[Duhan Plastic Surgery Double Eyelid Revision] - [Severe Sausage Eyes, Double Fold Re-Formation, Double Eyelid Scars]

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http://www.doublefold.co.kr

Problems with a thick double eyelid line

A double eyelid line that is excessively thick looks artificial and awkward,

and gives the impression that the surgery was done recently.

It also often causes ptosis, which makes the eyes look sleepy.

Causes of a thick double eyelid line

① The line was designed too high during the initial surgery

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

However, because each person’s eye size and shape are different, the height of the double eyelid line should also be adjusted accordingly.

The design should always begin by temporarily creating the line while sitting, then finding the line that best suits the person’s eyes.

But when the design is done while lying down, it is difficult to find a suitable line, and because it is designed based on the tarsal plate, there is a high chance of creating a large double eyelid line.

� ② When the skin is thick

Even if the line is placed at the same height as other people’s, thick skin can make the line look thicker and awkward.

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

� ③ When ptosis is present

When ptosis makes the eyes look half-closed and sleepy, even a line at the same height as other people’s can look larger.

This is because the eyes cannot open widely.

If ptosis is present, the line must be placed lower, or ptosis correction should be performed at the same time.

� ④ Protruding eye contour

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

This is because protrusion of the eyeball makes the line appear larger.

It is important to temporarily create the line while sitting and find the most natural line for the individual’s eye shape.

� ⑤ Sunken eyelids

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

This happens because the line is dragged upward together with the skin as the eye appears sunken.

In such cases, the line should be placed lower than in normal cases, or fat grafting should be performed first before double eyelid surgery to create a more normal eye shape, and then double eyelid surgery should be performed several months later to achieve a satisfying result.

Why it is difficult to reduce a double eyelid line using the usual method

In cases of a high line, the incision line is usually 8 mm or more above the eyelashes.

This usually needs to be reduced to a line of about 5 to 6 mm,

and for that, it is common to excise about 2 to 3 mm of skin, including the existing scar line.

It is necessary to understand what happens if the skin is excised and simply sutured.

If you simply excise and suture, the skin below the excision line will pull up and adhere to the skin above the excision line, resulting in a large line of 8 mm or more again, so the surgery will fail 100%.

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

To do this, tissue repositioning must take place, and for tissue repositioning, the plane between the levator palpebrae superioris and the orbital fat must be dissected precisely so that the tissue can be rearranged and the line reduced.

How to reduce a thick double eyelid line

Full incision method

Correction of ptosis with a thick line is possible through the full incision method.

The full incision revision process is very complex and requires extensive experience, advanced skill, and know-how.

It usually takes about 2 to 3 hours.

The surgical process proceeds in 10 steps, and if even one step is omitted, it may lead to subpar results.

Even if it takes some time, better results can be achieved only by carefully checking each of these steps and performing the surgery with care.

Two goals of full incision surgery

There are two major goals in correcting a thick line and ptosis.

① To reduce the thick, unattractive double eyelid line and make it into a natural, thinner inner double eyelid line

② To make the half-closed, sleepy-looking eyes open wider and look clearer

With these two goals, double eyelid revision surgery is performed as described below.

Full incision surgery process

① The planned incision line is designed, including the existing incision scar tissue.

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

The excision width is based on the new double eyelid line, extending to the existing scar line.

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 standard is determined based on the midpoint width.

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

The average height of the revision line is about 5 to 7 mm.

� ② The skin and scar tissue are removed.

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 excision line becomes the new double eyelid line, and the upper line must be released after tissue dissection so it can be naturally pulled downward and sutured.

� ③ The orbicularis muscle, orbital fat, and skin adhered to the levator palpebrae superioris are dissected.

Because the skin above the incision line must be pulled downward, the firmly adhered scar tissue must be released.

Scar tissue dissection is performed by dissecting between the orbital fat layer and the levator palpebrae superioris, and in some cases also between the muscle and the fat for forward repositioning of the fat.

This dissection process enables forward tissue repositioning and is an important preparatory step for obtaining a natural double eyelid line.

� ④ If there is contraction of the orbicularis muscle, the muscle is incised or excised to remove the contraction.

In rare cases where adhesion of the scar tissue is very severe, the orbicularis muscle may be vertically incised by about 1 to 2 mm to release the contraction.

� ⑤ To prevent re-adhesion, the orbital fat is repositioned up to the incision line.

Forward repositioning of the orbital fat is a process to prevent re-adhesion of the tissue.

If the fat is not repositioned, the tissue will adhere again, which can lead to ptosis and make the eyes look half-closed and sleepy.

Sometimes this also causes triple eyelids, which can distort the double eyelid line.

Another effect of repositioning the orbital fat is that it can partially correct sunken eyelids. If the eyelid is sunken and fat grafting may be needed later, the surgery itself may provide some improvement, sometimes making fat grafting unnecessary.

