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What is double eyelid revision surgery?

It refers to a procedure that corrects the double eyelid line and restores it to a natural, refreshed shape when the line is too large, uneven, or has come undone.

What are the indications for double eyelid revision surgery?

◇ When the double eyelid line is too large

◇ When the double eyelid line has come undone

◇ When the line is asymmetric

◇ When the eyes feel tired after double eyelid surgery

◇ When there is a thick sausage-like appearance below the incision line

◇ When the impression looks worse after double eyelid surgery

◇ When the goal is to restore beautiful, natural-looking eyes

What is the purpose of double eyelid surgery?

The purpose of double eyelid surgery is not simply to create a double eyelid line.

The purpose of double eyelid surgery is to make the eyes look larger and brighter, and to create 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 goal is to correct the eye shape so that it looks larger, brighter, and more natural.

Correcting asymmetric double eyelid lines

Causes of asymmetric double eyelid lines

◇ When the heights of the double eyelid creases are different

◇ When one eye has ptosis

◇ When one double eyelid line has come undone

◇ When the skin on one side has sagged

◇ When the eyelid tissue sinks due to insufficient orbital fat, causing the line to be pulled upward

◇ When the line is pulled upward due to scar adhesion

When the skin on one side has sagged

If the heights of the double eyelid lines are the same but asymmetry occurs because of sagging skin,

the sagging side is corrected by removing the excess skin with the full incision method.

When both sides are asymmetric and both lines look awkward

If both sides are asymmetric and neither line looks pretty or natural, both sides need revision surgery.

The lines must be designed at the same height, the existing scar line must be removed, and the line must be completely repositioned to create a new line.

When one double eyelid line has come undone

If one side’s line has come undone, the loosened side is corrected using either the partial incision method or the full incision method.

As a rule, if the skin is very thick or the scarring is not severe, correction is first attempted with the partial incision method.

If it still comes undone, correction is done with the full incision method.

When one eyelid has sunk, pulling the line upward and causing asymmetry

When the eyelid sinks because of insufficient orbital fat, the line is pulled upward and appears larger.

In such cases, simple correction with micro fat grafting is possible without revision surgery.

Micro fat grafting is a simple procedure that injects fat with a syringe.

Correcting a thick pseudo-ptosis line - full incision method

A thick pseudo-ptosis line can be corrected with 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 procedure is carried out in 10 steps, and if any one step is omitted, the results may fall below expectations.

Even if it takes some time, better results can be achieved only when all of these steps are carefully checked and performed with great care.

Two goals of full incision surgery

There are two main goals in correcting thick pseudo-ptosis.

First: To reduce the large, unattractive double eyelid line and create a natural, thinner line

Second: To make the sleepy, drowsy-looking eyes open more widely and look brighter

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

Full incision surgery process

● Step 1 - The planned incision line is designed to include the existing incision scar tissue.

Before surgery, the design is made to create a new double eyelid line below the scar line and to determine the amount of skin to be removed up to the 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 resection width becomes 3 mm. The new double eyelid line is determined by considering how much the line should be lowered and the amount of extra skin available.

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

● Step 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 edge of the excised area becomes the new double eyelid line, and the upper edge must be dissected so that it can be naturally pulled downward and closed with sutures.

● Step 3 - The orbicularis muscle, orbital fat, and skin adherent to the levator muscle are dissected.

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

Scar tissue dissection involves separating the area between the orbital fat layer and the levator muscle, and in some cases the space between the muscle and the fat is also dissected to allow forward repositioning of the fat.

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

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

If scar adhesion is very severe, in rare cases a 1 to 2 mm vertical incision is made in the orbicularis muscle to release the contracture.

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

Forward repositioning of the orbital fat is a process that helps prevent re-adhesion of the tissues.

If the fat is not repositioned, the tissues may adhere again, which can lead to ptosis and a sleepy, drowsy appearance.

Sometimes a triple eyelid can also form, which distorts the double eyelid line.

