[Duhan Plastic Surgery Eye Surgery] - [Double Eyelid Scar, Double Eyelid Scar Tissue, Revision Surgery for Pigeon Eyes and Ptosis Correction]

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##Double Eyelid Revision Surgery

This refers to surgery that revises the double eyelid line and restores a natural, refreshed double eyelid shape when the line is too large, uneven, loosened, or otherwise problematic.

##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 appearance below the incision line
When the impression looks worse after double eyelid surgery
When you want to restore beautiful, natural-looking eyes

##The Purpose of General Double Eyelid Surgery

Double eyelid surgery is not simply intended to create a double eyelid line.

The purpose of double eyelid surgery is to make the eyes look larger and more open, and to create bright, refined eyes.

Surgery performed only to make a double eyelid line is likely to lead to unwanted results.

The purpose of double eyelid revision surgery is the same.

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

##When the Incision Scar Is Dark

This is a case where, if you slightly lower your gaze, the incision mark is very noticeable, leaving an unattractive double eyelid that looks as if it has been cut with a knife.

The causes may include constitutional factors, but also incorrect suturing and improper timing of stitch removal.

It should be corrected by excising the scar and performing delicate suturing, similar to scar revision surgery.

##Problems in Managing a Very High Scar Line

In many cases, the existing scar line cannot be excised during surgery.

In principle, the existing scar line should be removed, but if the scar line is excessively high and cannot realistically be excised, there are cases where surgery must be performed by spreading the tissue without removing the scar.

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

A new double eyelid line must be created just below the existing scar, and the scar should be excised.

Although the existing scar line can be removed, the line must be placed higher, so it cannot be reduced as much as desired.

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

Instead of excising the existing scar line, it is released and spread out.

Then the existing scar line remains faintly visible, so a slight scar can still be seen when the eyes are closed.

However, because a new double eyelid line can be created in the desired location, the advantage is that the line can be reduced sufficiently.

##Problems in Managing an Excessively Wide Scar

There are issues with reducing the line after scar excision and with preventing distortion of the double eyelid shape.

The reasons the scar line becomes darker include incorrect suturing, lack of excess skin causing the scar line to spread, and frequent eye rubbing.

To address the problem of a large scar line, the scar should be excised while considering the amount of excess skin, and not by simple closure alone; the tissue must be dissected and sutured layer by layer with precision to reduce scarring.

Also, distortion of the double eyelid should be prevented due to excision of a wide scar tissue, and the more scar tissue that is removed, the greater the limitation in how much the line can be reduced.

##Problems When Scar Tissue Becomes Very Thick After Multiple Revisions

There is a problem in that it becomes very difficult to create a proper line because of hard, thick scar tissue.

The more times surgery is repeated, the harder the tissue becomes and the thicker the scar gets.

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

The line may not form properly because of the hard scar tissue.

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

##Candidates for Double Eyelid Revision Surgery: When the Incision Scar Is Too Severe

If the scar is very visible when the eyes are closed after double eyelid incision surgery, it should also be corrected by the incision method so that almost no scar remains.

♥ Causes

• Incorrect suturing of the incision line

• Sutures removed too early, causing the scar gap to widen

• Sutures removed too late, leaving the shape of the sutures behind

• Individual constitutional variation

♥ Correction

After excising the existing scar, the muscle and skin must be sutured in a strong, layered manner with great precision so that they do not shift against each other.

It is also important to remove the sutures at an appropriate time so that the suture removal itself does not affect the scar.

##Candidates for Double Eyelid Revision Surgery: When the Line Is Distorted by Scar Adhesion

After the previous double eyelid surgery, the scar above the incision line may adhere and create another line above the original line, resulting in a double line.

The appearance of another line above the incision line means the previous surgical method was incorrect, and it is a candidate for correction.

♥ Causes

• When orbital fat was not repositioned

• Atrophy of orbital fat

• Excessive fat removal, etc.

♥ Correction

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

In all cases of double eyelid surgery, the incision line should become the double eyelid line.

