[Douhan Plastic Surgery Double Eyelid Revision] - [Correction of Uneven Eyes, Revision for Sausage Eyes, Ptosis Revision]

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When the double eyelid line is too large (thick double eyelids)

A double eyelid line that is too large is rarely flattering in any case.

A natural-looking line is best when it is only slightly visible when the eyes are open.

A large line is a representative example of unattractive double eyelids and one of the most common indications for revision surgery.

When the area below the line looks swollen (sausage eyes)

The phenomenon in which the area below the double eyelid line appears puffy is commonly called the sausage phenomenon.

It gives the impression of someone who had surgery only a few days ago,

and can make viewers feel uncomfortable.

The causes of the sausage phenomenon include

thick skin and orbicularis oculi muscle,

a line designed too high,

or a partially loosened line.

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

When the double eyelid lines are asymmetrical (uneven eyes)

Everyone has a slight degree of asymmetry, but noticeable asymmetry should be corrected.

Causes include poor design, loosening of the line, scar adhesion, or ptosis on one side.

If the double eyelid lines are uneven on both sides,

surgery must be redone to match the desired side.

However, if revision surgery is performed on only one side, the eyes will not be perfectly symmetrical immediately after surgery.

Even with proper surgery, you must be patient for at least 1 to 2 months

and watch how the asymmetry is corrected,

so if only one side is operated on like this, the decision must be made carefully.

Sleepy-looking eyes (ptosis)

After double eyelid surgery, if the eyes do not open naturally

and the eye shape looks drowsy, this should be corrected

so the eyes can open naturally and clearly again.

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

Causes include congenital ptosis, pseudoptosis, and scar adhesion,

and the most common surgical method is correction through levator aponeurosis shortening or resection.

Problems when ptosis correction is not possible

If the levator muscle has no function, further ptosis correction may not be possible, or lagophthalmos may occur.

There are cases where the eyes still look sleepy even after ptosis correction has been performed several times.

If the levator muscle has almost no function, correction may not be possible even if ptosis is corrected again.

In such cases, only the eyelid line is corrected without ptosis correction.

Attempting excessive ptosis correction can worsen lagophthalmos while leaving the ptosis almost unchanged.

More than 20 years of expertise in double eyelid revision, with countless successful cases~

Problems when eye shape correction is overdone

Reducing an overcorrected eye shape back to a normal size is much more difficult than ptosis correction.

If ptosis correction or eye shape correction is overdone and too much white of the eye is exposed, levator muscle relaxation surgery is needed to reduce the eye size again. But if the levator muscle is loosened carelessly, ptosis may develop several months later and the eyes may not open as well.

Surgery to lower an overcorrected result is much more difficult than ptosis correction, and its long-term outcome is harder to predict.

The amount of levator muscle relaxation must be carefully controlled through extensive experience and know-how.

Double eyelid revision

This refers to surgery that corrects the double eyelid line and restores it to its original natural and clear shape when the line is too large, uneven, or has loosened.

□ Indications for double eyelid revision

• When the double eyelid line is too large

• When the double eyelid line has loosened

• When the lines are asymmetrical

• When the eyes feel tired after double eyelid surgery

• When there is a thick sausage-like phenomenon below the incision line

• When the impression looks worse after double eyelid surgery

• When you want to restore beautiful, natural eyes

□ Purpose of general double eyelid surgery

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

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

Surgery done only to create a double eyelid line can easily lead to unwanted results.

The purpose of double eyelid revision is the same.

Its goal is to correct the eye shape so it looks larger, clearer, and more natural.

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

First, one must accurately understand what was wrong with the initial surgery,

and how it should be improved,

only then can good results be achieved.

During consultation, various examinations and tests are performed to predict the post-surgery outcome, and surgery is only performed when there is enough likelihood of improvement after surgery.

As long as there is sufficient skin available, revision surgery is definitely possible.

The purpose of revision surgery is largely twofold.

Restoring a larger, clearer eye shape 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 is designed too high,

causing the skin to slide downward.