Another effect of repositioning the orbital fat is that if the eyelid has sunken, the depression can be corrected to some extent. As a result, 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 - The levator palpebrae superioris muscle is shortened to strengthen its function.

Levator shortening is one method of correcting ptosis.

It is simple and effective, and has the advantage of correcting the condition with almost no tissue damage.

Rather than cutting the levator muscle, the method simply advances it and ties it to the tarsal plate (cartilaginous plate).

In revision surgery, levator shortening has two effects: it makes the eyes open wider so the eye shape can be corrected more clearly, and it also reduces the double eyelid line as the eyes open wider.

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

In addition to forward repositioning of the fat, fat is inserted into the inner canthus of the eye to prevent scar tissue adhesion.

The inner part of the eye is the area most prone to scar adhesion. Adhesion in this area makes the eyes look drowsy, makes it difficult to open them fully, 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 fixed with sutures.

● Step 8 - During suturing, layered closure is performed so that the repositioned structures do not shift.

The suturing method for revision surgery is not simple.

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

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

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

In addition, the orbicularis muscle and skin above the incision line must both be passed through by the sutures and securely closed in layers to obtain the desired double eyelid line.

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

The swelling reducer hyaluronidase is a medication with a water-dispersing effect, and it quickly reduces swelling as soon as it is administered. However, excessive use can instead cause more bruising, so it is used only in a limited way to reduce swelling.

● Step 10 - Removal of the sutures is done in two stages, on day 4 and day 7.

Sutures are usually removed around 7 days after surgery.

The reason sutures are removed late is that in revision surgery there is usually not enough excess skin, and because the tissues are advanced during surgery, the suture line is placed under significant tension.

Therefore, if the sutures are removed on day 3 or 4, the tense suture line may open, or the scar line may widen and become more noticeable, causing larger scars and making the tissues gradually pull upward, which can also make the double eyelid line larger.

Thus, the sutures should remain in place until the tissues stabilize, so it is better to leave them in longer.

To prevent the suture marks from making the scar look messy, most of the sutures are removed on day 4 and only 3 to 4 sutures are left, so there are almost no visible suture marks.

To reduce early inflammation and swelling quickly, steroids are administered for about 1 to 2 days.

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

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

Examples of full incision surgery applications

Lateral canthoplasty surgery

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

Lateral canthoplasty refers to a procedure that opens the outer corner of the eye, the opposite of epicanthoplasty.

Types of side effects from lateral canthoplasty

◇ Eversion of the eyelid and a lifted appearance

◇ Distorted scars at the outer corner of the eye

◇ Exposure of the mucosa and sagging of the eyelid

◇ Excessive exposure of the lower white of the eye

◇ Deformation of the eye shape and twisting of the outer canthus

◇ Dry eye and tearing

Examples of side-effect correction surgery from other hospitals

Duhan Plastic Surgery’s competitive edge - lateral and lower canthoplasty

Based on more than 20 years of abundant clinical experience and know-how, when the outer eye corners are upturned and the horizontal length of the eyes is short, combining lateral canthoplasty and lower canthoplasty can create a larger, gentler impression.

However, with lateral and lower canthoplasty, there are eyes that benefit greatly and eyes that do not, depending on the shape and structure of the eye and eyeball.

In lateral and lower canthoplasty, tissue that would reattach is sufficiently removed through skin dissection, so it does not reattach. In addition, the procedure delicately sutures according to the anatomical structure from the inner conjunctiva of the eye to the ligament-fascia layer, muscle layer, and skin layer.

This surgical method addresses the drawback of traditional lateral canthoplasty, which is reattachment.

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 other hospitals, it is not performed with skin incision alone. By firmly fixing it to the periosteum, it does not loosen and is a safe procedure that can also be reversed later.

The sutured area is naturally hidden along the eye corner line to minimize visible scarring, and thanks to years of know-how in double eyelid revision surgery,

delicate and precise suturing leaves almost no scar.

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

Our clinic does not perform surgery in a uniform, one-size-fits-all way.

