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In the case of a double eyelid line that is too large

A double eyelid line that is large is hardly ever flattering, no matter the case.

A natural line is appropriate when it is only 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 revision surgery.

When the area below the line appears swollen (sausage phenomenon)

When the area below the double eyelid line appears swollen, it is commonly called the sausage phenomenon.

It gives the impression of someone who had surgery only a few days ago and makes the viewer feel uncomfortable.

Causes of the sausage phenomenon include thick skin and orbicularis muscle, a line designed too high, or partial loosening of the line.

Correction is performed by partially removing the orbicularis muscle and then tightening the skin.

When the double eyelid line is too thick

From a general perspective, a double eyelid line that is only slightly visible looks natural and beautiful.

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

○ Causes

A line designed too high

Scar adhesion

Ptosis

Not enough excess skin, etc.

○ Correction

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

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

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Problems that arise during double eyelid revision surgery

● Problems in handling a very high scar line

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

In principle, the existing scar line should be excised, but if the scar line is too high and cannot be excised at all, surgery may have to be performed by flattening it rather than removing it.

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

The new double eyelid line must be created just below the existing scar so that the scar can be excised.

Although the existing scar line can be excised, it is difficult to reduce it as much as desired because the line must be placed high.

○ When the scar line is very high but the scar is faint

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

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

However, the advantage is that a new double eyelid line can be created where desired, allowing the line to be reduced sufficiently.

● Problems in handling excessively wide scar tissue

There is the problem of reducing the line after scar excision and the problem of preventing deformity in the shape of the double eyelid.

Causes of a pronounced scar line include improper suturing, lack of excess skin causing the scar line to widen, and frequent eye rubbing.

To solve the problems caused by a large scar line, the scar must be excised while considering skin excess, and rather than simple suturing, the tissue must be dissected and sutured precisely in layers to reduce scarring.

Also, deformity of the double eyelid must be prevented due to the excision of wide scar tissue, and the more scar tissue is removed, the more limited the ability to reduce the line becomes.

● Problems when scar tissue becomes very thick after multiple revision surgeries

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

The more surgeries are repeated, the firmer the skin tissue becomes and the thicker the scar becomes.

It is not easy to flatten thick, firm tissue and recreate the line.

Because of the firm scar tissue, the line may not form properly.

To create a new line, the existing firm scar tissue must be excised as cleanly as possible, and the scar tissue beneath the skin must also be neatly cleared away.

● Problems caused by an excessively outer-fold line

The outer fold must be reduced or changed to an in-fold, and this is the most difficult revision 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.

The outer fold must be reduced to an in-fold in order to create an overall natural line.

One of the most difficult techniques in revision surgery is turning an outer fold into an in-fold.

If the line cannot be properly reduced into an in-fold, the desired line cannot be achieved.

● Problems when an excessive epicanthoplasty has already been done

An excessive epicanthoplasty limits the ability to convert the line into an in-fold or a natural line.

Because of unnecessary excessive epicanthoplasty, a severe outer-fold line, excessive exposure of the mucosa, or side effects such as eyes appearing too close together may occur.

In cases of excessive epicanthoplasty, the priority is to make the line as much like an in-fold as possible, and if that is still not enough, epicanthoplasty restoration should be performed after six months.

● Problems when lack of skin causes lagophthalmos

If 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 because of multiple revision surgeries or excessive skin removal during surgery, the eyelids need to be made to close again, but if there is not enough tissue reserve, correcting lagophthalmos is essentially impossible.

The lagophthalmos is left as is, and only the thickness of the line is adjusted.

Reducing a thick line when there is insufficient skin is a very high-level, difficult operation that requires maximizing tissue stretching and rearrangement.

● Problems with wrinkled eyelids that lack elasticity

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

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

The key is to create the line while minimizing wrinkle lines, but in many cases the wrinkles cannot be fully smoothed, so surgery must be performed with certain limitations in mind.

● Problems when ptosis correction is not possible

If the upper eyelid levator has no function, further ptosis correction may not be possible, or lagophthalmos may occur.

Even after several ptosis corrections, some people still have sleepy-looking eyes.

If the upper eyelid levator has almost no function even after another ptosis correction, correction may be impossible.

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

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

● Problems when eye correction has been overdone

Reducing an overcorrected eye shape back to a normal size is much more difficult than ptosis correction.

