[Duhan Plastic Surgery Double Eyelid Surgery] - [Frequently Asked Questions and Answers About Eye Surgery Methods]

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Frequently Asked Questions and Answers About Double Eyelid Revision Surgery

Q. I want to have my first double eyelid surgery. Is it okay to see a doctor who specializes in revision surgery?

A. The first double eyelid surgery must be done well to avoid the unfortunate need for revision surgery.

The highest level of double eyelid surgery is double eyelid revision surgery, so the first operation should be done properly so that revision surgery is not needed.

Q. Is double eyelid revision surgery something anyone can do?

A. Double eyelid revision surgery requires the highest level of skill and experience among cosmetic surgeries.

If you undergo surgery at a hospital without sufficient experience or skill, there may be no improvement at all, and it can even damage your appearance.

Therefore, revision surgery must be decided carefully, and you should definitely have it done by a doctor with extensive experience.

Q. Should double eyelid revision surgery and epicanthoplasty be done together?

A. If a hospital recommends doing revision surgery and epicanthoplasty at the same time, be extremely careful, as it is likely a hospital that does not understand double eyelids.

Epicanthoplasty (removal of the epicanthal fold) has the effect of making the inner line thicker.

In principle, it should not be done together with revision surgery intended to reduce the line.

If you combine a surgery meant to reduce the line with epicanthoplasty, which does the exact opposite by thickening the inner line, the inner part of the eye line may become distorted or thicker, and you may not achieve the desired result.

This is like two boatmen riding one boat, with one rowing east and the other rowing west.

Epicanthoplasty is a procedure that should only be done when it is truly indicated. If epicanthoplasty is really needed, it is better to decide on it only several months after the revision surgery, once everything has fully settled.

You should not recklessly make the mistake of doing revision surgery and epicanthoplasty at the same time and creating a bad result.

Q. If the eyelid is sunken, can fat grafting be done together with double eyelid revision surgery?

A. If the eyelid is hollow and the double eyelid line also looks unnatural, making revision surgery necessary, fat grafting should be done first, and then double eyelid revision surgery can be performed 3 to 6 months later.

After the fat grafting restores the eyelid to a flatter shape, revision surgery should be done.

When performing revision surgery, tissue must be dissected, and fat grafting cannot be done into the dissected tissue. If fat grafting and revision surgery are done at the same time, it is like scattering fat into an empty space created by dissection, so the fat will not properly survive, and the result will only damage the double eyelid line.

Therefore, doing the two surgeries at the same time is not appropriate. If a hospital recommends doing them together, it is likely a hospital with somewhat limited experience, so be aware.

Q. I dislike my existing double eyelid line and want to completely erase it. Is that possible?

A. There is a so-called surgery to "undo" a double eyelid, but such surgery should not be performed.

Once more than a week has passed after surgery, whether it was done by the buried method or the incision method, there can no longer be a surgery that conceptually "undoes" the operated eye shape.

This is because the incision line remains exposed whether the eyes are open or closed, which is not only very unattractive but often makes the eyelid appear uneven or saggy.

Instead, the double eyelid should be made into a hidden double eyelid so that the line is barely visible when the eyes are open.

Some people try an undoing surgery and then find that their eye shape looks even more unnatural, so they want the line created again. However, after an undoing surgery, it is almost impossible to create a line again through revision surgery, so keep this in mind.

Q. I had surgery at another clinic. When can double eyelid revision surgery be done?

A. In general, revision surgery is possible about 6 months after the last surgery.

The reason is that scar tissue must heal and settle completely for revision surgery to produce good results.

If red erythema or bumpy hypertrophic scars remain in the scar tissue, surgery is difficult.

The period for scars to settle varies by person. Usually, scars settle to some extent after 6 months, but some people take longer depending on their constitution, so revision surgery is possible when all redness in the scar area has disappeared.

Q. I am afraid of revision surgery.

A. Having to repeat a double eyelid surgery that already failed once is several times more frightening than having the first surgery.

That is because of the fear of what happens if it fails again.

However, if you have enough consultation and leave it in the hands of a revision surgery specialist, you can achieve the desired result.

Q. I had revision surgery elsewhere, but it did not improve at all. Is revision surgery still possible?

A. Depending on the condition, there are indeed cases where it is impossible.

But if a preoperative consultation shows enough room for improvement, it can be returned to a natural eye shape.

Q. What if revision surgery fails again?

A. In principle, if a preoperative examination and tests show no possibility, we do not attempt surgery at all.

However, if it is sufficiently possible, the surgery can succeed and restore a beautiful eye shape.

Q. After double eyelid revision surgery, when can I return to daily life?

A. After surgery, no bandages or tape are applied.

Therefore, you can return to daily life right away.

There may be some swelling and bruising, but it is generally less than with the first surgery.

Even after only about a week, the eye shape is not very unnatural.

Also, not using bandages helps the swelling go down faster and helps the line settle a little better.

