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Revision Surgery Guide

INTRODUCTION OF REOPERATION

We offer alternatives for double eyelid revision surgery and restore a beautiful, natural eye shape.

Double Eyelid Revision Surgery

When the double eyelid line is too large, uneven, or has loosened, this surgery modifies the double eyelid line to restore the original natural and clear-looking double eyelid shape.

Indications for Double Eyelid Revision Surgery

When the double eyelid line is too large
When the double eyelid line has loosened
When the lines are asymmetric
When the eyes feel tired after double eyelid surgery
When there is a thick, sausage-like appearance below the incision line
When the overall impression looks worse after double eyelid surgery
When you want to restore a beautiful, natural-looking eye

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 clearer, and to create bright, refined eyes.

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

The purpose of double eyelid revision surgery is the same.

Its goal is to correct the eyes so they look larger, clearer, and more natural.

Revision Candidates

Object of reoperation

Please check whether you fall into any of the double eyelid revision candidates below.^^

Double eyelid line that is too large

A double eyelid line that is large is rarely a good fit, no matter the case.

A natural line is usually 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 one of the most common indications for revision surgery.

When the area below the line looks puffy and swollen - sausage phenomenon

This refers to the swelling of the area below the double eyelid line, commonly called the sausage phenomenon.

It gives the impression that the person had surgery only a few days ago, and can make viewers feel uneasy.

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

Correction is done by partially removing the orbicularis oculi muscle and then pulling the skin downward.

When the incision scar is prominent

This refers to a case where, even if you slightly lower your gaze, the incision mark is very visible and the double eyelid looks unattractive, as if it had been cut with a knife.

The cause may be constitutional factors, but it can also result from poor suturing or incorrect timing of stitch removal.

It should be corrected in line with scar revision surgery by excising the scar and suturing carefully.

When epicanthic folds are present

There are cases where the double eyelid line does not continue to the end and disappears halfway.

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

Epicanthoplasty is also called inner corner surgery, and if double eyelid surgery is performed together with inner corner surgery to create the fold, the line can continue to the end and look natural.

When there are wrinkles below the line

If there are multiple lines below the double eyelid line, the eyelid can look messy.

A beautiful line should be small and formed as one precise line. If there are many fine wrinkles in addition to the double eyelid crease, the eyes can look older and the overall impression may worsen.

In such cases, correction should be done with the partial incision method, or if that is not suitable, a certain amount of skin should be removed with the full incision method.

When the line is not clear and looks blurred

A double eyelid line should have a certain degree of clarity to look attractive.

When the line loosens and becomes blurred, it can look like a crease without any refined quality, creating an unfavorable impression.

In such cases, it should be corrected back to a clear line.

When the line is too deep and dark

It also looks awkward when the double eyelid line appears too deep or too dark.

Causes include sagging skin and sunken areas around the incision line.

The line should be clear, but a double eyelid line that looks too deep is also considered unattractive.

When the out-fold line extends excessively beyond the inner corner of the eye

An overly extended out-fold double eyelid line often looks unnatural because it gives a strong artificial impression.

An in-fold line that disappears in the middle due to an epicanthic fold is also awkward, but an out-fold line that extends beyond the inner corner of the eye and stretches too far also falls into the category of an unattractive double eyelid because it creates a strong and harsh impression.

When the double eyelid line is not smooth and has curvature

A beautiful double eyelid should follow a smooth curved line.

The ideal line is one where the inner side is small and gradually widens toward the outer side without any irregularity.

However, a curved line that is wide on the inner side, narrows in the middle, and widens again toward the outer side is one of the awkward line shapes.

When the eyelid is sunken

If there is sunken eyelid tissue above the double eyelid line, it can make the face look older or cause the line to appear larger or deformed, creating an awkward appearance.

Sunken eyelid tissue is a major cause of double eyelid deformity, so the sunken area should be corrected with micro fat grafting.

When there is an unnecessary inner corner surgery on the double eyelid line

Various problems can occur due to unnecessary inner corner surgery.