If ptosis correction or eye correction has been overdone and the white of the eye becomes exposed, upper eyelid levator relaxation surgery must be performed to reduce the eye size again. However, if the upper eyelid levator is relaxed and then, a few months later, ptosis is induced, the eyes may open less.

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

The degree of upper eyelid levator relaxation must be carefully controlled through extensive experience and know-how.

● Problems when a patient visits after having undergone a reversal surgery

When a patient visits after having undergone reversal surgery at another hospital, recreating the line is often difficult or impossible.

One of the most difficult problems in double eyelid revision surgery is when the patient comes in after a reversal surgery performed at another hospital.

Nine out of ten cases cannot be revised.

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

Since such tissue later turns into thick scar tissue, it is almost impossible to excise the thick scar tissue again and create a natural line.

For the future as well, reversal surgery is not a procedure that should be done whenever possible.

Indications for double eyelid revision surgery

◇ 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 thick sausage-like phenomenon in the area below the incision line

◇ When the impression looks worse after double eyelid surgery

◇ When wanting to recover beautiful, natural eyes

Double eyelid revision surgery

This refers to surgery that corrects the double eyelid line and restores the original natural, 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 is to make the eyes larger and brighter and to create clear, sparkling 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 revision surgery is the same.

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

Features of our double eyelid revision clinic

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

② We have a systematic system for revision surgery.

③ Before surgery, we perform various examinations and tests through consultation to predict the post-surgical outcome.

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

If we determine that the desired result cannot be achieved for the patient, we make it a rule not to attempt surgery.

⑤ Through examinations, we identify what was wrong with the previous surgery, provide sufficient and clear explanations, and suggest the best surgical method for the best possible outcome.

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

⑦ We provide thorough aftercare after surgery.

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

⑧ The Duhan Plastic Surgery double eyelid revision clinic makes every effort and conducts research with the goal of being the last hospital a person visits so that they no longer need additional surgery.

Types of examinations and tests during consultation

The most important test for determining whether revision is possible is the amount of excess skin.

Because revision surgery requires removing at least some of the scar area before operating, the amount of excess skin is an important indicator for predicting the prognosis of the surgery.

If there is no excess skin, surgery may not be possible.

If surgery is performed forcefully when there is insufficient skin, the results will be poor and lagophthalmos, where the eyes do not close properly, will worsen. Therefore, this is the most important examination that must be done before revision surgery.

The second important test for determining whether revision is possible is the upper eyelid levator function test.

When ptosis is severe, the key issue is how much function remains in the upper eyelid levator.

The upper eyelid levator is the muscle that lifts the eyelid upward.

A certain amount of function in this muscle is necessary to predict the success of revision surgery.

In patients with ptosis, surgery may be impossible if the upper eyelid levator function is significantly weakened.

As a rule, surgery should not be performed when the upper eyelid levator function has declined beyond a certain threshold.

● Other examinations and tests

Measurement of eyelid skin thickness

Examination for the presence of eyelash eversion

Examination of the scar and degree of scar adhesion from the existing double eyelid line

Selection of methods that can maximize satisfaction by producing excellent procedural results

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 orbicularis muscle

Measurement of the degree of ptosis by measuring palpebral fissure height (vertical size when the eyes are naturally looking forward at eye level)

Measurement of eye width and the distance between the eyes (to determine the presence of an epicanthal fold)

Examination for strabismus

● Surgical plan based on the above test results

1. 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 upper eyelid levator shortening

4. Determine whether orbicularis muscle excision is necessary

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 why, or explain how far surgery can realistically be performed.

Revision from a thick outer fold line to an in-fold line

An outer fold refers to a line where the inner line remains visible all the way through.

A thin outer fold may suit some people, depending on the individual, but in severe outer folds it can create an awkward eye shape, so it must be corrected to an in-fold line.

Surgery that changes an outer fold line into an in-fold line is the core of double eyelid revision surgery and represents the peak of the surgeon’s skill.

If the inner line cannot be properly arranged as desired, the overall line becomes awkward and it is difficult to achieve the desired result.

Changing an outer fold to an in-fold when there is insufficient skin or severe scarring is one of the most difficult revision procedures.

● Causes of a thick outer fold

When the overall double eyelid line is designed too high

When the inner design line is placed too high

When unnecessary epicanthoplasty or excessive epicanthoplasty has been performed

Excessive skin excision

● Revision method for a thick outer fold line to an in-fold line

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

There are cases in which buried suture or partial incision methods may work, but these are only possible when adhesion is weak and the line has partially loosened.