Q. After double eyelid revision surgery, how many times do I need to visit the hospital?

A. After surgery, you will usually visit about three times: the next day, and on days 4 and 7 for suture removal.

However, if the hospital is too far from home, it is fine to visit only on the day the stitches are removed.

The final sutures are usually removed around 7 days after surgery.

Q. After double eyelid revision surgery, how much swelling and bruising should I expect compared with the first surgery?

A. Compared with the first double eyelid surgery by the incision method, revision surgery generally causes less swelling.

Revision surgery does not necessarily mean more swelling or bruising.

In fact, swelling and bruising are often milder than in the first surgery, so you do not need to worry too much about them.

Q. What happens to scars after double eyelid revision surgery?

A. One of the goals of revision surgery is to improve the messy and dark scars from the first surgery as much as possible.

For about 3 to 6 months after surgery, there is redness and the scar line may be somewhat noticeable.

This is a normal course for anyone who has had double eyelid surgery by the incision method.

Usually, at least 3 to 6 months must pass before the scar line gradually fades and settles.

After 6 months, the scar line fades in most cases and becomes less noticeable than the initial surgical scar.

Method by full incision

① Excise the scar.

② Dissect precisely between the levator aponeurosis and the orbital fat so that tissue repositioning can take place.

③ After dissecting the tissue and preventing adhesion of scar tissue, advance and reposition the fat.

④ Firmly fix the skin below the excision line to the tarsal plate so that the skin below the excision line does not get pulled upward.

⑤ Perform levator shortening to help the eyes open a little larger.

The more widely the eyes open, the more the double eyelid line can be reduced.

⑥ Complete the tissue repositioning by firmly layering the sutures through the tissue, and prevent the tissue from being pulled upward.

⑦ Remove the stitches a little later so that the scar does not widen and the repositioned tissue can stabilize.

Method by partial incision

① Design the desired double eyelid line.

In most 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 determines the most suitable line and designs it accordingly.

Also, the design direction changes depending on whether an outfold or an infold is chosen.

② Mark three incision points with design ink.

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

③ Under sedation anesthesia, after about 5 minutes of sleep, local anesthetic is injected into the three marked areas.

The local anesthetic is administered in minimal amounts 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, much scarring will remain, so the surgery is performed with minimal incisions to leave almost no scar.

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

The orbicularis oculi muscle is the muscle layer covering the eyelid and 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 pre-tarsal fat beneath the muscle layer is also removed.

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

Fat removal is mainly done from the outer side.

⑦ Grasp 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 sink, so it is better to remove only as much as comes out.

⑧ After fat removal, use an electrocautery device to stop bleeding so that there is no bleeding.

If hemostasis is not properly achieved, orbital bleeding can occur, making bruising and swelling worse, so proper hemostasis is important.

⑨ Through the three incisions, connect the levator aponeurosis and the skin using very fine absorbable sutures to create the double eyelid line.

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

You can wash your face and wear makeup starting the next day.

Use the cold pack provided by the hospital for cold compresses for 3 days.

If you do cold compresses for more than 3 days, swelling will not go down further, so it is best to do it for exactly 3 days.

Extreme revision surgery

This is surgery that restores the eye shape to normal through revision surgery in extremely severe cases or in situations judged to be too difficult for further surgery.

It is performed in cases where the condition of the double eyelids is very poor, making restoration to a normal eye shape difficult or nearly impossible, with the goal of bringing the eye shape as close to normal as possible.

The goal of extreme revision surgery is to restore eyes with severe deformity, after multiple previous revision surgeries, filler-like foreign substances injected into the eyelids, or large fat grafts that have caused severe irregularity and adhesion, as well as severe ptosis, to a normal eye shape.

■ Differences between extreme revision surgery and general revision surgery

General revision surgery may simplify or omit certain steps depending on the condition, but in extreme eye (double eyelid) revision surgery, when there is not enough extra skin or the existing scar line is too high and dark, making revision surgery almost impossible, the scar is not excised. Instead, subcutaneous dissection is performed and a new line is created beneath it.

To smooth out scar adhesions, all available techniques are mobilized to restore a natural and beautiful double eyelid, including multi-layer tissue dissection and repositioning, insertion of micro-fat tissue, levator shortening, and dissection and excision of the orbicularis oculi muscle below the incision line. In other words, all the techniques of revision surgery are concentrated into one procedure.

■ Plan for extreme revision surgery

① If tissue or skin is insufficient, measure the limit of how much can be stretched and stretch it.

② If the levator aponeurosis has almost no function, calculate the maximum amount it can be lifted.

③ If the skin is very thick, create a plan to thin the tissue by excising the orbicularis oculi muscle.

④ If scar adhesion is severe and cannot be smoothed out, plan micro-fat grafting after scar dissection.

⑤ If the sausage-like appearance is severe, plan to remove it through incision-line dissection and partial excision of the orbicularis oculi muscle.