� ⑥ The levator palpebrae superioris is shortened to strengthen its function.

Levator shortening is one method of correcting ptosis.

It is simple and effective, with the advantage of being correctable with almost no tissue damage.

The levator is not cut out; instead, it is simply advanced and tied to the tarsal plate (cartilage plate).

In revision surgery, the effect of levator shortening is to help the eyes open wider so they look clearer, while also reducing the double eyelid line as the eyes open more widely.

� ⑦ After incising the orbicularis muscle at the medial canthus, orbital fat is inserted between the muscles to prevent re-adhesion.

Along with forward fat repositioning, fat is inserted into the inner corner of the eye to prevent adhesion of the orbicularis muscle.

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

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

� ⑧ During suturing, layered sutures are used so the repositioned structures do not shift.

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 this, the skin below the incision line must be firmly fixed to the tarsal plate, and the advanced fat must also be secured so it does not get pulled upward.

In addition, the orbicularis muscle and skin above the incision line must both be traversed by the sutures and firmly layered together; only then can the desired double eyelid line be achieved.

� ⑨ A small amount of anti-swelling medication (hyaluronidase) is administered to the surgical area to prevent hematoma and inflammation.

Hyaluronidase, an anti-swelling agent, is a medication with a substance that helps disperse water, and it can quickly reduce swelling as soon as it is administered.

However, using too much can instead cause significant bruising, so it is used selectively only to reduce swelling.

� ⑩ The sutures are kept in place for a relatively long time, from 7 to 14 days, depending on the patient’s condition.

Sutures are removed in two stages, on day 4 and day 7.

The reason they are removed late is that in revision surgery, there is often not enough extra skin, and because the surgical process involves repositioning all tissues, a lot of tension is placed on the suture line.

If the sutures are removed on days 3 or 4, the tense suture line may open up or the scar line may widen, causing a large scar and adversely affecting the tissue by gradually pulling upward, which also enlarges the double eyelid line.

Therefore, until the tissue stabilizes, the sutures should remain in place to hold the tissue, so it is better to leave them in longer.

At many hospitals, sutures are removed early for fear of stitch marks, but that applies only to the initial double eyelid surgery.

It does not apply to revision surgery.

To minimize stitch marks, most of the sutures are removed on day 4, leaving only 3 to 4 stitches, and these are removed on day 7. This helps minimize stitch marks and prevent the scar from widening while also minimizing distortion of the double eyelid line.

To quickly reduce early inflammation and swelling, steroid medication is given for about 2 days.

After surgery, artificial tears are used for about 1 month to prevent dry eye.

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

Examples of correcting a thick double eyelid line with the full incision method

Turning a severe outfold line into an infold line

An outfold refers to a line where the inner line remains visible all the way to the end,

and while a thin outfold line may suit some people depending on the individual,

in severe outfold cases, it looks obvious that surgery was done and

it causes an awkward eye shape,

so it needs to be changed into an infold line.

The highlight and core of double eyelid revision surgery,

and the peak of skill, is transforming an outfold into an infold.

If the inner line cannot be organized as desired,

the overall line becomes awkward and it is difficult to achieve the desired result.

When there is little extra skin or when the scar is severe,

changing an outfold line into an infold line

is one of the most difficult types of double eyelid revision surgery.

Causes of outfold

▷ The double eyelid line was designed too high overall

▷ The inner design line was placed too high

▷ Unnecessary or excessive epicanthoplasty was performed

▷ Excessive skin excision

Surgical method

In most cases, it can be corrected with full incision surgery. In some cases, buried suture or partial incision methods may be possible,

but this is only possible when the adhesion is weak or partially released.

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

The method involves performing a full incision, precisely dissecting the space between the orbital fat and the levator palpebrae superioris, then repositioning the inner orbital fat,

and also dissecting and flattening the inner scar line.

This requires highly advanced skill and accumulated experience.

Turning an outfold into an infold is the most difficult.

Revision surgery is performed at many hospitals, but the results are generally not very good.

Please note that there are not many people in Korea who can consistently produce results that satisfy patients after revision surgery.

To achieve good results, one must accurately understand what was wrong with the initial surgery and how it needs to be improved.

At our clinic, during consultation we perform various examinations and tests to predict the post-surgical result, and we only proceed with surgery when there is a sufficient chance of improvement after surgery.

The biggest key in revision surgery is the amount of extra skin, the position of the scar line, and how dark it is.

The goal is to restore a large, clear eye shape and recover a natural double eyelid line.

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

The thickened area below the incision line (sausage-like appearance)

This refers to a swollen-looking condition in which the area below the eyelid line bulges up in a pouch-like shape,

making it look as if the surgery was done only a few days ago.