The surgery removes the existing scar line

and creates a new line below it.

The orbicularis oculi muscle that causes the sausage phenomenon must be partially removed to thin it out.

If ptosis is present, revision surgery also opens the eyes more fully and corrects the sleepy-looking eye shape.

The surgery takes about 2 to 3 hours,

recovery takes about one week,

and stitches are usually removed about one week after surgery.

Director Shin Douhan

Sausage eyes and eye shape correction

This refers to a swollen-looking phenomenon in which the area below the double eyelid line bulges in a sac-like shape, looking as if the surgery was performed only a few days ago.

It can usually be corrected only with full incision surgery, and part of the orbicularis oculi muscle below 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 eyes below the incision line

• When the line is made too high

• When the skin and orbicularis oculi muscle are thick

• When the buried-suture fixation for the double eyelid line is placed below the height of the incision line

• When the sutured area loosens and the double eyelid line is pushed downward

□ Sausage eyes after the buried-suture method

This occurs because the line was designed too high and, after surgery, part of the line loosened and slid downward. In such cases, the partially loosened line can be pulled upward and firmly re-fixed with tension.

Surgery is performed with either the partial-incision method or the full-incision method.

□ Example of thick sausage phenomenon below the incision line + eye shape correction

Ptosis revision surgery

When the eyes do not open clearly and always look sleepy, this is called ptosis.

It is broadly divided into congenital ptosis and acquired ptosis.

It is also divided into true ptosis, in which the levator muscle that lifts the eyelid has reduced function, and pseudoptosis, which only appears to be simple ptosis.

The purpose of ptosis (sleepy-eye shape) correction is to restore a larger, clearer eye shape.

Depending on the severity, an appropriate method must be selected, along with the surgeon’s skilled know-how and technique.

The purpose of double eyelid surgery is to create a larger, clearer eye shape, add a crease to the eyelid, and make the eyes look more refined.

However, if the eyes end up looking even sleepier after surgery, it would be worse than not having surgery at all.

□ Examples of ptosis (sleepy-looking eyes)

□ Causes of ptosis (sleepy-looking eyes)

• When the double eyelid line is made too high

• When habitual eye rubbing causes scar tissue inside the eyelid, interfering with levator muscle function

• When levator muscle function declines due to aging

• When the levator muscle is damaged by trauma

□ Difference between ptosis (sleepy-looking eyes) 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 to 2 mm.

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

② When the eyes are opened naturally and looking straight ahead

The vertical width of the eye should be at least 8 mm to be considered normal.

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

③ When looking upward after looking downward as much as possible

The eyelid should move through a range of about 14 to 16 mm.

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

□ Surgical methods for ptosis (sleepy-looking eyes)

• Levator muscle shortening

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

Because surgery must be performed through an incision, a double eyelid line is created during the process, so those without a double eyelid have no choice but to form at least a hidden double eyelid.

• Surgical process for levator muscle shortening

1. 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 muscle.

4. After exposing the levator muscle and marking the amount to be shortened, the marked area is tied to the upper edge of the tarsal plate with thread.

5. To create the double eyelid line, the thread is buried in three places.

6. The outer skin is sutured.

• Levator muscle resection

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

It is mainly applied in cases of moderate ptosis.

• Frontalis suspension

This method is performed in cases of severe ptosis with levator function of 5 mm or less, and is used when recovery of function through levator shortening or resection is difficult to expect.

The frontalis muscle in the forehead is advanced and tied to the tarsal plate of the eyelid so that the frontalis muscle replaces the function of the levator muscle.

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

• Müller muscle shortening

Instead of levator muscle shortening, shortening using the Müller muscle beneath the levator muscle may also be used.

The advantage of Müller muscle shortening is that it can minimize lagophthalmos, but the postoperative prognosis is difficult to predict and recurrence is common.

To access the Müller muscle, surgery must be performed while damaging the levator muscle, so it is not a method with any special advantage.

Anatomically, many people have almost no Müller muscle or only a very thin one, and in such cases Müller muscle shortening cannot be applied.

