #Duhan #Duhan Plastic Surgery #Dr. Shin Duhan #Duhan Double Eyelid Revision Surgery #Double Eyelid Swelling #One-Sided Double Eyelid #Failed Double Eyelid Revision #Failed Eye Revision #Double Eyelid

#In-out Line Double Eyelid Surgery #Types of Eye Surgery #Sausage Eyes #Sausage Eye Revision Surgery #Double Eyelid Incision Scar #Incision Double Eyelid Surgery #Outer Line Double Eyelid #Outer Line Double Eyelid #Famous Hospital for Eye Revision Surgery #Double Eyelid

#Surgery to Make Eyes Bigger #Gangnam Eye Revision Surgery #Double Eyelid Surgery Clinic #Eye Correction Surgery #Outer Line Double Eyelid #Types of Double Eyelid Surgery #Uneven Eye Revision #Surgery to Remove Double Eyelids #Double Eyelid Line #Types of Eye Plastic Surgery

#Double Eyelid Swelling #Seoul Double Eyelid Surgery #Types of Double Eyelids #Uneven Double Eyelids #Gangnam Double Eyelid Surgery #Hospital for Double Eyelid Revision Surgery #Gangnam Double Eyelid #Before and After Eye Plastic Surgery #Eyelid Surgery #Apgujeong Double Eyelid Surgery

#Types of Double Eyelid Surgery #Double Eyelid #Buried Method for Double Eyelid Surgery #Outer Line Double Eyelid Surgery #Best Place for Double Eyelid Revision Surgery #Famous Place for Eye Plastic Surgery #Outer Line Double Eyelid Surgery #Incision Double Eyelid

#Apgujeong Eye Plastic Surgery #Lowering the Double Eyelid Line #Famous Hospital for Double Eyelid Surgery #Crowded Eyes #Best Place for Double Eyelid Surgery #Double Eyelid Surgery Incision #Uneven Eye Surgery #Double Eyelid Surgery for People in Their 50s #Epicanthoplasty Surgery

#Famous Hospital for Double Eyelid Revision Surgery #Best Hospital for Double Eyelid Revision Surgery #Best Place for Eye Correction Surgery #Seoul Double Eyelid #Best Hospital for Eye Plastic Surgery #Double Eyelid Eye Correction #Double Eyelid Plastic Surgery Clinic

#Before and After Double Eyelid #Double Eyelid Incision Revision Surgery #Famous Place for Double Eyelid Revision Surgery #How to Correct Eye Shape #Recommended for Double Eyelid Surgery #Thin Outer Line #Gangnam Eye Plastic Surgery Clinic #Partial Incision Double Eyelid #Eye Enlargement

#In-out Line Double Eyelid #Seoul Double Eyelid Surgery #Hospital for Eye Revision Surgery #Hospital for Double Eyelid Surgery #Double Eyelid Partial Incision #Lateral Canthoplasty Revision Surgery #Partial Incision Eye Correction Surgery #Double Eyelid Incision

Revision surgery process

Full incision method

To correct ptosis with a thick line, the full incision method is used.

The full incision revision surgery process is very difficult,

and requires extensive experience, advanced skill, and know-how.

It usually takes about 2 to 3 hours,

is broadly carried out in 10 steps,

and if even one step is omitted, it may lead to results below expectations.

Even if it takes a somewhat long time, good results can only be achieved by carefully checking every step

and performing the surgery with great care.

Two goals of surgery

The goals for correcting a thick line and ptosis are largely twofold.

① Reducing a thick and unattractive double eyelid line to create a natural, thin inner double eyelid

② Making eyes that look half-open and sleepy appear larger and more refreshed when opened

With these two main goals, double eyelid revision surgery is performed as follows.

Step 1 - Design the incision line, including the existing incision scar tissue.

Before surgery, a design is made to create a new double eyelid line below the scar line, and the width of skin excision up to the scar line is determined.

For example, if the existing scar line is 10 mm above the eyelashes and the new double eyelid line is set at 7 mm, the skin excision width becomes 3 mm.