With 1:1 custom 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

Care guidelines before and after double eyelid revision surgery

Pre-surgery care guidelines

1. Through 충분한 consultation before surgery, you should understand on your own the causes of the failed double eyelid surgery and the surgical process.

2. Do not consume alcohol the day before surgery.

Alcohol reduces the effect of anesthetic drugs, so anesthesia may not work properly during surgery.

3. Whenever possible, avoid undergoing surgery during menstruation.

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

Post-surgery care guidelines

After surgery, visits are generally made the next day and again one week later, for two visits in total.

◇ Day 1 after surgery: You will receive disinfection of the surgical area at the hospital, an injection to reduce swelling, and follow-up observation.

◇ Day 4 after surgery: Your progress will be checked and the continuous sutures will be removed.

◇ Day 7 after surgery: Your progress will be checked to see whether the surgery went well or whether there are any problems, and the remaining sutures will be removed.

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

Things to do at home

◇ Cold compress

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

This should be done for 3 days, 2 hours a day.

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

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

◇ Disinfection and eye drops

Disinfect the surgical area with the prescribed medication.

Disinfection is done only until you remove the sutures yourself.

To prevent dry eye, use the artificial tears and eye drops prescribed by the hospital.

◇ 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 redness, so apply it twice a day for 3 to 4 weeks.

◇ Makeup and face washing

This is possible starting one week after the sutures are removed.

Until then, wash your face with a damp towel instead.

Swelling after surgery

There are individual differences, and in most cases the swelling subsides to some extent within 7 to 14 days, but the period for full settling is 1 to 3 months.

If levator shortening is performed during revision surgery, temporary lagophthalmos, where the eyes do not fully close, may occur.

Depending on the degree of ptosis and the extent to which the levator muscle is shortened, it usually takes 15 days and in very rare cases more than 6 months.

Lagophthalmos management

When levator shortening is performed to help the eyes open wider, temporary lagophthalmos, where the eyes do not fully close, may appear. Depending on the degree of ptosis and the extent to which the levator muscle is shortened, it may take as little as 15 days or as long as more than 6 months.

On average, this progresses for about 2 to 3 months before the eyes naturally begin to close fully again.

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

Q&A about double eyelid revision surgery

I want my first double eyelid surgery. Is it okay to get it from a specialist in revision surgery?

It would be unfortunate to need revision surgery, so the first double eyelid surgery should be done well.

The highest level of double eyelid surgery is double eyelid revision surgery, so the initial surgery should be performed properly to avoid needing revision later.

Can just anyone perform double eyelid revision surgery?

Double eyelid revision surgery requires top-level skill and experience among cosmetic surgeries.

If you hastily undergo surgery at a hospital without experience or skill, there may be no improvement at all, and the impression may be made worse.

Therefore, revision surgery should be decided carefully, and you should make sure to be treated by an experienced specialist.

Can double eyelid revision surgery and epicanthoplasty be done at the same time?

If a hospital recommends doing revision surgery and epicanthoplasty at the same time, it may be a hospital that does not understand double eyelids, so this should be kept in mind very carefully.

Epicanthoplasty (removal of the Mongolian fold) has the effect of thickening the inner line.

It should, in principle, not be done together with revision surgery intended to reduce the line.

If epicanthoplasty, which thickens the line, is performed together with surgery intended to reduce the line, the inner eye line may become distorted or the line may become thicker, making it impossible to achieve the desired result.

This is like two boatmen sharing one boat, with one rowing east and the other rowing west.

Epicanthoplasty is a surgery that should be performed only when there is a clear indication. If epicanthoplasty is truly needed, the decision should be made several months after revision surgery, once the result has fully settled.

One should never recklessly perform revision surgery and epicanthoplasty at the same time and end up with a poor result.

If the eyelid has sunken, can fat grafting be done together with double eyelid revision surgery?

If the eyelid has sunken and the double eyelid line is awkward, making revision surgery necessary, fat grafting should be done first, and then double eyelid revision surgery can be performed 3 to 6 months later.

