[Duhan Plastic Surgery Double Eyelid Revision Surgery] - [Double Eyelid Scar]

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In cases where the incision line scar is too severe

If the scar is very noticeable when the eyes are closed after double eyelid incision surgery,

the scar also needs to be corrected with an incision method so that almost no scar remains.

Causes of severe incision line scarring

① Improper suturing of the incision line

② Sutures removed too early, causing the scar gap to widen

③ Sutures removed too late, leaving the shape of the stitches behind

④ Individual constitution-related differences

Correction methods for severe incision line scarring

The existing scar must be excised, and the muscle and skin must each be sutured in a solid layer so that they do not shift out of alignment, with very precise suturing.

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

♥ This refers to correcting the double eyelid line when the line is too large, uneven, or has loosened.

Double eyelid surgery is not simply about creating a double eyelid line.

The goal is to make the eyes look larger and more refreshed, and to create bright, refined eyes.

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

The purpose of double eyelid revision surgery is likewise to correct the eye shape so that it looks more refreshed and natural. ♥

In cases where the double eyelid scar line is dark

When surgery is performed with the incision method, a scar will inevitably form at the surgical site.

If the double eyelid scar line is faint and light, there is no problem, but

if it is a dark and deeply sunken scar line, then even when the eyes are closed

the line needs to be corrected so that it is not easily visible.

Causes of a double eyelid scar line

① The scar becomes wider due to excessive removal of skin

② The scar darkens because excess skin was not removed and the skin covers the incision line

③ Sunken scarring occurs due to excessive removal of the orbicularis oculi muscle beneath the skin

④ If there is not enough extra skin, the scar line gradually widens or becomes deformed

⑤ Habitually rubbing the eyes often after surgery

⑥ A constitutional tendency to scar easily

Double eyelid scar line correction surgery method

The edges of the double eyelid scar line are designed precisely, and only the scarred area is excised and removed. Then, together with the orbicularis oculi muscle beneath the skin, the normal skin is sutured together with precision.

If there is not enough extra skin, it may be necessary to delay the time for removing the sutures, so it is also important to remove them only after confirming that healing is sufficient and the scar will not widen.

If there is a thick so-called sausage-like swelling below the incision line, part of the orbicularis oculi muscle layer beneath the skin is excised and the skin is pulled upward and smoothed to correct it. ​

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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 width of skin excision down to the scar line.

The width to be excised extends 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, then the skin excision width will be 3 mm.

The standard is determined based on the midpoint width.

The new double eyelid line is determined by considering how much to reduce the line and how much extra skin is available.

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

② The skin and scar tissue are cut out.

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 line after excision becomes the new double eyelid line, and the upper line must be detached and naturally pulled downward for suturing.

③ The orbicularis oculi muscle, orbital fat, and skin that are adherent to the levator palpebrae superioris are dissected.

Because the skin above the incision line must be pulled downward, the firm scar tissue that has become stuck together must be dissected.

Scar tissue dissection proceeds by dissecting between the orbital fat layer and the levator palpebrae superioris, and in some cases, dissection is also performed between the muscle and the fat for anterior repositioning of the fat.​

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

④ If there is contracture of the orbicularis oculi muscle, the muscle is incised or excised to remove the contracture.

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

⑤ To prevent readhesion, the orbital fat is repositioned to the incision line.

Anterior repositioning of orbital fat is a process used to prevent the tissue from readhering.

If the fat is not repositioned, the tissue will stick together again, and as a result ptosis may occur, making the eyes appear half-closed and sleepy.

Sometimes a triple double eyelid forms, which can distort the double eyelid line.

Another effect of repositioning the orbital fat is that if the eyelid is sunken, the sunken area is corrected to some extent, so in some cases where fat grafting might otherwise be needed in the future, the surgery itself may provide enough improvement that fat grafting is not necessary.

⑥ The levator palpebrae superioris is shortened to strengthen its function.

Levator palpebrae superioris shortening is one method for correcting ptosis.

It is simple yet effective, and has the advantage of being correctable with almost no damage to the tissue.

The method does not cut out the levator palpebrae superioris; instead, it simply advances it and secures it to the tarsal plate (cartilaginous plate).

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

⑦ After incising the orbicularis oculi muscle at the medial canthus, orbital fat is inserted between the muscles to prevent readhesion.

Along with anterior repositioning of the fat, fat is inserted into the medial canthus of the eye to prevent adhesion of the orbicularis oculi muscle.