##Double Eyelid Revision Surgery Method When the Scar Line Is Dark After Double Eyelid Surgery

When surgery is performed using the incision method, a scar occurs 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, it is necessary to lighten the scar line so that the double eyelid line is not easily visible even when the eyes are closed.

♥ Causes of a Dark Scar Line After Double Eyelid Surgery

• The scar widens due to excessive skin removal

• The remaining skin was not removed, causing the skin to cover the incision line and darken it

• Lack of excess skin causes the scar line to gradually widen or become distorted

• Depressed scarring occurs due to excessive removal of the orbicularis oculi muscle beneath the skin

• Frequent eye rubbing after surgery

• A constitutional tendency toward scarring

♥ Surgical Method for a Dark Scar Line After Double Eyelid Surgery

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

The normal skin is carefully sutured together with the orbicularis oculi muscle beneath the skin.

If there is no excess skin, it may be necessary to delay stitch removal, so it is important to remove the stitches only after confirming that the wound has healed sufficiently and the scar will not widen.

If there is a thickened area below the incision line, known as a sausage-like double eyelid, part of the orbicularis oculi muscle beneath the skin is excised and the skin is pulled upward to flatten and correct it.

♥ Examples of Surgery for a Dark Scar Line After Double Eyelid Surgery

♥ Postoperative Precautions When the Scar Line Is Dark After Double Eyelid Surgery

• After stitch removal, continue disinfecting for a few more days until the holes from the suture line fill in.

• Wipe the scar area well with antiseptic so that foreign matter or dead skin does not accumulate there.

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

• Rubbing the eyes can distort the double eyelid line or make the scar look messy, so never rub them.

♥ Timing of Double Eyelid Revision Surgery: Revision surgery is possible only after at least 6 months have passed since the last surgery.

The reason for the 6-month period is to wait until the scar tissue from the previous surgery becomes softer.

Because scar tissue has a strong tendency to cling together, reoperation before the scar tissue has fully matured can lead to unpredictable results.

The point at which these changes are complete can be considered the time when revision surgery is possible, and that time is judged to be about 6 months after surgery.

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

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

Based on extensive clinical experience and know-how over more than 20 years, surgery is performed only when various examinations and tests during consultation predict the postoperative result and there is sufficient potential for improvement after surgery.

As long as there is enough excess skin, revision surgery is fully possible.

A thick, sausage-like line occurs when the skin is thick and the line was designed too high, causing the skin to push downward.

The surgery should involve incision along the existing scar line and partial removal of the orbicularis oculi muscle beneath the skin, which is the cause of the sausage-like appearance, to thin it out.

##When the Area Below the Line Appears Swollen and Bulging (Sausage Phenomenon)

The swollen appearance below the double eyelid line is called the sausage phenomenon.

It gives the impression that the person had surgery only a few days ago and makes the viewer feel uncomfortable.

The causes of the sausage phenomenon include thick skin and orbicularis oculi muscle, designing the line too high, or partial loosening of the line.

Correction is performed by partially excising the orbicularis oculi muscle and pulling the skin upward.

##Problems with an Excessive Outer Fold Line

The outer fold must be reduced or changed into an inner fold, and this is one of the most difficult revision techniques.

To reduce the line, the inner line must be properly reduced.

If the line is thick and the inner line is also very wide, it becomes an outer fold.

Only by reducing the outer fold into an inner fold can the overall line become natural.

One of the most difficult revision techniques is turning an outer fold into an inner fold.

If the line cannot be properly reduced into an inner fold, the desired line cannot be created.

##Candidates for Double Eyelid Revision Surgery: When the Double Eyelid Line Is Too Thick

From a general perspective, a slightly visible double eyelid line looks the most natural and beautiful.

If the line is too thick, the eyes look sleepy, and the impression appears stronger and more rugged to others.

♥ Causes

• A line designed too high

• Scar adhesion

• Ptosis

• Lack of excess skin, etc.

♥ Correction

The existing high line should be spread out or removed by incision, 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 the line while considering factors such as excess skin and eye size, finding the height that looks most natural for the individual.