Inner corner surgery should only be done when necessary for eyes with an epicanthic fold. Unnecessary or excessive inner corner surgery can cause excessive exposure of the inner mucosa, a severe out-fold line, a narrow-looking eye distance, or a harsh eye shape.

Unnecessary inner corner surgery often makes the overall impression look worse, so care is needed.

When there is eyelash eversion in the double eyelid line

Sometimes the skin below the double eyelid line is pulled upward, causing the eyelashes to turn outward.

This can occur when scar adhesion is severe, when there is not enough skin, or when the sutures were pulled too far upward.

The adhesion must be released, and the skin must be pulled downward for correction.

When the eye has undergone lateral canthoplasty

This is a procedure that even plastic surgery textbooks state is better not to be done.

Lateral canthoplasty can cause various side effects, including mucosal exposure, eyelid eversion, a harsh eye shape, and severe scarring.

The rate of side effects from lateral canthoplasty is said to be over 90%, and it is a procedure that can create irreversible and serious complications, so caution is needed.

During Double Eyelid Revision Consultation

Types of examinations and tests

Measurement of skin laxity

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

Because revision surgery must remove at least some scar tissue before performing the procedure, skin laxity is an important indicator for predicting surgical prognosis.

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

If surgery is attempted aggressively when there is not enough skin laxity, the result may be poor, and lagophthalmos, in which the eyes cannot close properly, may worsen. Therefore, this is the most important test that must be done before revision surgery.

Measurement of levator palpebrae superioris strength (the eyelid-lifting muscle)

The second most important test for determining whether revision surgery is possible is the function test of the levator palpebrae superioris (eyelid-lifting muscle).

In cases of severe ptosis, how much function remains in the levator palpebrae superioris is an important factor.

The levator palpebrae superioris is the muscle that lifts the eyelid upward.

A certain level of function in this muscle is needed to predict a successful revision.

In patients with ptosis, if the levator function is significantly reduced, surgery may not be possible.

As a general rule, surgery should not be performed when the levator function is below a certain threshold.

Other examinations and tests

Measurement of eyelid skin thickness
Check for eyelash eversion
Examine the scar and degree of scar adhesion in the existing double eyelid line
Choose the method that can maximize improvement and satisfaction with excellent treatment results
Measure the height and degree of symmetry of the existing double eyelid line (scar line)
Measure the amount and presence of orbital fat, and the thickness and presence of the orbicularis oculi muscle
Measure the degree of ptosis by assessing the palpebral fissure height (vertical size when looking naturally straight ahead at eye level)
Measure the horizontal length of the eyes and the distance between the eyes (to determine whether an epicanthic fold is present)
Check for strabismus

Surgical plan based on the above examination 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 levator palpebrae superioris shortening

④ Determine whether orbicularis oculi muscle excision is needed

Based on the examination results, we predict the postoperative outcome and the likelihood of surgical success.

We recommend surgery only when it is judged to be possible.

If surgery is not possible, we explain why, or explain how far the procedure can realistically be taken.

http://www.doublefold.co.kr

Causes and Correction Methods for Double Eyelid Revision Candidates

Revision Candidate 1.

When the double eyelid line is too thick

For Korean faces, a double eyelid line that is only slightly visible suits the overall facial proportions and can be considered a natural and beautiful double eyelid shape.

If the double eyelid line is too thick, the eyes can look sleepy, and the other person may perceive the face as strong and rough.

● Causes

• A line designed too high without considering the eye shape

• Scar adhesion

• Ptosis

• As a result, insufficient skin laxity, etc.

● Correction method

The existing elevated line should be flattened or removed, and a new line should be designed at an appropriate height.

However, the height of the new line varies from person to person, and it is important to design it by considering skin laxity, eye size, and other factors to find the most natural height for that individual.

Revision Candidate 2.