Revision surgery should be performed only after the eyes have been restored to a flatter appearance following fat grafting.

During revision surgery, tissues must be dissected, and fat grafting cannot be done inside the dissected tissue. If fat grafting and revision surgery are performed at the same time, it is like scattering fat into an empty dissected space, so the fat will not properly survive, and only the double eyelid line will be damaged.

Therefore, doing both surgeries at the same time is not reasonable. If a hospital suggests doing them together, it is likely a hospital without proper understanding or experience, so please keep this in mind.

I dislike my existing double eyelid line and want to remove it completely. Is that possible?

There is a so-called surgery to "undo" double eyelids, but such surgery should not be done.

Once more than a week has passed after surgery, whether it was done by the buried suture method or the incision method, there is in principle no such thing as surgery that simply undoes the surgical eye shape.

That is because the incision line remains visible when opening or closing the eyes, which is truly unattractive, and the eyelid often becomes uneven or appears saggy.

Instead, the double eyelid should be made into a hidden, subtle line so that it is barely visible when the eyes are open.

Some people undergo an undoing procedure and then find their eye shape even more awkward, wanting to create a line again. However, if an undoing procedure has already been done, it is almost impossible to later redo the line with revision surgery, so this should be kept in mind.

I had surgery at another hospital. When can revision surgery be done?

Usually, revision surgery is possible about 6 months after the last surgery.

The reason is that the scar tissue must heal and settle completely for the results to be good even if revision surgery is performed.

If reddish redness or bumpy hypertrophic scars remain in the scar tissue, surgery is difficult.

The time it takes for scars to settle varies from person to person. Usually, after 6 months the scars have settled to some extent, but some people take longer depending on their constitution, so revision surgery is possible when all redness at the scar site has disappeared.

I’m scared of having revision surgery.

Doing double eyelid surgery again after one failure is several times more frightening than doing it for the first time.

It is because of the fear of what if it fails again.

However, if you have enough consultation and entrust the procedure to a revision surgery specialist, you can achieve the desired result.

I had revision surgery elsewhere, but it did not improve at all. Is revision surgery still possible?

Depending on the condition, there are indeed cases where it is not possible.

However, if there is enough room for improvement through preoperative consultation, it can be returned to a natural-looking eye.

What if revision surgery fails again?

If preoperative examination and evaluation show that there is no possibility, we do not attempt surgery at all, as a rule.

However, if the procedure is sufficiently feasible, we can restore a beautiful eye shape along with a successful surgery.

When can I return to daily life after double eyelid revision surgery?

No bandage or tape is applied after surgery.

Therefore, you can return to daily life immediately.

There may be some swelling and bruising, but it is generally less than with a first-time surgery.

Even after about a week, the eye shape is usually not very awkward.

Also, not using bandages helps the swelling go down faster and allows the line to settle a little sooner.

How many times do I need to visit the hospital after double eyelid revision surgery?

After surgery, you will generally visit the hospital about 3 times: the next day after surgery, and on days 4 and 7 when the sutures are removed.

However, if the distance between the hospital and your home is too far, it is fine to visit only on the day the sutures are removed.

The final sutures are usually removed around day 7.

After double eyelid revision surgery, how much swelling and bruising occurs compared with first-time surgery?

Compared with first-time double eyelid surgery using the incision method, revision surgery generally causes less swelling.

Revision surgery does not necessarily mean more swelling and bruising.

In many cases, swelling and bruising appear more mildly than in first-time surgery, so there is no need to worry too much about them.

What happens to scars after double eyelid revision surgery?

One of the goals of revision surgery is to improve the messy, dark scars from the original surgery as much as possible.

For about 3 to 6 months after surgery, there is redness, so the scar line may appear slightly noticeable.

This is a normal course for anyone who has had double eyelid surgery with the incision method.

Usually, only after at least 3 to 6 months have passed does the scar line gradually fade and settle.

After 6 months, the scar line has usually faded and in most cases becomes less noticeable than the original surgical scar.