□ Examples of ptosis revision (sleepy-looking eyes)

□ Postoperative care instructions after ptosis (sleepy-looking eyes) correction

1. Apply cold compresses with the cooling pack provided by the hospital.

Do this for 2 hours a day for 3 days.

The cold compresses can be done continuously for 2 hours or divided into 20 to 30 minutes at a time.

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

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

3. Postoperative visits are usually twice: the day after surgery and on the day of stitch removal.

Stitches are removed on days 3 to 4.

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

Until then, wash the face with a wet towel.

5. No adhesive bandage is applied to the surgical site, so daily life is possible.

6. Postoperative swelling varies from person to person. In most cases, swelling largely subsides in about 7 days, but it takes about 1 to 3 months for everything to settle completely.

7. Lagophthalmos, in which the eyes do not close fully, varies depending on the degree of ptosis and how much the levator muscle was shortened, but it usually takes from 15 days to as long as 6 months or more.

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

Full incision method

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

The full-incision revision process is very difficult and requires extensive experience, advanced skill, and know-how.

It usually takes about 2 to 3 hours.

The surgical process proceeds in 10 stages, and if even one stage is omitted, the result may fall short of expectations.

Even if it takes some time, a better result can be achieved by carefully checking every step and performing the surgery with great care.

□ Two goals of surgery

The goals of correcting thick-line pseudoptosis are largely twofold.

① First: to reduce the large, unattractive double eyelid line and create a natural, thin double eyelid line

② Second: to make the drowsy-looking eye shape open more widely and clearly

With these two goals, double eyelid revision is performed as follows.

□ Surgical process

Step 1 - Design the incision line, including the existing 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 to be excised 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 excision width is 3 mm.

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

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

Step 2 - Cut out the skin and scar tissue.

Scar tissue is excised along the design line.

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

The lower cut line becomes the new double eyelid line, and the upper line must be naturally pulled downward after tissue dissection and then sutured.

Step 3 - Dissect the orbicularis oculi muscle, orbital fat, and skin that are adherent to the levator muscle.

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

Scar 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 fat is also dissected to allow the fat to be advanced.

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

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

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

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

Advancing the orbital fat is part of preventing the tissue from readhering.

If the fat is not repositioned, the tissue can adhere again, which may cause ptosis and make the eyes look drowsy.

In some cases, a triple eyelid may also occur, damaging the double eyelid line.

Another effect of repositioning the orbital fat is that if the eyelid is sunken, the sunken appearance can be corrected to some extent. In cases where fat grafting might otherwise be needed later, the surgery itself may improve the condition enough that fat grafting is no longer necessary.

Step 6 - 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 correcting the problem with almost no tissue damage.

The levator muscle is not cut out; instead, it is simply repositioned forward and tied to the tarsal plate (cartilage plate).

In revision surgery, levator shortening has the effect of opening the eyes wider so they can be corrected more clearly, and as the eyes open wider, the double eyelid line also becomes smaller.

Step 7 - After the orbicularis oculi muscle at the inner canthus is incised, orbital fat is inserted between the muscles to prevent readhesion.

Along with advancing the fat, fat is inserted at the inner canthus of the eye to prevent scar tissue from adhering.

The inner side of the eye is the area most prone to scar adhesion, and adhesion in this area can make the eyes look drowsy and prevent them from opening well.

To prevent this, orbital fat that can act like a lubricant is placed between the orbicularis oculi muscle and the tarsal plate and secured with sutures.

Step 8 - During suturing, layered sutures are used to keep the repositioned structures from shifting.

The suturing method in revision surgery is not simple.

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

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 (cartilage plate), and the repositioned fat must also be secured with sutures so it does not get pulled upward.

In addition, only when the orbicularis oculi muscle and skin above the incision line are both firmly sutured layer by layer can the desired double eyelid line be achieved.

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

The swelling-reducing agent hyaluronidase is a medication with a water-dispersing effect, and it rapidly reduces swelling when administered.