##Double Eyelid Revision Method for Thick, Sausage-like Tissue Below the Incision Line + Ptosis Correction

This refers to a swollen-looking condition in which the area below the double eyelid line bulges like a sack, appearing as if the surgery had been done only a few days ago.

It is usually possible only with a full incision method, and part of the orbicularis oculi muscle beneath the incision line must be removed to reduce the muscle thickness.

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

♥ Causes of Thick, Sausage-like Tissue Below the Incision Line

• The line was made too high

• The skin and orbicularis oculi muscle are thick

• The buried sutures of the double eyelid line were placed below the height of the incision line

• The sutured area loosened, causing the double eyelid line to push downward

♥ Sausage Phenomenon After the Buried Suture Method

This occurs because the line was designed too high and part of it sagged after surgery. The partially loosened line can be pulled upward and securely, tightly fixed again.

It is treated with either the partial incision method or the full incision method.

♥ Examples of Thick Tissue Below the Incision Line + Ptosis Correction

♥ If the sausage phenomenon is present, it can be corrected through double eyelid revision surgery.

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

Based on extensive clinical experience and know-how over more than 20 years, surgery is performed only when various examinations and tests during consultation predict the postoperative result and there is sufficient potential for improvement after surgery.

As long as there is enough excess skin, revision surgery is fully possible.

The two main goals of revision surgery are:

restoring larger, more open-looking 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 occurs when the skin is thick and the line was designed too high, causing the skin to push downward.

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

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

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

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

##Full Incision Method

For correcting ptosis with a thick line, the full incision method can be used.

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

It usually takes about 2 to 3 hours.

The surgical process is carried out in 10 steps, and omitting even one step can lead to less-than-expected results.

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

##Full Incision Method Surgical Process

STEP 01 - Design the planned incision line, 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 width of skin excision up to the scar line.

The excision width is measured from the new double eyelid line 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 will be 3 mm.

The 기준 is determined based on the width at the exact center.

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

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

STEP 02 - Remove the skin and scar tissue.

The scar tissue is excised along the design line.

The incision is made accurately with a scalpel, and then the tissue is removed with surgical scissors.

The lower excision line becomes the new double eyelid line, and the upper line should be dissected and pulled down naturally so that it can be sutured.

STEP 03 - Dissect the orbicularis oculi muscle, orbital fat, and skin that are adhered to the levator muscle.

Since the skin above the incision line must be pulled downward, the hardened scar tissue that is stuck together must be dissected.

Scar tissue dissection proceeds by separating the area between the orbital fat layer and the levator muscle, and in some cases the area between the muscle and the fat is also dissected to allow the fat to be advanced.

Through this dissection process, the tissue can be repositioned downward and advanced, which is important as preparation for obtaining a natural double eyelid line.

STEP 04 - If the orbicularis oculi muscle is contracted, incise or excise the muscle to release the contraction.

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

STEP 05 - Reposition the orbital fat to the incision line to prevent re-adhesion.

Forward repositioning of the orbital fat is a process to prevent the tissue from adhering again.

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

In some cases, a triple fold may occur, which can damage the double eyelid line.

Another effect of orbital fat repositioning is that if the eyelid is sunken, it can be corrected to some extent, and in some cases fat grafting may not be needed because the surgery itself improves the sunken eyelid to a certain degree.

STEP 06 - Shorten the levator muscle to strengthen its function.

Levator muscle shortening is one method of correcting ptosis.

It is simple and effective, and has the advantage of being correctable with little tissue damage.

The levator muscle is not cut away; instead, it is simply advanced and tied to the tarsal plate.

In revision surgery, the effect of levator shortening is to make the eyes open wider so they can be corrected to look more refreshed, and by opening the eyes wider, the double eyelid line is also reduced.

STEP 07 - After incising the orbicularis oculi muscle at the inner corner, insert orbital fat between the muscles to prevent re-adhesion.

In addition to advancing the fat, orbital fat is inserted into the inner corner of the eye to prevent adhesion of the orbicularis oculi muscle.

The inner part of the eye is the area most prone to scar adhesion, and adhesion in this area can make the eyes appear sleepy and make it difficult to open them properly.

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

STEP 08 - During suturing, layered closure is performed so that 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 a double eyelid line.

