[Duhan Plastic Surgery Secondary Double Eyelid Surgery] - [Sleepy Eye Appearance, Asymmetrical Eye Appearance, Ptosis]

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What is ptosis

Ptosis refers to eyes that do not open clearly and always look sleepy.

The purpose of double eyelid surgery is to create a larger, clearer eye appearance and form a line on the eyelid,

with the goal of making the eyes look more refined.

However, if the eyes look even sleepier after surgery, it is better not to have the surgery at all.

Examples of ptosis

Types of ptosis

1. Congenital true ptosis

This occurs because the function of the levator palpebrae superioris, the muscle that lifts the eyelid, is reduced. Most congenital ptosis falls into this category, and ptosis caused by trauma can also occur.

2. Pseudoptosis after surgery

This is when the function of the levator palpebrae superioris, the muscle that lifts the eyelid, is normal, but its function is hindered by external factors so the muscle cannot exert its strength properly.

Example) * The double eyelid line was made too high

• Habitually rubbing the eyes causes scar tissue inside the eyelid, which interferes with the function of the levator palpebrae superioris

3. Pseudoptosis caused by drooping eyelids

When the eyelids droop, the pupil becomes covered, so the eyes may appear as if they are not opening fully, like ptosis.

In such cases, the eyelid skin should be temporarily lifted or a temporary double eyelid should be created to check the actual vertical opening of the pupil.

A condition in which the eyelid is simply covering the eye should not be diagnosed as ptosis.

Differences between ptosis and normal eyes

1. When the eyes are opened naturally and looking straight ahead

It is normal for the upper part of the black pupil to be slightly covered by about 1–2 mm.

If more of the black pupil is covered than that, ptosis should be suspected.

2. When the eyes are opened naturally and looking straight ahead, the vertical height of the eye should be at least 8 mm to be considered normal.

If the vertical height is less than that, it is ptosis.

3. When looking downward at the maximum extent and then looking upward, the range of eyelid movement should be about 14–16 mm.

If it is less than that, it can be judged as true ptosis.

How to test for ptosis

The method of testing for ptosis is to check the vertical height of the pupil while looking straight ahead.

For normal individuals, the vertical height is between 8 and 9 mm, and in general, a measurement of 8 mm or less is considered ptosis.

However, because everyone’s eye shape and size differ, ptosis is not diagnosed using numbers alone.

The diagnosis is made by judging whether the person gives a strongly sleepy appearance, and this is compared with the measurements.

The function of the levator palpebrae superioris is also measured and assessed.

1. Measure the palpebral fissure height (vertical eye opening)

2. Check whether the overall impression looks sleepy

3. Measure the function of the levator palpebrae superioris (normal: 14–16 mm)

Surgical methods for ptosis

■ Levator palpebrae superioris shortening

This method shortens the eyelid-lifting muscle (the levator palpebrae superioris) by overlapping and suturing it by about 4–8 mm, and is mainly applied in cases of mild ptosis.

Ptosis correction must be performed through an incision, so a double eyelid line is created during the process. Therefore, people without a double eyelid have no choice but to create at least a hidden double eyelid.

1. The design is made and local anesthesia is administered.

2. An incision is made along the design line.

3. After the incision, the orbital septum is opened to expose the levator palpebrae superioris.

4. After exposing the levator palpebrae superioris and marking how much to shorten it, the marked area and the upper edge of the tarsal plate are tied together with sutures.

5. Three sutures are buried to create the double eyelid line.

6. The outer skin is sutured.

7. Visit the clinic the next day after surgery to disinfect the surgical site and receive an anti-inflammatory injection.

8. Use the cool pack provided by the clinic for cold compresses for about 3 days to reduce swelling.

9. The stitches are removed after 3–4 days, and the entire process is complete.

10. After ptosis correction, the eyes may not close fully for a while, so use the prescribed artificial tears before sleeping and when the eyes feel irritated.

11. Temporary lagophthalmos, in which the eyes do not close fully, varies depending on the degree of ptosis and the amount the levator palpebrae superioris was shortened, but it usually takes 15 days and in some cases more than 6 months.

On average, it progresses for about 2–3 months before the eyes naturally close fully.

■ Levator palpebrae superioris resection

This method shortens the eyelid-lifting muscle (the levator palpebrae superioris) by resecting about 5–10 mm, and the cut end of the levator palpebrae superioris is sutured to the tarsal plate.

It is mainly applied in cases of moderate ptosis.

■ Frontalis sling surgery

This method is performed in cases of severe ptosis with levator palpebrae superioris function of 5 mm or less, when recovery of function cannot be expected with shortening or resection of the levator palpebrae superioris.

It is a surgical method in which the frontalis muscle of the forehead is advanced and tied to the tarsal plate of the eyelid so that the frontalis muscle takes over the function of the levator palpebrae superioris.

General anesthesia is required, and severe lagophthalmos can occur as a side effect.

■ Müller muscle shortening

Instead of levator palpebrae superioris shortening, a shortening procedure using the Müller muscle beneath the levator palpebrae superioris is sometimes performed.

Müller muscle shortening has the advantage of minimizing lagophthalmos, but it is difficult to predict postoperative results and recurrence is common.

Because the surgery requires access to the Müller muscle while damaging the levator palpebrae superioris, it is not a procedure with any special advantages.

In addition, anatomically, many people have little or a very thin Müller muscle, and in such cases, Müller muscle shortening cannot be applied.

Examples of ptosis and before-and-after surgery

Postoperative care instructions for ptosis surgery

1. Apply cold compresses using the cool pack provided by the clinic.

Do this for 2 hours a day for 3 days.

The cold compresses can be done continuously for 2 hours or divided into 20–30 minute sessions.

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

2. Use the prescribed artificial tears and eye drops to prevent dry eye.

3. Postoperative visits are usually twice: the day after surgery and on the day the stitches are removed.

The stitches are removed on day 3 or 4.

4. Makeup and face washing are allowed after the stitches are removed.

Until the stitches are removed, wash the face with a damp towel.

5. Since no bandage is applied to the surgical site, normal daily activities are possible.

6. Swelling after surgery varies from person to person, and in most cases it subsides significantly after about 7 days, but the period until everything fully settles is about 1–3 months.

7. Temporary lagophthalmos, in which the eyes do not close fully, varies depending on the degree of ptosis and the amount the levator palpebrae superioris was shortened, but it usually takes 15 days and in some cases more than 6 months.

On average, it progresses for about 2–3 months before the eyes naturally close fully.

Asymmetry in the lines usually occurs because the design was different,

or because too much skin was removed on one side,

or because one side partially loosened,

or because of adhesion of scar tissue on one side,

or because ptosis developed on one side.

Ptosis can be corrected through revision surgery, and uneven eyes can also be improved.

At our clinic,

based on more than 20 years of rich clinical experience and know-how,

we predict the postoperative result by undergoing various examinations and tests during the consultation,

and we only perform surgery when there is sufficient potential for improvement after surgery.

The most important factor in revision surgery is

the amount of excess skin and the position and depth of the scar line.

The purpose of revision surgery is broadly divided into two goals.

Recovery to a larger, clearer eye appearance and restoration of a natural double eyelid line.

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

During surgery, the existing scar line is removed

and a new line is created below it.

During revision surgery, the eyes are also opened wider to correct the sleepy-looking appearance.

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