When the eyes look sleepy (ptosis)

If the eyes do not open naturally after eyelid surgery and look sleepy, they should be corrected so the eyes open naturally and clearly again.

A sleepy-looking impression can easily leave a bad impression on anyone.

● Causes

• Congenital ptosis

• Pseudoptosis

• Scar adhesion caused by previous double eyelid surgery, etc.

● Correction method

Whether congenital or acquired, in cases of ptosis, the function of the levator palpebrae superioris should be measured and corrected accordingly with levator shortening or resection.

Revision Candidate 3.

When the double eyelid lines are asymmetrical

Everyone has some degree of asymmetry, but if the difference between both sides is obvious, it should be corrected.

● Causes

• Incorrect design from previous double eyelid surgery

• The lines loosen in different patterns

• Scar adhesion

• Ptosis on one side, etc.

● Correction method

If the double eyelid lines on both sides differ, surgery should be redone to match the eye that the patient wants to emphasize.

However, if revision surgery is performed on only one side, the eyes will not be perfectly symmetrical immediately after surgery. Even with a proper operation, it takes at least 1–2 months of patience to observe correction of the asymmetry, so deciding to operate on only one side should be done carefully.

Revision Candidate 4.

When the incision scar is too severe

If a severe scar remains when the eyes are closed after incisional double eyelid surgery, the incision should be redone to minimize scarring.

● Causes

• Poor suturing during the original double eyelid surgery

• Early stitch removal, causing wider scar spacing

• Late stitch removal, leaving the shape of the stitches behind

• Individual constitutional differences

● Correction method

After excising the existing scar, the muscle and skin should be sutured separately in a single layer with great precision so they do not shift out of alignment.

It is also important to remove stitches at an appropriate time so they do not affect the scar.

Revision Candidate 5.

When the double eyelid line has loosened

It may look fine right after surgery, but over time the width of the line narrows or loosens again. In such cases, this often happens after buried-suture methods, with the line gradually loosening and dropping.

● Causes

• Using a buried-suture method despite thick skin

• Incorrect double eyelid surgical technique

• Naturally thick skin or orbicularis oculi muscle

• Constitutional factors that make line adhesion less likely, etc.

● Correction method

Considering the patient's eye condition, correction is done using the incision method or partial incision method so that the line does not loosen again and remains clear.

Revision Candidate 6.

When the line is deformed due to scar adhesion

After previous double eyelid surgery, scar tissue above the incision line may adhere, creating a second line above the original one and resulting in a double-line appearance.

The appearance of another line above the incision indicates that the previous surgical method was incorrect, and it should be corrected.

● Causes

• When orbital fat repositioning was not performed

• Atrophy of orbital fat or excessive fat removal, etc.

● Correction method

In such cases, the adhered incision line must be released and turned into a single line.

In all double eyelid surgeries, the incision line should be the double eyelid line.

Revision Candidate 7.

When triple double eyelid lines occur

The double eyelid line should be based on the incision line, but sometimes another line forms above or below the incision line.

● Causes

• Adhesion of the scar from the existing double eyelid line

• Sagging skin

• Sunken eyelid

• Loosening of the line, etc.

● Correction method

For triple or quadruple lines, the method will vary depending on the cause, but the other lines except for the incision line that serves as the standard should be excised and corrected.

Revision Candidate 8.

When the inner line is thicker than the outer line

The ideal double eyelid line gradually widens from the inner corner of the eye toward the outer corner.

However, if the inner line is wider than the outer line, this is an abnormal shape and should be corrected.

● Causes

• Unnecessary inner corner surgery

• Incorrect design line

• Excessive skin removal during double eyelid surgery, etc.

● Correction method

A new design should be created to flatten the existing scar line, make the inner line as close as possible to an in-fold line, and correct the line so it naturally widens from the inner to the outer side.

Dr. Shin column

A double eyelid revision specialist with over 20 years of experience

Plastic surgery specialist Director Shin Duhan

When seeing people who have had double eyelid surgery, the first thing an expert tends to think is divided into categories such as “beautiful,” “too obviously operated on,” or “why did they have it done like that?”