The new double eyelid line is determined by considering how much the line will be lowered and how much excess skin is available.

The average line height in revision surgery is 5 to 7 mm.

Step 2 - Remove the skin and scar tissue.

The scar tissue is excised along the design line.

The incision is made precisely with a scalpel, and then the tissue is excised with surgical scissors.

The lower edge of the excised area becomes the new double eyelid line, and after tissue dissection, the upper edge must be naturally pulled downward for suturing.

Step 3 - Dissect the orbicularis oculi muscle, orbital fat, and skin adhered to the levator palpebrae superioris.

Because the skin above the incision line must be pulled downward, the firm scar tissue that has stuck together must be dissected.

Scar tissue dissection proceeds by separating the area between the orbital fat layer and the levator palpebrae superioris, and in some cases, dissection is also performed between the muscle and the fat to allow forward repositioning of the fat.

Through this dissection process, the tissue can be advanced and repositioned downward, and it is an important preparatory step for obtaining a natural double eyelid line.

Step 4 - If there is contracture of the orbicularis oculi muscle, the muscle is incised or excised to remove the contracture.

In rare cases where scar tissue adhesion is very severe, a 1 to 2 mm vertical incision may be made in the orbicularis oculi muscle to relieve the contracture.

Step 5 - Reposition the orbital fat to the incision line to prevent readhesion.

Forward repositioning of orbital fat is a process used to prevent readhesion of the tissue.

If the fat is not repositioned, the tissue will stick together again, which can lead to ptosis and a half-open, sleepy-looking eye.

Sometimes triple eyelids also occur, causing the double eyelid line to become distorted.

Another effect of repositioning orbital fat is that when the eyelid is sunken, the hollowing can be corrected to some extent. So even if fat grafting would otherwise be needed later, the surgery itself may improve the condition enough that fat grafting is no longer necessary.

Step 6 - Shorten the levator palpebrae superioris to strengthen its function.

Levator palpebrae superioris shortening is one method of correcting ptosis. It is simple, effective, and has the advantage of correcting the condition with almost no tissue damage.

This is a method of not cutting the levator palpebrae superioris, but simply advancing it and securing it to the tarsal plate (cartilage plate).

During revision surgery, the effect of levator shortening is to help the eyes open wider so they look more refreshed, and by opening the eyes more widely, it also reduces the double eyelid line.

Step 7 - After incising the orbicularis oculi muscle at the inner canthus, insert orbital fat between the muscles to prevent readhesion.

Along with forward repositioning of the fat, fat is inserted at the inner canthus of the eye to prevent adhesion of the orbicularis oculi muscle.

The inner part of the eye is the area where scar tissue most easily adheres. Adhesion in this area makes the eyes look half-open, prevents them from opening well, and causes discomfort when opening the eyes.

To prevent this, orbital fat that can act like a lubricant is placed between the orbicularis oculi muscle and the tarsal plate and secured with sutures.

Step 8 - During suturing, layered suturing keeps the repositioned structures from shifting.

The suturing method in revision surgery is not simple.

The purpose of suturing is to close the open wound and create the double eyelid line.

Therefore, to achieve the double eyelid line as originally designed, the skin below the incision line must not be pulled upward.

To do so, the skin below the incision line must be firmly fixed to the tarsal plate (cartilage plate), and the advanced fat must also be secured with sutures so that it is not pulled upward.

In addition, the orbicularis oculi muscle and skin above the incision line must all be passed through with sutures and firmly layered together in order to obtain the desired double eyelid line.

Step 9 - To prevent hematoma and inflammation, a small amount of swelling-preventing agent (hyaluronidase) is administered to the surgical site.

The swelling-preventing agent hyaluronidase is a drug with the function of dispersing fluid, and it quickly reduces swelling as soon as it is administered.

However, using too much can instead cause significant bruising as a side effect, so it is used only in a limited way to reduce swelling.

Step 10 - Suture removal is done in two stages, on day 4 and day 7.