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

The method is to perform a full incision, accurately dissect the space between the orbital fat and the upper eyelid levator, 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.

● Examples of revision from a thick outer fold line to an in-fold line

What makes revision surgery difficult is that changing an outer fold into an in-fold is the hardest part.

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

Please understand that there are not many surgeons in Korea who can always produce results that satisfy patients after revision surgery.

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

At our clinic, with more than 20 years of extensive experience and know-how, we perform various examinations and tests during consultation to predict the postoperative outcome, and we only proceed with surgery when there is a sufficient chance of improvement after surgery.

The most important factors in revision surgery are the amount of excess skin and the location and intensity of the scar line.

The purpose of revision surgery can be broadly divided into two goals.

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

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

Thick sausage phenomenon below the incision line + eye correction

This refers to a swollen, blister-like appearance below the double eyelid line that looks as if surgery was done only a few days ago.

In most cases, surgery can only be done with full incision, and part of the orbicularis muscle below the incision line must be removed to reduce the thickness of the muscle.

The sagging skin is lifted upward, pulled tight, and fixed in place.

● Causes of a thick sausage-like double eyelid below the incision line

When the line has been made too high

When the skin and orbicularis muscle are thick

When buried sutures for the double eyelid line were placed below the incision line height

When the sutured area loosens and the double eyelid line is pushed downward

● Sausage phenomenon after the buried suture method

This occurs because the line was designed too high and partially sags downward after surgery. It can be corrected by lifting the partially loosened line upward and re-fixing it firmly and tightly.

Surgery is performed with a partial incision or full incision method.

● Examples of thick sausage-like skin below the incision line + eye correction

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

First, one must accurately understand what was wrong with the initial surgery and how it should be improved in order to achieve good results.

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

If there is enough excess skin, revision is fully possible.

The purpose of revision surgery can be broadly divided into two goals.

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

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

A thick sausage-like line phenomenon occurs when thick skin is designed too high and then pushed downward.

During surgery, the existing scar line must be removed and a new line must be created below it.

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

If ptosis is present, revision surgery also opens the eyes more widely and corrects sleepy-looking eyes.

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

Correction of a thick line (Correction of thick fold line)

A double eyelid with an excessively thick line looks artificial and awkward, and gives the impression that the surgery was done very recently.

It also often causes ptosis that makes the eyes look sleepy.

● Causes of a thick double eyelid line

When the line was designed too high during the first surgery

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

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

The design standard is to first make a temporary line while sitting and find the line that best suits one’s own eye shape.

However, when designing while lying down, it is difficult to find a suitable line, and because the tarsal plate is used as a reference, there is a greater chance of designing a large double eyelid line.

When the skin is thick

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

In cases where the skin is thick, it is often necessary to set the line slightly lower than the average height.

When ptosis is present

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

This is because the eyes do not open fully.

When ptosis is present, the line should be set lower, or ptosis correction should be performed at the same time.

Protruding eye shape

When the eyes protrude, the line height should be set slightly lower than normal.

This is because protrusion of the eyeball can make the line appear larger.

It is important to make a temporary line while sitting and find the most natural line for one’s own eye shape.

Sunken eyelids

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

This occurs because the line is drawn upward along with the skin as the eyes sink.

In such cases, the line should be placed lower than normal, or fat grafting should be done first before double eyelid surgery to restore a normal eye shape, and only after several months should double eyelid surgery be performed to create a satisfying double eyelid.

● Why it is difficult to reduce a double eyelid line with the general method

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

This usually needs to be reduced to around 5 to 6 mm, and to do so, about 2 to 3 mm of skin, including the existing scar line, is typically excised.

One must understand what happens when 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, creating another large line of 8 mm or more, and the surgery will fail 100%.

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

To do this, tissue repositioning must occur, and for tissue repositioning, the space between the upper eyelid levator and the orbital fat must be accurately dissected so that the tissue can be repositioned and the line reduced.

● How to reduce a thick double eyelid line

Method using full incision

1. Excise the scar.

2. Dissect accurately between the upper eyelid levator and the orbital fat so that tissue repositioning can occur.

3. Advance the fat to prevent adhesion of scar tissue after dissection.

4. Firmly fix the skin below the excision line to the tarsal plate so that the skin does not pull upward.

5. Perform upper eyelid levator shortening so that the eyes open slightly wider.

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

6. Complete tissue repositioning by performing firm layered sutures through the tissues, preventing the tissues from pulling upward.