The most important purpose of double eyelid surgery is, of course, to create beautiful eyes.

If the surgery is performed simply to create a double eyelid line, it can actually ruin the impression.

That is why double eyelid surgery is also called eye-shape correction.

What kind of double eyelids are beautiful?

People often think a successful double eyelid surgery is one where the line is clearly visible from the front. But if you look at TV commercials or actors and models, it is actually rare to find one whose double eyelid line is clearly visible when looking straight ahead.

However, when they slightly lower their gaze or try to close their eyes, a clear and beautiful double eyelid line appears.

I also think that models and actors have very well-done double eyelids.

Of course, I also perform double eyelid surgery at a level comparable to that of actors and models, but creating such ideal and beautiful results is not easy.

A person’s eye shape varies greatly, so it is not possible to operate on everyone with the same method and design.

The design must be tailored to each individual’s characteristics, and the height of the double eyelid must be determined precisely.

In addition, the surgery must be designed while anticipating how it will look once the line settles after 3 to 4 months.

After it fully settles, the most ideal double eyelid line is one that is barely visible when the eyes are open, or only slightly visible by about 1 mm.

Also, the skin below the incision line should not protrude as if it were swollen.

A double eyelid that appears raised below the incision line is a result of the line loosening and dropping, which reflects a technical problem in the surgery.

And after double eyelid surgery, the eyes are naturally expected to look larger.

However, there are cases where the eyes actually look sleepy after surgery.

No matter how pretty the double eyelid line is, if the eyes do not open in a clear and refreshed way, that is also an incorrect double eyelid.

Likewise, if the incision mark is visible when the eyes are closed, that is also an incorrect result.

If incision marks are visible despite having had the incision method, that is not acceptable.

A beautiful double eyelid should give others the impression that the eyes are large and attractive.

If someone says, “That person had a good double eyelid surgery,” it may sound like praise at first, but it also means the surgery is obvious to others, so it can only be seen as a problem.

A well-done double eyelid should look natural and should not appear obviously surgical to others.

At the same time, the eyes should look large, the double eyelid line should be barely visible, and there should be no visible incision marks when the eyes are closed, nor any protrusion of the skin below the incision line.

But very few people meet all of these conditions.

That is how difficult and delicate double eyelid surgery is.

Even though it is one of the most common operations performed by plastic surgeons, it is also one of the most difficult because every person’s eye shape and characteristics are different, requiring many variables to be considered during surgery.

A person who repairs machines handles the same kind of machine all the time, so once skilled, they make almost no mistakes and can fix machines well. But human tissue is not rigid like a machine, so many unexpected variables can lead to unwanted results, surprising both the doctor and the patient.

However, if a doctor has experience and skill, even if an undesired result occasionally occurs after surgery, there is no problem as long as it can be corrected immediately and a satisfactory outcome is achieved.

In conclusion, double eyelid surgery is about creating beautiful eye shape.

I hope those who want the surgery understand that it is not simply about creating a double crease in the eyelid.

Features of the Duhan Plastic Surgery Double Eyelid Revision Clinic

Dou

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

Re

We have a systematic system for revision surgery.

Su

Through preoperative consultation, we perform various examinations and tests to predict the postoperative outcome.

We only perform surgery when the examinations and tests show sufficient room for improvement.

If we judge that the desired result cannot be achieved, our principle is not to attempt surgery.

Ex

We identify problems with the previous surgery through examinations, provide sufficient and clear explanations, and suggest the best surgical method for the best results.

Su

We explain the surgical process and postoperative course clearly, and we also make sure to explain any possible side effects that may occur after surgery.

Su

We provide thorough postoperative care after surgery.

Su

We closely observe the postoperative progress to make sure the recovery process is proceeding properly.

Dou

We do our best through research and effort to make our clinic the last one patients need to visit, so that those who want double eyelid revision surgery will not need further surgery.