The inner part of the eye is the area where scar tissue adhesion most easily occurs, and adhesion in this area can make the eyes appear half-closed and make it difficult to open them comfortably.

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.

⑧ During suturing, layered sutures keep the repositioned structures from shifting.

The suturing method for 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 (cartilaginous plate), and sutures must also be placed to keep the advanced fat from being pulled upward.

In addition, only when the orbicularis oculi muscle and skin above the incision line are all passed through by the sutures and firmly closed with layered suturing can the desired double eyelid line be achieved.

⑨ To prevent hematoma and inflammation, a small amount of anti-swelling agent (hyaluronidase) is administered to the surgical area.

The anti-swelling agent hyaluronidase is a medication that has the function of dispersing fluid, and it rapidly reduces swelling as soon as it is administered.

However, excessive use can instead cause significant bruising, so it is used selectively only for reducing swelling.

⑩ Removal of the sutures is kept relatively late, from 7 to 14 days depending on the patient's condition.

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

The reason for removing the sutures later is that in revision cases there is usually not enough extra skin, and because the surgery process involves advancing and repositioning all tissues, the suture line is under significant tension.

Therefore, if the sutures are removed on day 3 or 4, the tense suture line may open up or the scar line may widen, causing a larger scar, and the tissues may gradually be pulled upward, which also enlarges the double eyelid line and creates an adverse effect.

So, until the tissue stabilizes, the sutures need to hold the tissue in place, which is why it is better to leave them in longer.

In many hospitals, sutures are removed early for fear of leaving stitch marks, but that applies only to the initial double eyelid surgery.

It does not apply to revision surgery.

To minimize stitch marks, most of the sutures are removed on day 4, and if only about 3 to 4 remain, removing the rest on day 7 can minimize stitch marks and prevent the scar from widening while also minimizing deformation 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 administered for about 1 month to prevent dry eyes.

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

Examples of double eyelid scar line correction surgery

Postoperative precautions when the scar line after double eyelid surgery is dark

① After suture removal, continue disinfecting for a few more days until the holes along the suture line close.

② Wipe the scar line area well with antiseptic so that foreign substances or dead skin do not settle there.

③ Do not rub the eyes with your hands just because they feel tired or have eye discharge. It is better to wipe them with a cotton swab.

④ If you rub your eyes, the double eyelid line may become deformed or the scar may become messy, so never rub them.

The surgery is performed directly by Director Shin Duhan, a double eyelid revision specialist with over 20 years of expertise.

♥ The timing for double eyelid revision surgery is at least 6 months after the last surgery.

The reason for waiting 6 months is to allow the scar tissue from the previous surgery to soften.

Because scar tissue has a strong tendency to stick together, if surgery is performed again before it has fully matured, unpredictable results may occur.

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

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

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

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

As long as there is enough extra skin, revision surgery is entirely possible.

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

The surgery involves incising along the existing scar line and partially removing the orbicularis oculi muscle beneath the skin, which is the cause of the sausage-like appearance, to make it thinner. ♥

DR. Column

Side effects of eye plastic surgery: How can you avoid failing eye revision surgery?

As double eyelid surgery has become more common, cases of side effects and dissatisfaction due to indiscriminate surgery have been increasing.

In particular, double eyelid surgery is often regarded as a simple procedure.

However, because even slight differences in height or shape can create major changes in appearance, there are many cases of side effects, and double eyelid revision surgery is also a difficult procedure.

To succeed with double eyelid revision surgery, you must accurately understand where and how the first surgery went wrong and how it should be improved in order to achieve a good result.

Double eyelid revision surgery is quite difficult.

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

Through this careful dissection process, later problems such as a bumpy line or adhesion that causes the line to roll upward must be prevented.

In addition, only when all tissues in the skin layer, fat layer, and muscle layer are neatly organized one by one can a satisfactory result be achieved.

Double eyelid revision surgery is not completed through analysis based on short-term experience.

Because even a subtle 1 to 2 mm difference in the double eyelid line can lead to very different results, it is important to make an accurate diagnosis of whether sausage-like swelling, an unnaturally high line, improper eye-opening correction, and scar correction are possible, and how much extra skin can be obtained.

Also, if one insists on a uniform double eyelid line simply because it is revision surgery, a perfect line suited to each patient cannot be achieved.

The patient's double eyelid condition must be considered based on gender, age, overall facial harmony, and the patient's own wishes.

The height and shape of the double eyelid line (in-line, in-out line, out-line, etc.) should reflect the patient's preferences while creating a natural double eyelid line.