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

● Examples of correcting a thick double eyelid line with full incision

Cause of revision surgery failure (Cause reoperation fail)

If double eyelid revision surgery was performed but the result was not as desired, there can be several reasons.

● Major phenomena seen after revision surgery failure

The surgery was done to make a large line smaller, but the line barely changed or remained the same.

The swelling does not go down easily and looks awkward. - sausage phenomenon

Opening the eyes feels uncomfortable and the eyelids feel heavy.

There is a pulling sensation when opening the eyes, and they feel tight.

The line is severely asymmetrical.

Eyelash eversion does not recover.

Opening the eyes feels uncomfortable, but the eyes close well.

The scar line at the incision site is too dark.

● Causes of revision surgery failure

The biggest cause of failure is when the patient themselves thinks of double eyelid revision surgery as something simple.

After a failed double eyelid surgery, the idea of "we can just fix it again" leads to failed double eyelid revision surgery.

In order to undergo revision surgery, the patient themselves must understand the cause of the original mistake more than anyone else, so that failure does not happen again.

The following content analyzes the causes of revision failure in cases where the patient underwent revision surgery at another hospital, failed, and then came to our clinic for revision, through various examinations.

1. When revision surgery is performed together with epicanthoplasty

Some hospitals perform revision surgery to reduce the double eyelid line together with epicanthoplasty.

Epicanthoplasty tends to make the inner line thicker.

It does not make sense to perform revision surgery to reduce the line while at the same time performing surgery that makes the inner line larger.

A variety of problems can arise from epicanthoplasty that was completely unnecessary.

Epicanthoplasty should only be applied when necessary for eyes with an epicanthal fold. Unnecessary epicanthoplasty may cause excessive exposure of the inner mucosa, severe outer-fold lines, or side effects such as eyes appearing too close together or overly sharp.

Unnecessary epicanthoplasty often ruins the impression rather than improving it, so care is needed.

2. When scar tissue is not properly dissected during revision surgery

During revision surgery, the existing scar must be removed or clearly dissected to release the adhesion between the stuck tissues.

Otherwise, tissue repositioning cannot occur.

If the muscle layer and fat layer are not clearly dissected while releasing adhesions, tissue repositioning becomes impossible and it is difficult to narrow the double eyelid line.

If suturing is done without proper dissection, the double eyelid line will not narrow at all, and instead the skin below the incision line will be pulled upward, causing eyelash eversion.

3. When orbital fat is not repositioned

If the fat that needs repositioning is neglected, the dissected tissue can stick back together, the eyes do not open widely, and even a triple eyelid may form.

Along with scar tissue dissection, repositioning the orbital fat is one of the important surgical steps that serves as a lubricant to prevent tissues from sticking together.

4. When fat is not repositioned to the inner corner of the eye

If orbital fat is not repositioned toward the inner corner of the eye, scar tissue may form on the inner side of the eye and interfere 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 opening the eyes widely, and if too much scar tissue forms in this area, the eyes cannot open widely or a natural line cannot be created.

5. When ptosis correction (eye correction) is not performed

In the case of sleepy-looking eyes, eye correction must be performed to make the eyes open wider.

Usually, upper eyelid levator shortening is performed. The upper eyelid levator is an important structure that opens the eyes, and most patients undergoing double eyelid revision have weakened eyelid-lifting muscles.

It is important to perform upper eyelid levator shortening (step 6) to make the eyes open widely.

If this is not done, the existing sleepy-looking eyes will not be corrected, reducing the effect of double eyelid revision surgery.

6. When stitches are removed too early

The reason stitches are removed later during revision surgery is that most revision patients have little excess skin, and because tissue repositioning has been performed, the tissues must be held in place with the force of the sutures to secure them firmly.

The repositioned tissues have a tendency to return to their original state like a spring, so they must be held in place by the sutures. But if the sutures are removed before the tissues have stabilized in their new positions, the tissues return to where they were and lead to poor surgical outcomes.

7. When fat grafting and double eyelid revision are performed at the same time in patients with sunken eyelids

Some hospitals perform fat grafting and double eyelid revision at the same time when the eyelids are sunken and revision is needed, but this should not be done.