⑥ If the scar line is very high, plan to flatten it instead of excising it.

⑦ If the scar line is very dark and sunken and cannot be excised, plan to fill in the depressed area.

⑧ If eyelash eversion is severe, plan correction of entropion by sub-eyelash-root dissection.

Examples of double eyelid revision surgery applications

Questions and Answers About Restoring the Double Eyelid Line with Fat Grafting

Q. I was told that eyelid fat grafting has many side effects and should not be done at another clinic. Is that true?

A. That does not mean all other clinics are like that.

The area that requires the highest level of experience and skill in fat grafting is the upper eyelid and under-eye dark circle fat grafting.

It is an area that cannot be handled carelessly without accumulated experience and skill.

I always say in the consultation room that fat grafting is absolutely not a procedure just anyone can do.

As with all surgeries, the results vary depending on the surgeon’s experience and know-how.

There are many clinics that perform fat grafting, but only a few do it properly.

Fat grafting is easy to do, but difficult to produce proper results.

In principle, fat grafting can lead to good results only when it is performed accurately.

The method differs by clinic, and the results vary greatly depending on experience.

You may have a negative impression from hearing about or experiencing poor fat grafting, but if it is done properly, satisfactory results can be achieved in a single session.

In particular, the upper eyelid area (sunken eyelids, hollow eyelids) requires a great deal of experience, skill, delicacy, and precision, so it cannot be done by just anyone.

Q. I had eyelid fat grafting at another clinic, but most of it has sunken away and little remains. Can it be done again in this case?

A. Even after treatment at another clinic and poor survival of the graft resulting in almost complete loss, repeat treatment is possible.

However, it must be done at least 3 months later.

Since fat graft survival takes at least 3 months, you can receive treatment again once 3 months have passed since the last procedure.

Even if repeat treatment is done at our clinic, the result is almost no different from the first time.

Q. I had eyelid fat grafting at another clinic, and it became bumpy and makes it hard to open my eyes. Is this a side effect?

A. The goal of eyelid fat grafting is to restore sunken eyelids and functionally improve the ability to open the eyes, thereby reducing eye fatigue.

To achieve this goal, the procedure must be precise and refined.

With fat grafting performed by someone with somewhat limited experience, the fat may be placed in the orbicularis oculi muscle layer rather than the orbital fat layer, causing irregularities, or it may be placed near the deep levator aponeurosis layer, making it harder to open the eyes than before the procedure.

If such side effects occur, the fat must be removed again, which is quite difficult.

To prevent side effects, it is better not to be treated by someone with insufficient experience or by a non-specialist in plastic surgery.

Q. What if filler is injected into the eyelid instead of fat grafting?

A. The eyelid is a structure that moves constantly, so procedures that interfere with eyelid movement should not be done.

Fat grafting can act as a cushion and lubricant that makes eyelid movement smoother, but injecting foreign substances such as filler can seriously interfere with the function of opening the eyes, regardless of the eyelid shape, and in severe cases swelling may not go down or the eye shape may become distorted.

Inflammation can even occur, so fillers should absolutely not be injected into the eyelids.

Q. Isn’t eyelid fat grafting dangerous because it is close to the eyeball?

A. Not at all.

The risk is higher when the procedure is done by a doctor with somewhat limited experience or by a non-specialist in plastic surgery. If an experienced specialist performs the procedure accurately, there is no need to worry.

Eyelid fat grafting must be performed with precise anatomical knowledge and know-how gained through extensive experience with double eyelid surgery. If done according to proper principles, it is one of the safe procedures.

Q. I developed puffiness after eyelid fat grafting at another clinic. Can it be corrected?

A. In some cases, people come to our clinic for correction because too much fat was injected at another clinic, making the eyelids feel heavy and puffy.

Depending on the condition, the fat must be removed by suction. If the fat can be felt as a lump by hand, it can be corrected by inserting a microcannula and suctioning it out.

However, 100% removal is impossible, and usually about 50% to 80% can be suctioned out and corrected.

Method for correcting the double eyelid line with micro-fat grafting

This is applied only when the upper eyelid is sunken.

Micro-fat grafting requires highly skilled technique and know-how.

The anatomical structure of the eyelid must be understood accurately.

Therefore, eyelid fat grafting can only be done properly by someone with extensive double eyelid revision experience.

It is a very high-difficulty procedure that must also take into account correction of the unnatural double eyelid line along with the sunken eyelid.

It is better not to receive the procedure from someone with insufficient experience or from a non-specialist in plastic surgery.

① Sedation anesthesia and local anesthesia are administered.

② Fat is finely harvested from the abdomen with a syringe.

③ The harvested fat is centrifuged and purified.

④ The purified fat then goes through another oil-removal process.

⑤ Tunneling is performed in the treatment area to secure space for grafting.

⑥ Precise grafting is performed into the orbital fat layer of the sunken eyelid.

⑦ The procedure is finished by molding and retunneling to adjust the contour of the eyelid and the height of the double eyelid line.