Causes

▷ When the line was made too high

▷ When the skin and orbicularis muscle are thick

▷ When the buried suture for the double eyelid line was placed below the height of the incision line

▷ When the sutured area loosens and the double eyelid line slides downward

Surgical method

① Sausage-like appearance after full incision surgery

Usually, correction is possible only with full incision surgery. Some of the orbicularis muscle below the incision line should be removed to reduce the thickness of the muscle, and the sagging skin should be pulled upward, tightened, and then fixed.

� ② Sausage-like appearance after buried suture surgery

When sausage-like swelling occurs after buried suture surgery, it is caused by the line being designed too high and partially sagging downward after surgery. The partially loosened line can be pulled upward and firmly refixed under tension.

The surgery is performed using the partial incision method or full incision method.

If you have a sausage-like appearance, it can be corrected through double eyelid revision surgery.

If there is enough extra skin, revision surgery is certainly possible.

The goals of revision surgery are broadly two things.

Restoring a large, clear eye shape and recovering a natural double eyelid line.

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

The thick sausage-like appearance occurs when the line is designed too high in a person with thick skin, and the skin slides downward.

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

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

If ptosis is present, revision surgery also helps the eyes open wider and correct the sleepy-looking eyes.

The surgery takes about 2 to 3 hours, the recovery period is about one week, and in most cases the sutures are removed around one week after surgery.

When the scar line is dark

When surgery is performed with the incision method, scars will form at the surgical site.

If the scar line is faint and light, there is no problem,

but if the scar line is dark and deeply indented,

it can feel unpleasant when the eyes are closed.

In such cases, the scar line needs to be lightened so that when the eyes are closed,

the double eyelid line is not easily visible.

Causes

▷ When excessive skin excision widens the scar

▷ When excess skin is not removed and the skin covers the incision line, making it darker

▷ When there is no extra skin, causing the scar line to gradually widen or become distorted

▷ When excessive excision of the orbicularis muscle beneath the skin causes a sunken scar

▷ When caused by the habit of rubbing the eyes frequently after surgery

▷ When the person is constitutionally prone to scarring

Surgical method

The edges of the scar line are precisely designed, and only the scar tissue is excised and removed,

then the normal skin and the orbicularis muscle beneath it are carefully sutured together.

If there is no extra skin, the time for stitch removal may need to be delayed, so it is also important to remove the stitches only after confirming that healing is sufficient and the scar will not widen.

If there is a thickened so-called sausage double eyelid below the incision line,

part of the orbicularis muscle layer beneath the skin is excised and the skin is pulled upward and flattened to correct it.

Precautions

▷ After stitch removal, continue disinfecting for a few more days until the holes in the suture line close.

▷ Wipe the scar line area well with antiseptic so that foreign substances or dead skin do not accumulate.

▷ Do not rub with your hands just because your eyes feel tired or have eye discharge. It is better to wipe with a cotton swab.

▷ If you rub your eyes, the double eyelid line may change or the scar may become messy, so never rub them.

The timing of double eyelid revision surgery is at least 6 months after the last surgery.

The reason for waiting 6 months is to allow the scar tissue from the previous surgery to soften.

Because scar tissue has a strong tendency to stick together, if surgery is performed again before the scar tissue has fully matured, unpredictable results may occur.

The point at which these changes have finished can be considered the time when revision surgery can be performed, and that is judged to be around 6 months after surgery.

In the end, only after 6 months, when the scar tissue has softened and the previous surgery has fully settled, can the outcome of a later revision be predicted.

If, after 6 months, there is a pulling sensation or a sausage-like appearance, revision surgery with the full incision method is performed.

At our clinic, based on more than 20 years of extensive clinical experience and know-how, we perform surgery only after predicting the postoperative result through various examinations and tests during consultation, and only when there is a sufficient chance of improvement after surgery.

If there is enough extra skin, revision surgery is certainly possible.

The thick sausage-like appearance occurs when the line is designed too high in a person with thick skin, and the skin slides downward.

The surgery must incise along the existing scar line and partially remove the orbicularis muscle beneath the skin, which causes the sausage-like appearance, to make it thinner.

http://www.doublefold.co.kr

After coming in for consultation and examination, there are cases where, from the surgeon’s perspective, the eye shape is extremely difficult or it is hard to be confident that a satisfying result can be achieved.

In such cases, it is not always possible to answer with complete confidence, but if one answers that it is difficult, trust in the clinic may decline or one may be mistaken for an inexperienced doctor.

From the surgeon’s perspective, if they honestly and firmly assess the patient’s condition and explain what is difficult and where the result may turn out poorly, some patients accept that, but many others do not.

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 that contains no exaggeration and a surgeon who stands by their judgment.

http://www.duhans.com