Stitches are usually removed around 7 days after surgery.

The reason stitches are removed later in revision surgery is that in most cases there is not enough excess skin, and because all tissues are advanced during surgery, a great deal of tension is placed on the suture line.

Therefore, if the stitches are removed on day 3 or 4, the tense suture line may open or the scar line may widen, resulting in a larger scar. Tissue may also gradually be pulled upward, making the double eyelid line higher, which is an adverse effect.

Therefore, until the tissue stabilizes, the stitches need to hold the tissue in place, so it is better to leave them in longer.

To prevent the scar from becoming unsightly due to stitch marks, most of the stitches are removed on day 4, and only the remaining 3 to 4 stitches are left, so there are hardly any stitch marks left.

To quickly reduce initial inflammation and swelling, steroid medication is administered for about 1 to 2 days.

After surgery, artificial tears are used for about 1 to 3 months to prevent dry eyes.

When all of the above principles are followed with skilled technique, satisfactory results can be achieved.

​http://www.doublefold.co.kr​

Partial incision method

The partial incision method is mainly a surgical method used to restore the original clear line when the line becomes smaller, loosens, or becomes blurred.

It is also a method that can make a small line slightly larger.

1. Design the desired double eyelid line.

Usually, the design is made along the existing scar line.

Sometimes the line is designed to match the height and shape the patient wants, or the surgeon determines the most suitable line and designs accordingly.

Also, depending on whether an outer fold or an inner fold is desired, the direction of the design line changes.

2. Mark three points on the design ink where the incision will be made.

The points are lightly marked on the inner, middle, and outer areas.

3. Under sleep anesthesia, after sleeping for about 5 minutes, local anesthetic is injected into the three marked areas.

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

4. A very small incision of about 2 mm is made at the three marked points.

If the incision is made too large, a lot of scarring remains, so surgery is performed with the smallest possible incision to leave almost no scar.

5. Through the incision, the orbicularis oculi muscle is first pulled out and removed with scissors.

The orbicularis oculi muscle is the muscle layer covering the eyelid and is a tissue that interferes with double eyelid formation, so it must be removed in order to prevent the double eyelid line from loosening.

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

6. If there is a lot of orbital fat, the fat is pulled out through the outer incision so it can be exposed.

Fat removal is mainly performed from the outer side.

7. The exposed fat is clamped with a hemostat and the base of the fat is cut off with a scalpel.

Excessive fat removal can cause the eyelid to become sunken, so it is better to remove only as much as comes out.

8. After excising the fat, hemostasis is performed with an electrocautery device to prevent bleeding.

If hemostasis is not properly achieved, orbital bleeding can occur, making bruising and swelling severe, so good hemostasis is important.

9. Through the three incision sites, a very fine dissolvable thread is used to connect the levator palpebrae superioris and the skin to create the double eyelid line.

10. After burying the thread, ointment is applied to the eyes and the surgery is complete.

Washing the face and applying makeup are possible starting the next day.

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

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

http://www.doublefold.co.kr

Cause of double eyelid revision surgery failure

If double eyelid revision surgery was performed but an undesired result occurred, there can be many reasons.

The biggest cause of failure is the patient himself or herself thinking of double eyelid revision surgery too simply.

After a failed double eyelid surgery, the thought of “I can just fix it again” leads to failure of double eyelid revision surgery.

To undergo revision surgery, you must understand the cause of the failed surgery better than anyone else in order to avoid failing again.

The items below are the results of analyzing the causes of failure after revision surgery was performed at another hospital and the patient visited our clinic for examination for revision surgery.

1. When revision surgery is combined with epicanthoplasty

There are hospitals that combine revision surgery with epicanthoplasty to reduce the line.

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

Performing revision surgery to reduce the line while, on the contrary, performing surgery that makes the inner line larger is not a logical procedure.

Various problems can arise from completely unnecessary epicanthoplasty.