Fat grafting should be performed first, and double eyelid revision can be done 3 to 6 months later.

During revision surgery, tissue must be dissected, but fat grafting cannot be performed into dissected tissue.

If fat grafting and revision are done at the same time, it is like scattering fat into an opened dissected space; the fat does not settle properly and only damages the double eyelid line.

Therefore, performing the two surgeries at the same time is not appropriate.

8. Problems that occur when fat grafting and double eyelid revision are performed together

If fat grafting is done, swelling makes it almost impossible to precisely assess or adjust the double eyelid line.

As a result, the desired line is not achieved and the patient becomes dissatisfied with the surgery.

If the eyelids are incised for double eyelid surgery immediately after fat grafting, the transplanted fat will spill out through the incision site.

During revision surgery, one must dissect between the orbital fat layer and the upper eyelid levator layer, but fat has been grafted into that area.

Conversely, if fat is directly grafted into the orbital fat layer after incision, the grafting will not be precise or delicate, and the fat may not settle properly later or may cause irregular contours and other unsatisfactory outcomes.

Attractive double eyelids

There is no fixed standard for an attractive and beautiful double eyelid line, but here we will look at what is generally considered an attractive double eyelid line.

A beautiful double eyelid is one that does not look surgical and appears natural and attractive.

Please refer to the following.

It is not good if the double eyelid line is too large.

In general, a large line often makes the impression awkward.

Depending on one’s aesthetic viewpoint, a large and prominent line can give an artificial and awkward impression.

The most beautiful and ideal double eyelid line is one that is only slightly visible, about 1 to 2 mm, when the eyes are open.

It is good if the double eyelid line extends clearly to the inner corner of the eye.

Depending on the case, East Asian eyes may have an epicanthal fold (inner canthal fold), and if this is overlooked during surgery, the inner line may disappear, creating a feeling of heaviness.

It is best to make the line visible all the way to the inner corner as much as possible. If the line is not properly formed because of an epicanthal fold, epicanthoplasty should be performed; if there is no epicanthal fold, the design should be done well so the line does not break off at the inner side.

Surgical scars should not be visible.

The biggest drawback of incisional surgery is scarring.

How much scar remains depends on the surgeon’s skill and the patient’s individual physical factors.

Scars are relatively more likely to occur in people with thick skin and thick orbicularis muscle.

Once a scar forms, there is no way to erase it, although severe scars can be made less visible through scar revision surgery.

Therefore, it is important during the first surgery to minimize scarring through appropriate skin excision and delicate suturing.

The eyelids should look thin.

The causes of eyelids looking swollen include thick skin or orbicularis muscle, or a large amount of orbital fat or preaponeurotic fat.

It is better to solve these problems while performing double eyelid surgery.

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

This can be removed during double eyelid surgery.

Another method is to partially remove a thick orbicularis muscle layer beneath the skin. The orbicularis muscle below the incision line can be partially removed, whereas the orbicularis muscle above the incision line is difficult to remove.

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

In some East Asian people, an epicanthal fold (inner canthal fold) causes the skin at the inner corner of the eye to cover the eyeball, creating a cramped appearance. Removing it increases the horizontal width of the eyes and makes them look brighter, so the double eyelid line is also clearly visible to the inner side.

However, surgery must be done carefully with consideration of the eye shape to avoid unsatisfactory results.

If the eyes do not appear too far apart and there is almost no epicanthal fold at the inner corner, doing epicanthoplasty may instead make the eyes appear too close together or sharpen the eye shape, causing side effects. Therefore, epicanthoplasty should only be done after an accurate physical examination and only when it is indicated.

If ptosis is present, it should be corrected together.

Ptosis refers to a sleepy-looking eye in which the upper eyelid droops and covers the pupil because the function of the upper eyelid levator that lifts the eyelid is weak. If this is overlooked during surgery, the double eyelid line may not look beautiful.

Before double eyelid surgery, the eyes should look large and bright for the double eyelid to look beautiful as well.

Depending on the degree of ptosis, if ptosis correction is judged to be necessary, it is better to correct it together with the incisional method.

Pre- and post-operative care (Before & after management)

Preoperative care guidelines

1. Through sufficient consultation before surgery, the patient should understand the causes of the failed double eyelid surgery and the surgical process.