Examples of restoring the double eyelid line with micro-fat grafting

Questions and Answers About Quick Double Eyelid Surgery (Partial Incision Method)

Q. What is the biggest difference between quick double eyelid surgery (partial incision method) and the buried method?

A. Quick double eyelid surgery (partial incision method) is a method intended to gain the advantages of the incision method, which does not loosen easily.

A simple buried method creates the double eyelid line by only burying sutures, so if the skin is thick or there is a lot of muscle and fat, it can loosen easily.

Quick double eyelid surgery (partial incision method) has several advantages: orbital fat can be removed, scarring is minimal, and it does not loosen easily.

Q. Does quick double eyelid surgery (partial incision method) leave scars?

A. Like the buried method, it leaves almost no scar.

The period for scars to settle is usually after 3 months.

Until 3 months, redness remains and the scar is still developing, so a slight scar may be visible until 3 to 4 months, but after 3 to 6 months, the scar becomes almost invisible.

Q. How much swelling and bruising occurs after quick double eyelid surgery (partial incision method)?

A. There is almost no swelling or bruising, so you can return to daily life right away.

Even if a little bruising occurs depending on the person, it is barely noticeable and almost disappears within a week.

Q. When can I wash my face and wear makeup after quick double eyelid surgery (partial incision method)?

A. You can wash your face and wear makeup starting the day after surgery.

After washing your face, apply the disinfectant and ointment prescribed by the hospital, and then you can wear makeup.

The 4 principles of quick double eyelid surgery (partial incision method)

① Swelling should be minimal

Quick double eyelid surgery is one of the methods that causes the least swelling compared with any other method.

② The line should not loosen

By removing the orbicularis oculi muscle and orbital fat, the line almost never loosens.

③ Scarring should be minimal

With a minimal 2 mm incision, scar formation is almost nonexistent.

④ The line should be natural

The surgery is performed after previewing the line while seated, so the most natural line is selected.

Comparison of quick double eyelid surgery (partial incision method) and the buried method

	Quick Double Eyelid (Partial Incision Method)	Buried Method
Use of sutures	Absorbable sutures	Non-absorbable sutures
Degree of incision	About 2 mm, 3 incisions	About 2 mm, 3 incisions
Postoperative swelling	Slight	Slight
Degree of loosening	Almost never loosens	Loosens or becomes thinner more often
Line definition	Maintains definition like the incision method	Often loosens or is not distinct
Fat removal	Possible	Not possible
Suture removal	Not necessary; can be removed if desired	Impossible or very difficult
Scar formation	Almost none	Almost none

Examples of quick double eyelid surgery (partial incision method)

At our clinic, we perform double eyelid surgery using the quick double eyelid (partial incision method) instead of the pure buried method.

The difference is that the buried method has the drawback of loosening easily, so we compensate for this by using the partial incision method.

By making the partial incision as small as 2 mm, we have differentiated it from other partial incision methods.

Quick double eyelid surgery (partial incision method) is a method that uses very small incisions of about 2 mm in different areas. Like the buried method, it is natural and allows immediate return to daily life, and swelling is generally minimal.

It also leaves almost no scar.

If there is a lot of fat, fat removal is also possible.

In the buried method, if swelling occurs, there is no pathway for tissue exudate to drain, so people who swell a lot may swell as much as they would with the incision method.

In quick double eyelid surgery (partial incision method), tissue exudate drains directly through the incision holes, which is a major advantage because swelling and bruising are less than with any other method.

It also has the advantage of not loosening easily like the incision method.

Questions and Answers About the Incision Method

Q. Does the incision method leave a lot of scars?

A. Scarring cannot be avoided with the incision method, but the best result is considered one in which only a very faint incision line is visible when the eyes are closed.

If the surgery is done poorly, a sunken scar like a trench may remain.

To minimize scarring with the incision method, meticulous suturing must be performed.

In other words, the degree of scarring depends on how the suturing is done and on the patient’s constitutional factors.

If precise and delicate suturing is done, scars can be kept to a minimum.

Q. Are swelling and bruising worse than with the buried method or the partial incision method?

A. It is true that the incision method causes more swelling and bruising than the buried method or the partial incision method.

However, the difference is about 1 to 2 weeks.

The amount of swelling and bruising varies from person to person.

Q. When can I return to daily life after the incision method?

A. In the incision method, stitches are usually removed on day 3 or 4.

However, because no bandage is applied, you can return to daily life the next day after surgery.

When the eyes are open, the suture thread is hardly visible, so there is not much difficulty in daily life.

Incision method

This refers to a method of making the line by making an incision along the entire design line for creating the double eyelid.

◆ Indications for the incision method

When skin is sagging and needs to be excised

When the skin is thick and the buried or partial incision method is likely to loosen

When the existing double eyelid line needs to be revised

When ptosis needs to be corrected

◆ Advantages and disadvantages of the incision method

Advantages	Disadvantages
When skin is sagging, the skin can be excised.	If you do not like the line, it is difficult to revise.
It does not loosen easily.	Scars remain.
The shape of the line can be designed as desired.	Swelling lasts a long time.
Muscle below the incision line can be excised to create a refined line.