As new hospitals continue to spring up and perform double eyelid surgery indiscriminately, it is true that the number of patients seeking double eyelid revision surgery is also increasing, and it is truly regrettable.

If double eyelid revision surgery is repeated and then fails, the amount of extra skin decreases, making the next revision even more difficult and extreme.

Double eyelid surgery is important not only in the first choice, but also when considering revision surgery, it should be approached carefully with the mindset that it may be the last chance.

Requirements for successful double eyelid revision surgery

♥ The surgery must be performed by a board-certified plastic surgeon.

You should confirm whether the surgeon holds a board certification in plastic surgery before proceeding.

There are many hospitals that only display a plastic surgery sign but are actually staffed by non-specialists.

It is important to identify this well and avoid being operated on by a non-specialist.

♥ There must be extensive surgical experience in double eyelid revision surgery.

Even among board-certified plastic surgeons, their specialties differ slightly.

If you are considering double eyelid revision surgery, it may be better to trust a specialist who focuses on double eyelid revision surgery.

Double eyelid revision surgery is one of the most difficult procedures in plastic surgery.

Being operated on by a specialist with proven know-how and accumulated experience in double eyelid revision surgery can help restore a more beautiful and natural eye shape.

♥ Double eyelid revision surgery should not be taken lightly.

If you think of double eyelid revision surgery as something easy, the probability of failing the surgery again is very high.

Double eyelid revision surgery is a highly difficult plastic surgery procedure, much more complicated and challenging than the first surgery.

We recommend thinking carefully before deciding on surgery.

♥ The cause of failure in double eyelid revision surgery must be identified accurately.

The patient themselves must understand the cause of the first surgery's failure.

Through consultation, you must be able to accurately understand with the surgeon why the first surgery went wrong and by what process double eyelid revision surgery will be performed in order to approach the surgery with trust and achieve a good result.

♥ The surgery time should not be too short.

Double eyelid surgery usually takes about 30 minutes to 1 hour.

Double eyelid revision surgery with a full incision method cannot be completed in a short time.

Unlike the first double eyelid surgery, revision surgery progresses from releasing the original double eyelid, to dissecting scar tissue, repositioning the tissue, and performing precise layered suturing.

Therefore, the surgery inevitably takes longer, and only when every step is carried out according to principle and procedure can a good result be achieved.

♥ Right after double eyelid revision surgery, the eyes should open well and widely.

Most patients have a large double eyelid line and half-closed pseudo-ptosis.

The goal of double eyelid revision surgery is to make the double eyelid line as thin as possible and allow the half-closed eyes to open clearly.

If the surgery is performed smoothly, in most cases the eyes should open clearly as soon as the surgery ends, which indicates success.

The immediate postoperative appearance should not look awkward, because after the swelling subsides later, the appearance usually becomes natural.

♥ Right after double eyelid revision surgery, the thick front line should become smaller.

The highlight of double eyelid revision surgery is naturally converting a severe out-fold line into an in-fold line.

From immediately after the surgery, the inner line that serves as the first step must form properly so that the outer line continues naturally, leading to a good prognosis.

If the line remains thick even immediately after surgery and the inner line is not properly narrowed, the prognosis cannot be considered good.

♥ There should be a slight degree of lagophthalmos for a certain period after double eyelid revision surgery.

If the eyes close properly immediately after surgery, that is considered an incorrect surgery.

In most double eyelid revision cases, there is not enough extra skin.

If surgery is performed in that state and the eyes close well, the skin has to stretch from somewhere, and in most cases it stretches below the incision line.

If that happens, the double eyelid line becomes larger again.

During the adaptation period, the skin above the incision line gradually stretches, and after a while the eyes close naturally.

If there was not enough extra skin, recovery from lagophthalmos is slow; conversely, if there is enough extra skin, recovery from lagophthalmos is faster.

♥ After double eyelid revision surgery, sutures should be removed a little later.

Usually, sutures are removed in two stages, on day 4 and day 7, depending on the amount of extra skin.

Unlike the first double eyelid surgery, where all sutures are removed around 3 to 4 days after surgery, in double eyelid revision surgery the last suture is removed around day 7.

If sutures are removed too early after double eyelid revision surgery, the scar will widen, and tissues above the incision line may be pulled upward again, making the surgery almost pointless.

Because revision suturing is performed when there is not enough tissue, the sutures must hold the tissues in place until they settle into their new positions.

If the sutures disappear before the tissue has settled, the unsettled tissue may be pulled upward again, resulting in a failed surgery.

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