2. Do not drink alcohol the day before surgery.

Alcohol reduces the effect of anesthetic drugs, which may cause problems with anesthesia during surgery.

3. Whenever possible, avoid surgery during the menstrual period.

If there is a lot of bleeding during surgery, it can interfere with the procedure and cause significant bruising.

Postoperative care guidelines

The usual schedule of visits after surgery is the day after surgery and one week later, for a total of two visits.

• Day 1 after surgery: The surgical area is disinfected at the hospital, you receive a shot to reduce swelling, and your progress is checked.

• Day 4 after surgery: Progress is checked and the continuous sutures are removed.

• Day 7 after surgery: Progress is checked to see whether the surgery went well or if there are any problems, and the remaining stitches are removed.

• One month after surgery: Check whether the double eyelid line is settling in well.

Things to do at home

• Cold compresses

Apply cold compresses with the cooling pack provided by the hospital.

Do this for 2 hours a day for 3 days.

The 2 hours can be done continuously, or split into 20 to 30 minute sessions.

It is usually convenient to do this before going to sleep.

• Disinfection and eye drops

Disinfect the surgical area with the prescribed medication.

Disinfection is done by yourself only until the stitches are removed.

Use the artificial tears and eye drops prescribed by the hospital to prevent dry eyes.

• Scar management

Apply the prescribed eye ointment to the surgical area for about one month.

The scar-prevention eye ointment helps reduce scarring and calm the redness, so apply it twice a day for 3 to 4 weeks.

• Makeup and washing the face

These are allowed starting one week after stitch removal.

Until then, use a wet towel instead of washing the face.

Swelling after surgery

There are individual differences, but usually the swelling subsides to some extent in 7 to 14 days, while the period for complete settling is between 1 and 3 months.

When upper eyelid levator shortening is performed during revision surgery, lagophthalmos may occur temporarily, meaning the eyes do not close fully.

Depending on the degree of ptosis and the extent to which the upper eyelid levator has been shortened, this usually lasts around 15 days, but in very rare cases it may continue for more than 6 months.

Lagophthalmos management

When upper eyelid levator shortening is performed to make the eyes open more widely, temporary lagophthalmos may appear, meaning the eyes do not close fully. Depending on the degree of ptosis and how much the levator has been shortened, this usually lasts about 15 days, but in some cases it may continue for more than 6 months.

On average, it progresses for about 2 to 3 months and then the eyes close naturally.

During this period, artificial tears (eye drops) prescribed by the hospital are used to prevent dry eye.

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Double eyelid revision surgery accounts for a large portion of plastic surgery procedures.

As double eyelid surgery is one of the most commonly performed procedures in plastic surgery, there are many possibilities for various problems to occur.

In addition to board-certified plastic surgeons, surgeries are also being performed by non-specialists, so concerns about side effects are inevitably high.

Unfortunately, these problems are also a matter of the medical system itself.

It is wrong to refer patients to people who do not hold specialist qualifications, and because each specialty does not have a clearly defined exclusive area and overlaps in some areas with other departments, these issues arise.

For example, eye clinics performing double eyelid surgery, or ear, nose, and throat clinics performing augmentation rhinoplasty.

In principle, plastic surgery should be performed in plastic surgery clinics.

If cosmetic surgery were performed by a board-certified plastic surgeon, the risk of surgical side effects would be much lower.

A large number of victims are produced by cosmetic procedures performed by unqualified doctors, and patients who experience side effects of cosmetic surgery cannot trust the doctor who performed the first surgery, so they are forced to seek another plastic surgeon and go through the pain of having their unsatisfactory cosmetic surgery corrected again.

First and foremost, before choosing cosmetic surgery, rather than focusing on cost, you should check whether the doctor you plan to see is a board-certified plastic surgeon and then proceed with surgery.

Most people assume that if there is a plastic surgery sign on the clinic, then everyone there is a board-certified plastic surgeon, and the number of people who experience dissatisfaction or side effects after surgery continues to increase.

For the person who needs revision surgery, it can also be difficult and frustrating from the specialist’s point of view to correct a painful and unattractive double eyelid.

Even for the specialist who must perform revision surgery, there are sometimes cases in which they truly do not want to operate.

This is because there are cases where the condition of the patient’s eyes is so severe that it feels impossible to touch them.

Rather than undergoing revision surgery, it is more important that the patient does not create a situation that requires revision surgery in the first place.

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