Examples of the incision method

Questions and Answers About the Buried Method

Q. What is the biggest problem with the buried method?

A. The problem with the buried method is that the line may loosen partially or completely.

Statistically, it has a much higher chance of loosening than the incision method or partial incision method, so once a buried method loosens, there is still a high chance it will loosen again even if the buried method is done again.

Q. Does the buried method cause almost no swelling?

A. It is a method that creates the line by only placing sutures, so swelling is minimal.

However, swelling varies from person to person, so in some cases it may last a long time.

In particular, in the continuous single-knot buried method, because the sutures are buried continuously in a double layer, swelling often subsides later than with other buried methods.

The buried method cannot be said to cause relatively less swelling than other methods.

Q. If the skin is thick, should the buried method be avoided?

A. If the skin is thick, there is a lot of fat, or the orbicularis oculi muscle is thick, the buried method should be avoided as much as possible.

If you try the buried method even though it is not suitable for you, and the line does not look natural or loosens partially, the result may be worse than not doing it at all.

Buried method

This refers to a method in which, instead of making an incision along the entire design line for creating the double eyelid, only sutures are buried and the double eyelid line is created at the buried suture site.

It is mainly applied to young people with thin skin.

However, because the line can deform or loosen easily and because fat cannot be removed, it is not a particularly desirable method.

◆ Indications for the buried method

When the skin is thin and there is little fat

When you do not want any surgical scar

When you need to return to daily life immediately after surgery

◆ Advantages and disadvantages of the buried method

Advantages	Disadvantages
The surgery time is short and there is no incision at all.	If the skin is thick, the double eyelid line loosens easily.
There is little swelling and you can return to daily life right away.	Orbicularis oculi muscle or fat removal is not possible.
There is no scar and the result is natural.	It is difficult to apply when the skin is sagging.
If you do not like the line, correction is easy.	The line can partially loosen and easily become awkward.

Questions and Answers About Epicanthoplasty (Removal of the Epicanthal Fold)

Q. What is the epicanthal fold?

A. The epicanthal fold, also called the medial canthal fold, refers to the condition where excess skin on the inner corner of the eye covers the white of the eye on the inside.

When the epicanthal fold is present, the eye shape often looks constricted and the eyes appear farther apart.

Q. Does epicanthoplasty leave scars?

A. Most epicanthoplasty procedures leave some scars.

Many methods have been developed, but only a few are actually used.

The best method is one that leaves as little scar as possible and looks natural.

Because each clinic differs in surgical method, it is best to choose a method that leaves less scarring, has no recurrence, and gives a natural result.

Q. Are epicanthoplasty and front corner eye surgery the same thing?

A. They mean the same thing.

Epicanthoplasty is also called medial canthal fold surgery, and the common term is front corner eye surgery.

However, lateral canthoplasty is a surgical method that opens the outer corner of the eye, so it is the opposite of front corner eye surgery.

Q. Can double eyelid surgery and epicanthoplasty be done at the same time, or should they be done separately?

A. Both surgeries can be done at the same time or separately.

You can have double eyelid surgery first and epicanthoplasty later, or epicanthoplasty first and double eyelid surgery later.

Epicanthoplasty (front corner eye surgery)

When the space between the eyes appears wide, the skin at the inner canthus often covers the eyeball excessively. The skin covering the eyeball at the inner corner of the eye is called the epicanthal fold.

This is a surgery that removes the skin of the inner canthus to normalize the distance between the eyes and open up the inner corner of the eye that looks constricted.

◆ Principles of epicanthoplasty (front corner eye surgery)

① There should be no scar.

The incision line should be hidden inside the eyelid boundary so that scarring is almost nonexistent.

② The shape should be natural.

The inner corner of the eye should be designed horizontally to create a natural front corner opening.

③ It should not recur.

The inner corner should be fixed and sutured to the ligament so it does not return to its original position.

◆ Comparison between exposed front corner eye surgery (epicanthoplasty) scars and the front corner eye surgery of the Duhan Plastic Surgery double eyelid clinic

The principles of epicanthoplasty are that it should leave little scarring, have a low recurrence rate, and be a method that can be done together with double eyelid surgery.

At our clinic, we perform surgery using the Furukwa, Y-V method.

The advantages of the surgery are that scars are less visible, the result is natural, and when performed together with double eyelid surgery, it has the advantage of being able to naturally continue the double eyelid extension line.

Examples of epicanthoplasty (front corner eye surgery)

Reasons why scars do not appear in epicanthoplasty and front corner eye surgery at the Duhan Plastic Surgery double eyelid clinic

If skin is incised, a scar will inevitably form.

The same is true for the epicanthal fold, since surgery is performed by incision, so scars are unavoidable.