Advantages and pride of Duhan Plastic Surgery’s double eyelid revision clinic

1. Experienced medical team and safety

Director Shin Duhan, who has focused on thousands of double eyelid revision cases and averages more than one case per day, works as a team with experienced nurses.

2. 1:1 customized surgical plan

Based on each patient’s double eyelid condition, we consider gender, overall facial harmony, and the patient’s wishes.

The proportion of correcting from out-line to in-line and performing epicanthoplasty or lateral canthoplasty at the same time as double eyelid surgery continues to increase.

If epicanthoplasty or lateral canthoplasty is appropriate for the eye and is performed together with revision surgery, the effect is doubled.

The height of the double eyelid line and the line shape (in-line, in-out line, out-line, etc.) reflect the patient’s preference, and the current trend in double eyelid lines is "naturalness."

3. Double eyelid revision surgery without side effects

People undergoing double eyelid surgery worry whether the line will come undone or whether scars will remain.

Side effects are reduced by Director Shin Duhan’s analysis and his ability to precisely carry out the line exactly as analyzed.

Also, delicate incision and suturing help prevent asymmetry.

4. Results that are hard to imitate

There are many hospitals that perform double eyelid revision surgery, but even if the surgery name and method are the same, the results are not the same.

With more than 20 years of extensive experience, we provide the optimal beautiful line for each individual patient.

Double eyelid surgery is often thought of as a simple procedure, but revision surgery is quite complicated.

Double eyelid revision surgery includes a detailed process of newly designing the line and completely separating and dissecting the previously adhered double eyelid tissue.

With this careful dissection process, there are no side effects such as the line becoming uneven later or adhering and curling upward.

By neatly organizing all tissues in the skin, fat, and muscle layers one by one, we can produce surgical results that are difficult to imitate even in very difficult revision cases.

5. Double eyelid revision surgery and eye correction at the same time

In Duhan Plastic Surgery’s double eyelid revision clinic, eye correction surgery is included with double eyelid surgery to correct sleepy eyes or eyes with hidden pupils that look dull.

By tying and shortening the levator palpebrae superioris muscle that opens the eyes, we adjust how much of the pupil is visible and make the eye shape clearer.

6. Research, lectures, and educational activities on double eyelid revision surgery

The most reliable answers come from extensive clinical experience.

Double eyelid revision surgery is like a premium product perfected through years of experience.

Through this accumulated experience, we also carry out research and educational activities.

7. Increase in consultation requests for revision surgery

As newly established hospitals spring up and perform double eyelid surgery indiscriminately, requests for revision surgery are also increasing, which is truly unfortunate.

If revision surgery is performed and fails repeatedly, the amount of excess skin decreases, making later revision surgery even more difficult and extreme.

Not only is the first choice important in double eyelid surgery, but when considering revision surgery, it should be approached carefully, as if it were the last chance.

8. Artisan craftsmanship for a more complete and beautiful face

A doctor who performs double eyelid surgery among cosmetic procedures must have the sensibility of both a doctor and a designer.

If one insists only on a uniform double eyelid line without understanding what makes a beautiful line, it is impossible to achieve a perfect line suited to each patient.

If there is no eye for beauty, or even if there is, no skill to reproduce it, a masterpiece cannot be created.

We do our best down to the very last stitch to provide beauty and satisfaction to each and every patient.

9. Honest surgery with sincerity

If a procedure is expected to achieve a satisfaction rate above 80%, we recommend it, but we do not perform unnecessary procedures, even if requested.

We aim for a hospital that treats patients honestly through skill and results.

10. A trustworthy premium hospital

There is a reason why an artisan’s work is expensive.

It is because they create work that is beautiful and valuable.

Duhan Plastic Surgery’s double eyelid revision clinic takes pride in and is confident about its procedures.

Proper surgery will become an opportunity for confidence throughout one’s life.

We aim to be a hospital that offers more expensive procedures but delivers satisfying results, rather than hospitals that recommend surgery at low prices and rotate different directors through the operation.

http://www.doublefold.co.kr

http://www.doublefold.co.kr