Therefore, in order to obtain 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 sutures must also be placed to keep the repositioned fat from being pulled upward.

In addition, the orbicularis oculi muscle and skin above the incision line must all be traversed by the sutures and firmly closed in layers in order to achieve the desired double eyelid line.

STEP 09 - To prevent hematoma and inflammation, a small amount of swelling-reducing agent (hyaluronidase) is administered to the surgical site.

Hyaluronidase, a swelling-reducing agent, is a medication that has the effect of rapidly reducing swelling as soon as it is administered, because it disperses fluid.

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

STEP 10 - Stitch removal is delayed relatively long, from 7 to 14 days depending on the patient's condition.

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

The reason for delaying stitch removal is that in revision surgery, most cases do not have enough excess skin, and because the surgical process involves advancing all tissues, a lot of tension is placed on the suture line.

Therefore, if the sutures are removed on day 3 or 4, the tense suture line may open or the scar line may widen, resulting in a larger scar, and the tissue may gradually be pulled upward, which can also enlarge the double eyelid line.

Thus, the sutures should remain in place until the tissue stabilizes, so it is better to keep them longer.

In most clinics, sutures are removed early for fear of leaving stitch marks, but that applies only to 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 about 3 to 4 sutures, and the remaining sutures are removed on day 7. This minimizes stitch marks and prevents the scar from widening while also minimizing distortion of the double eyelid line.

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

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

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

##Partial Incision Method Surgical Process

1. Design the desired double eyelid line.

In many cases, the design is made along the existing scar line.

Sometimes it is designed according to the height and shape the patient wants, or the surgeon may judge and design the line that suits the patient best.

The direction of the design line also changes depending on whether the goal is an outer fold or an inner fold.

2. Mark three incision points with design ink.

The points are lightly marked at the inner, middle, and outer parts.

3. Under sedation, while the patient is asleep for about 5 minutes, local anesthetic is injected into the three marked points.

The local anesthetic is used minimally so that swelling is kept to a minimum.

4. Make very small incisions of about 2 mm at the three marked points.

If the incision is too large, a lot of scar tissue remains, so the surgery is performed with minimal incisions to leave almost no scar.

5. Through the incision, pull the orbicularis oculi muscle first and remove it with scissors.

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

Along with removing the orbicularis oculi muscle, the preaponeurotic fat beneath the muscle layer is also removed.

6. If there is a lot of orbital fat, pull the orbital fat out through the outer incision.

Fat removal is mainly done from the outer side.

7. Hold the fat with a hemostatic forceps and cut off the base of the protruding fat with a scalpel.

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

8. After fat removal, cauterize with an electrocautery device to prevent bleeding.

If hemostasis is not achieved properly, orbital bleeding can occur, leading to severe bruising and swelling, so proper hemostasis is important.

9. Through the three incision sites, use very fine dissolvable sutures to connect the levator muscle and skin to create the double eyelid line.

10. After burying the sutures and applying ophthalmic ointment, the surgery is finished.

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

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

If cold compresses are continued for more than 3 days, the swelling may not go down as well, so it is best to limit them to exactly 3 days.

http://www.duhans.com

♥ Features of the Double Eyelid Revision Clinic at Duhan Plastic Surgery ♥

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

• We have a systematic system for revision surgery.

• Through preoperative consultation, we perform various examinations and tests to predict postoperative results.

• Through examinations and tests, we perform surgery only when there is sufficient room for improvement.

If we judge that the desired result cannot be achieved,

we make it a principle not to attempt surgery.

• We identify problems with the previous surgery through examinations,

provide a thorough and clear explanation,

and suggest the surgical method that will deliver the best results.

• We explain the surgical process and recovery clearly so that you fully understand them,

and we do not omit explanations of possible side effects after surgery.

• We provide thorough postoperative care.

• We carefully observe the postoperative course

to check whether recovery is proceeding properly.

• For those who want double eyelid revision surgery,

we make every effort and do our research so that our clinic will be the last one they need to visit,

so they will not need further surgery.

Dr. Shin Duhan

http://www.doublefold.co.kr