If surgery is done in a way that leaves the scar exposed, the scar can look unattractive no matter how carefully it is sutured.

However, if the scar line is buried at the edge of the eye corner and hidden, the scar becomes almost unnoticeable.

Because the scar is not exposed on the surface, it cannot be seen.

Questions and Answers About Ptosis Correction

Q. What is ptosis?

A. Ptosis commonly refers to a sleepy-looking eye shape.

Normally, a healthy eye shape looks bright and alert, but in the case of ptosis, the eyes look as if the person has just woken up from sleep.

However, sagging skin can also make the eyes look sleepy, so in such cases it is not ptosis, and you must receive an accurate examination from a plastic surgery clinic to determine whether ptosis is present.

Q. What problems occur when ptosis develops?

A. When ptosis is present, the eyes tire easily, opening the eyes feels uncomfortable, and the person has a sleepy-looking impression.

There are both cosmetic and functional problems, so correction is needed to restore a bright and refreshed eye shape.

Q. Can ptosis occur even after double eyelid surgery?

A. After double eyelid surgery, the eyes may not open as fully.

At first, the eyes may not open fully because of swelling, but if the eyes still do not open fully after the swelling has gone down, there is a problem.

Ptosis can occur when the double eyelid line is made too high.

This is called pseudoptosis.

Q. What is the difference between true ptosis and pseudoptosis?

A. True means real, and pseudo means false.

In other words, if the function of the levator aponeurosis is congenitally reduced, it is more likely to be true ptosis, while if ptosis occurs after double eyelid surgery, it is more likely to be pseudoptosis.

Pseudoptosis is a condition in which the levator aponeurosis function is normal, but scar tissue from the double eyelid interferes with it.

Ptosis

A condition in which the eyes do not open widely and always look sleepy is called ptosis.

It is broadly divided into congenital ptosis and acquired ptosis.

It is divided into true ptosis, where the function of the levator palpebrae superioris, the eyelid-lifting muscle, is reduced, and pseudoptosis, which only appears to be simple ptosis.

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

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

The purpose of double eyelid surgery is to create a large, refreshed eye shape and form a line on the eyelid to make the eye shape look more refined.

However, if the eye looks even sleepier after surgery, it becomes worse than not having surgery at all.

◆ Levator shortening

A method of shortening the eyelid-lifting muscle (levator aponeurosis) by overlapping and suturing it by about 4 to 8 mm, mainly used in mild ptosis.

Because the surgery must be done by incision, a double eyelid line inevitably forms during the process, so people without a double eyelid have no choice but to create at least a hidden double eyelid.

◆ Levator resection

A method of shortening the eyelid-lifting muscle (levator aponeurosis) by excising about 5 to 10 mm and suturing the cut end of the levator aponeurosis to the tarsal plate.

It is mainly used in moderate ptosis.

Examples of ptosis correction

Questions and Answers About Under-Eye Fat Removal

Q. What is the best method for under-eye fat removal?

A. For under-eye fat removal, no incision is made in the skin.

If an external incision is made, scarring remains, so in most cases a scar-free procedure through the conjunctiva is performed.

Q. How much swelling and bruising occurs after fat removal?

A. There is some swelling and bruising, but it mostly disappears within a week.

Q. Do I need to remove stitches?

A. Because the conjunctiva is incised, the fat is removed, and the area is sutured with absorbable sutures, there is no need to remove stitches.

Q. Does the fat grow back?

A. Fat once removed does not regenerate.

Fat removal has a permanent effect.

Under-eye fat removal

Normally, there are three fat pads in the lower eyelid: one on the inner side, one in the middle, and one on the outer side.

Among them, the middle fat pad is the largest, so the middle fat is removed, and if necessary, the middle and inner fat pads may also be removed.

How much fat to remove from how many areas varies by person, so it is important to remove an appropriate amount for each individual.

Excessive fat removal can cause under-eye hollowing, so the appropriate amount should be removed after an accurate examination.

◆ Indications for under-eye fat removal

When the under-eye area bulges due to forward displacement of orbital fat

When the under-eye area often swells in the morning

When wrinkle lines are visible around the bulging under-eye area

When there is a red dark circle under the eyes

◆ Effects of under-eye fat removal

Correction of puffy-looking eyelids

In the case of under-eye fat removal, restoration to a smoother eye shape along with correction of under-eye wrinkles

Correction of red dark circles under the eyes

Restoration to a younger-looking eye shape

No scar and a natural result

Almost no bruising or swelling, allowing immediate return to daily life

Examples of under-eye fat removal

Types of Unattractive Double Eyelids

Please refer to the unattractive double eyelids below.

In the case of a double eyelid line that is too large

A double eyelid line that is too large rarely looks suitable under any circumstances.

A natural line is one that is only slightly visible when the eyes are open.

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

In the case where the area below the line looks swollen - sausage-like appearance

This is a condition in which the area below the double eyelid line bulges outward, commonly called the sausage-like appearance.