Epicanthoplasty should only be applied when needed in eyes with an epicanthal fold, and unnecessary epicanthoplasty can cause various side effects such as excessive exposure of the inner mucosa, a severe outer fold line, eyes appearing too close together, or a sharper gaze.

Unnecessary epicanthoplasty often ruins the overall impression, so this should be kept in mind.

2. When scar tissue is not properly dissected

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

Otherwise, tissue repositioning will not occur.

If the muscle layer and fat layer are not properly separated during dissection to release adhesions, tissue repositioning becomes impossible and it is difficult to narrow the double eyelid line.

If suturing is performed without proper dissection, not only will the double eyelid line not narrow at all, but the skin below the incision line will be pulled upward, causing ectropion of the eyelashes.

3. When orbital fat is not repositioned

As in the Step 5 process above, the fat should be repositioned, and if this is neglected, the dissected tissue will stick together again, the eyes will not open widely, and even triple eyelids may form.

Along with dissection of scar tissue, repositioning of orbital fat is an important structure that acts like lubricant to prevent tissue from sticking together.

4. When fat is not repositioned in the inner canthus (the inner corner of the eye)

If orbital fat is not placed in the inner canthus, scar tissue forms in the inner corner of the eye and interferes with opening the eyes widely.

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

The inner corner of the eye plays an important role in helping the eyes open widely, and if too much scar tissue forms in this area, the eyes cannot open widely and a natural line cannot be created.

5. When levator palpebrae superioris shortening is not performed

The levator palpebrae superioris (eyelid-lifting muscle) is an important structure that helps open the eyes, and most patients undergoing double eyelid revision surgery have a weakened eyelid-lifting muscle.

Therefore, it is important to perform levator palpebrae superioris shortening (Step 6 above) to make the eyes open widely.

If this is not done, the existing half-open eye appearance will not be corrected at all, and the result may even make the eyes look sleepier.

6. When stitches are removed too early

The reason stitches are removed later in revision surgery is that most revision patients do not have much excess skin, and because tissue has been repositioned, the tissue needs to be held in place firmly by the force of the stitches.

Repositioned tissues have a tendency to return to their original position, like a spring. If the stitches are removed before the newly repositioned area stabilizes, the tissues will return to their original position, resulting in an undesired surgical outcome.

Choice when the consultation suggests the surgery is very complicated or difficult

After visiting for consultation and examination, there are cases in which, from the surgeon’s perspective, the eye shape is very difficult or there is no certainty that a satisfactory result can be achieved.

In such cases, one cannot simply answer with confidence, but if one says it is difficult, trust in the hospital may decline or the doctor may be misunderstood as lacking skill.

From the surgeon’s perspective, if one wants to provide honest and principled care, and accurately judges the patient’s condition to explain what is difficult and that the result may be poor, some people will accept it, but more people react negatively.

If a patient is swayed by exaggerated consultation and undergoes surgery, the situation may become even more dire.

From the patient’s perspective, it is very important to distinguish between consultation contents that are exaggerated and a surgeon who is principled.

There are various outcomes after revision surgery.

Some people think that if they meet a highly skilled doctor for revision surgery, they will definitely get good results.

This is a very dangerous thought.

Even for a skilled doctor, while surgery may improve some cases, there are cases where improvement is not possible, and sometimes the results may be insufficient.

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

When revision surgery is difficult or impossible

There are many cases in which revision surgery is impossible or difficult.

Examples include cases with insufficient excess skin, cases where the scar line is too thick and adhesions are difficult to release, cases where the skin and muscle are excessively thick, cases where the tissue has become hard and thick after multiple revision surgeries, cases with severe sausage-eye appearance where even after surgery it is highly likely to recur because it is pushed down again, and cases with severe ptosis.

When surgery is very complicated and difficult, the patient must understand the limits, but some people do not want to accept those limits.

If you undergo surgery with only vague hope, you are essentially bringing yourself into a major trap.

You must carefully assess the limits and prognosis in your current condition before deciding on surgery.

​http://www.duhans.com​

http://www.duhans.com