However, excessive use can instead cause more bruising, so it is used only in a limited way to reduce swelling.

Step 10 - Stitches are removed in two stages, on day 4 and day 7.

Stitches are usually removed around day 7.

The reason stitches are removed later is that in revision surgery, there is usually not enough skin available, and because the surgery involves advancing all tissues, a lot of tension is placed on the suture line.

Therefore, if the stitches are removed on days 3 to 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, making the double eyelid line larger as well.

Thus, the stitches should remain in place until the tissue stabilizes.

To prevent the scar from becoming messy due to stitch marks, most of the stitches are removed on day 4 and only 3 to 4 stitches are left in place, so stitch marks are hardly left behind.

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

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

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

Pre- and post-surgery care instructions

Pre-surgery care instructions

1. Through sufficient consultation before surgery, you should personally understand the causes of the previous unsuccessful double eyelid surgery and the surgical process.

2. Do not consume alcohol the day before surgery.

Alcohol can reduce the effectiveness of anesthetic drugs, which may cause problems with anesthesia during surgery.

3. Try to avoid surgery during menstruation if possible.

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

Post-surgery care instructions

Generally, postoperative visits are made twice: the day after surgery and one week later.

• Day 1 after surgery: The surgical area is disinfected at the hospital, a swelling-reducing injection is given, and the condition is checked.

• Day 4 after surgery: The progress is checked and the continuous sutures are removed.

• Day 7 after surgery: The progress is checked to see whether the surgery went well or whether there are any issues, and the remaining stitches are removed.

• One month after surgery: The double eyelid line is checked to see whether it is settling in well.

Things to do at home yourself

= Cold compresses

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

Do this for 2 hours a day for 3 days.

The cold compresses can be done continuously for 2 hours or in 20 to 30 minute intervals.

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

= Disinfection and eye drops

Disinfect the surgical area with the prescribed medicine.

Disinfection should be done only until you remove the stitches yourself.

Use the artificial tears and eye drops prescribed by the hospital to prevent dry eyes.

= Scar care

Apply the prescribed eye ointment to the surgical area for about one month.

The scar-preventive eye ointment helps reduce scarring and calm redness, so apply it about twice a day for 3 to 4 weeks.

= Makeup and face washing

These are possible starting one week after stitch removal.

Until then, use a wet towel instead of washing the face.

Postoperative swelling

There are individual differences, and although swelling usually subsides to some extent in about 7 to 14 days, it takes about 1 to 3 months to fully settle.

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

Depending on the degree of ptosis and how much the levator muscle was shortened, it usually takes 15 days, and in very rare cases more than 6 months.

Lagophthalmos care

When levator shortening is performed to make the eyes open wider, temporary lagophthalmos may occur, in which the eyes do not close fully. Depending on the degree of ptosis and how much the levator muscle was shortened, it usually takes 15 days and in some cases as long as 6 months or more.

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

During this period, use the artificial tears prescribed by the hospital to prevent dry eyes.

Features of Douhan Plastic Surgery’s double eyelid revision clinic

http://www.doublefold.co.kr

① It has accumulated more than 20 years of extensive experience and know-how in double eyelid revision.

② It has a systematic system for double eyelid revision.

③ Through preoperative consultation, various examinations and tests are performed to predict the postoperative result.

④ Surgery is performed only when examinations and tests show that there is sufficient room for improvement.

If it is judged that the desired result cannot be achieved, the policy is not to attempt surgery.

⑤ By identifying the problems with the previous surgery through examination, we provide thorough and clear explanations and suggest the best surgical method for the best result.

⑥ We explain the surgical process and progress clearly so that patients fully understand them, and we do not omit explanations about possible side effects that may occur after surgery.

⑦ Thorough postoperative care is provided.

⑧ The postoperative course is closely observed to ensure that recovery is proceeding properly.

⑨ We make every effort and continue our research so that those who want double eyelid revision do not need to undergo any further surgery and can make this their final hospital visit.

http://www.doublefold.co.kr