It gives the impression of someone who had surgery only a few days ago and makes the viewer feel uncomfortable.

Causes of the sausage-like appearance include thick skin and orbicularis oculi muscle, designing the line too high, or partial loosening of the line.

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

In the case of a thick incision scar

This is a case where the incision mark is very visible even when looking slightly downward, creating an unattractive double eyelid that looks as if it was cut with a knife.

Causes include constitutional factors, but also poor suturing and poor timing of stitch removal.

It should be corrected by scar revision surgery, scar excision, and meticulous suturing.

In the case of an epicanthal fold

There are cases where the double eyelid line does not continue all the way and disappears in the middle.

If the inner line of the double eyelid disappears, it can give a somewhat constricted feeling.

Epicanthoplasty is also called front corner eye surgery. If double eyelid surgery and front corner eye surgery are performed together to create the double eyelid, the line can continue to the end and create a natural line.

In the case of wrinkles below the line

If there are several lines below the double eyelid line, the double eyelid looks messy.

A beautiful line should be a small, precisely formed single line. If there are many fine wrinkles in addition to the double eyelid line, the eyes may look older and the impression may become less favorable.

In such cases, correction with the partial incision method is done, or if that is not feasible, a certain amount of skin must be excised using the full incision method.

In the case of a line that is not clear and appears blurred

A double eyelid line should be somewhat distinct to look beautiful.

If the line loosens and becomes blurred, it will look like a wrinkle without a refined feeling, which gives a bad impression.

In such cases, it must be changed back to a clear line.

In the case of a line that is too deep and dark

A double eyelid line that looks too deep or too dark also looks awkward.

Causes include sagging skin and a sunken incision area.

The line should be clear, but a double eyelid line that looks too deep also falls into the category of an unattractive double eyelid.

In the case of an excessive outfold line that extends beyond the inner corner of the eye

An excessive outfold double eyelid line often looks awkward because it gives a strong artificial impression.

An infold line that disappears in the middle because of an epicanthal fold is also awkward, but an outfold line that extends past the inner eye corner is also awkward and creates a strong impression, so it is considered an unattractive double eyelid.

In the case of an uneven double eyelid line with curves and irregularities

A double eyelid is beautiful when the line curves smoothly and connects without irregularities.

The most ideal line is one where the inner line is small and gradually widens outward without bends or irregularities.

However, a curved line in which the inner part is wide, then becomes narrow in the middle, and widens again at the outer part is one of the awkward line types.

In the case of a double eyelid line with a sunken eyelid

If there is eyelid hollowing above the double eyelid line, the face may look older or the line may become larger or distorted and awkward.

Eyelid hollowing is a major cause of double eyelid deformation, so the hollow area should be corrected with micro-fat grafting.

In the case of a double eyelid line with unnecessary front corner surgery

Unnecessary front corner surgery can cause various problems.

Front corner surgery should only be done when truly necessary in eyes with an epicanthal fold. Unnecessary or excessive front corner surgery can cause side effects such as excessive exposure of the inner mucosa, a severe outfold line, eyes that look too close together, or a sharp-looking eye shape.

Unnecessary front corner surgery often makes the face look worse, so be careful.

In the case of a double eyelid line with eyelash eversion

There are cases where the skin below the double eyelid line is pulled upward, causing the eyelashes to turn outward.

This occurs when scar adhesion is severe, when there is not enough skin, or when the suturing is pulled too far upward.

The adhesion must be released and the skin pulled downward to correct it.

In the case of a double eyelid line with lateral canthoplasty

This is one of the surgeries that should absolutely not be done in plastic surgery.

It is a surgery that is explicitly stated in plastic surgery textbooks as not recommended.

Lateral canthoplasty is a procedure that can cause various side effects, such as mucosal exposure, eyelid eversion, a sharp eye shape, and severe scarring.

The incidence of side effects from lateral canthoplasty is over 90%, and because it can create irreversible and serious side effects, it must be approached with caution.

Indications for double eyelid surgery

When the eyes look small

When there are wrinkles on the eyelids

When the eyelids look droopy

When only one eye has a double eyelid

Examples of eye shapes that need double eyelid surgery

◆ Basic principles and concept of double eyelid surgery

People often mistakenly think that double eyelid surgery is simply surgery to create a double eyelid line.

That is not the only purpose.

The purpose of double eyelid surgery is to make the eyes larger and brighter so that the impression becomes more intelligent and beautiful.

Surgery done only to create a double eyelid line can sometimes create a bad impression.

The ultimate goal of double eyelid surgery is to create a natural and beautiful eye shape.

The right double eyelid for me

Through a preoperative examination, it must be determined which line suits the individual.

Because eye shape and size differ from person to person, it is important to create a double eyelid line that suits the individual.

Infold double eyelid

An infold double eyelid is one in which the double eyelid line disappears toward the inner part of the eye.

This is created in eyes with a short horizontal eye length or with an epicanthal fold at the inner canthus.

Therefore, if the line is made too much into an infold, some people may intentionally design it closer to an outfold, but an artificial line can easily create an awkward result.

Outfold double eyelid

An outfold double eyelid is one in which the double eyelid line is visible all the way to the inner corner of the eye.

This type of double eyelid is created in eyes without an epicanthal fold and with a long horizontal eye length.

It is also more likely to be created when the line is designed larger during surgery.

Hidden double eyelid

A double eyelid with a small line that is barely visible when looking straight ahead.

This hidden double eyelid generally suits people with thick skin or large eyes.

It is suitable when you want a natural line that does not stand out.

Visible double eyelid

A double eyelid with a large line that is clearly visible when looking straight ahead.

In most cases, a double eyelid line that appears too clearly visible is not considered desirable from a current perspective.

An excessively large double eyelid line can sometimes lead to the need for revision surgery.

Advantages and pride of the Duhan Plastic Surgery double eyelid revision clinic

http://www.doublefold.co.kr

Medical staff with extensive experience and stability

Director Shin Duhan, who has focused on more than one double eyelid revision case per day and thousands of cases, works as a team with experienced nurses.

1:1 customized surgical plan

Based on each individual’s double eyelid condition, we consider gender, overall facial harmony, and the patient’s wishes.

The rate of correction from outline to inline and performing epicanthoplasty or lateral canthoplasty at the same time as double eyelid surgery continues to increase.

If epicanthoplasty or lateral canthoplasty is appropriate and performed together with double eyelid revision surgery, the effect is amplified.

The height of the double eyelid line and its shape (inline, in-out line, outline, etc.) reflect the patient’s preferences, and the trend these days is "naturalness."

Double eyelid revision surgery without side effects

People undergoing double eyelid surgery worry whether the line will loosen or whether scars will remain.

Side effects are reduced through Director Shin Duhan’s analysis and the ability to accurately perform the line as analyzed.

Also, because of delicate incision and suturing, there is no need to worry about asymmetry.

Results that are difficult to imitate

There are many clinics that perform double eyelid revision surgery, but just because the surgery name and method are the same does not mean the result will be the same.

With more than 20 years of extensive experience, we provide the optimal beautiful line for each patient.

Double eyelid surgery is often thought of as a simple procedure, but revision surgery is quite difficult.

Double eyelid revision surgery includes a delicate process of redesigning the line and completely separating and dissecting the previously adhered double eyelid tissue.

Thanks to the careful dissection process, there are no side effects such as the line becoming bumpy later or adhesions causing it to fold upward.

By neatly organizing not only the skin layer but also all the tissues in the fat and muscle layers one by one, even extreme revision surgery can produce results that are difficult to imitate.

Performing double eyelid revision and eye-shape correction at the same time

At the Duhan Plastic Surgery double eyelid revision clinic, eye-shape correction is included in double eyelid surgery, so we correct sleepy eyes and eyes that look dull because the iris is covered.

By tying and shortening the levator aponeurosis that opens the eyes, we adjust how much of the iris is visible and make the eye shape clearer.

Research, lectures, and educational activities on double eyelid revision surgery

The most trustworthy answers come from extensive clinical experience.

Double eyelid revision surgery is like a premium product perfected through years of experience.

Through this accumulated experience, we also carry out research and educational activities.

Increase in consultations for revision surgery

As newly established clinics are springing up and performing double eyelid surgery indiscriminately, the number of revision surgery requests is also increasing, which is truly unfortunate.

If revision surgery is repeated several times and fails, the amount of extra skin decreases, making future revision surgeries even more difficult and extreme.

Not only is the first choice for double eyelid surgery important, but when considering revision surgery, it should also be approached carefully as if it is the last opportunity.

Craftsmanship for a complete and beautiful face

A doctor who performs double eyelid surgery among cosmetic procedures must have the sense of both a doctor and a designer.

If one insists only on a uniformly preferred double eyelid line without understanding what a beautiful line is, a perfect line suited to the individual patient cannot be achieved.

If one does not have an eye for it, or even if one does, lacks the skill to reproduce it, a masterpiece cannot be created.

We do our best down to the last stitch to provide beauty and satisfaction to each and every patient.

Honest surgery with sincerity

We recommend surgery when the expected satisfaction is above 80%, but we do not proceed with unnecessary surgery even if requested.

We aim to be a clinic that treats patients honestly through skill and results.

A trustworthy premium clinic

There is a reason why a craftsman’s work is expensive.

It is because they create something beautiful and valuable.

The Duhan Plastic Surgery double eyelid revision clinic has pride and confidence in its surgeries.

Proper surgery will become an opportunity to gain confidence throughout one’s life.

We aim to be a clinic that, rather than suggesting surgery at a low price and having multiple doctors rotate through procedures, offers higher-priced but satisfying results.

​http://www.doublefold.co.kr​ ​