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Double eyelid revision surgery

If the double eyelid line is too large,

uneven, or has loosened,

this refers to surgery that corrects the double eyelid line

and restores it to its original, natural,

clear double eyelid shape.

Indications for double eyelid revision surgery

◇ When the double eyelid line is too large

◇ When the double eyelid line has loosened

◇ When the line is asymmetrical

◇ When the eyes feel tired after double eyelid surgery

◇ When there is a thick sausage-like appearance below the incision line

◇ When the impression looks worse after double eyelid surgery

◇ When you want to restore a beautiful and natural-looking eye shape

Purpose of general double eyelid surgery

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

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

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

The purpose of double eyelid revision surgery is the same.

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

When there is a Mongolian fold

Sometimes the double eyelid line does not continue to the end and disappears in the middle.

If the inner part of the double eyelid line disappears, it can make the eyes look somewhat cramped.

Mongolian fold removal is also called epicanthoplasty.

If double eyelid surgery and epicanthoplasty are performed together to create the double eyelid,

the line can extend all the way to the end and form a natural line.

Epicanthoplasty (Mongolian fold removal)

It is a common fold found in 60–70% of East Asians.

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

This makes the space between the eyes look wider and the eyes themselves appear smaller, creating a cramped impression.

This surgery removes the skin at the inner canthus to normalize the distance between the eyes and opens up the cramped-looking inner eye area.

It increases the horizontal width of the eyes and makes the inner part of the eyes look clearer and more open.

How to diagnose epicanthoplasty (Mongolian fold removal)

Mongolian fold (inner canthal epicanthal fold) is diagnosed when the distance between the eyes is 40 mm or more, or when the skin at the inner side of the eye covers the white of the eye, creating a cramped feeling.

Eyes with a Mongolian fold usually have an inner corner that is not sharp, but rather rounded or with a steep downward angle.

Indications for epicanthoplasty (Mongolian fold removal)

1. When the eyes appear far apart

As a rule, surgery is performed when the distance between the inner canthi exceeds 40 mm.

The normal distance between the eyes is about 36–37 mm, but if the distance is normal and there is still a Mongolian fold, it is better not to perform the surgery.

If done incorrectly, the eyes may appear too close together.

2. When you want to create an outfold double eyelid

If a Mongolian fold is present, an infold double eyelid is created, so Mongolian fold removal is necessary to create an outfold double eyelid.

Principles of epicanthoplasty (Mongolian fold removal)

★ There should be no scar.

The incision line should be hidden inside the eyelid boundary so that scarring is kept to a minimum.

★ The shape should look natural.

The inner eye shape should be designed horizontally so that the epicanthoplasty looks natural.

★ It should not recur.

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

Comparison between exposed epicanthoplasty scars and DuHan Plastic Surgery epicanthoplasty

The principles of Mongolian fold removal (epicanthoplasty) are that it should leave minimal scars, have a low recurrence rate, and be performed in a way that can be combined with double eyelid surgery.

At DuHan Plastic Surgery’s double eyelid clinic, surgery is performed using the Furukwa, Y-V method.

The advantages of this surgery are that the scar is less visible, the result looks natural, and when performed together with double eyelid surgery, it can be done naturally as an extension of the double eyelid line.

Various Mongolian fold surgical methods and scar shapes

The surgical process for epicanthoplasty (Mongolian fold removal)

1. The skin is pulled toward the nose to make it taut.

2. With the skin stretched, the design is drawn using special ink.

The shape of the design varies depending on the surgical method, so it is not a fixed shape.

At DuHan Plastic Surgery’s double eyelid clinic, the Y-V method is mainly used to keep the scar from being noticeable.

3. Under sedation anesthesia, local anesthesia is administered to the designed area.

4. A scalpel is used to make a precise incision along the design line.

5. The skin is lifted from the muscle.

6. The skin tissue is repositioned so that the Mongolian fold is pulled toward the nose.

At this time, any excess skin tissue is appropriately removed.

7. The skin is closed with fine sutures.

No bandage needs to be applied immediately after surgery, and the stitches are removed after 5–6 days.

Examples of epicanthoplasty (Mongolian fold removal)

Postoperative care after epicanthoplasty (Mongolian fold removal)

1. For the postoperative visit, return the next day after surgery to disinfect the surgical area and monitor the progress.

2. The stitches are removed on the 5th day after surgery.

3. Swelling is minimal after surgery, and the period for complete settling is about 1–3 months. During this period, the surgical area should not be rubbed strongly.

4. For about 3 months, a slight scar may be noticeable at the inner corner of the eye, but this is part of the normal healing process and after 3 months it becomes almost unnoticeable.

5. Take care not to rub the surgical area when washing your face.

If the surgical area is rubbed too hard, the scar may become rough or widen, so caution is needed.

When epicanthoplasty (Mongolian fold removal) should not be performed

★ If the distance between the eyes is less than 40 mm, the normal distance is usually about 36–37 mm.

If it is under 40 mm, removal surgery should not be performed.

If epicanthoplasty is performed on eyes with a normal distance between them, a side effect of the eyes appearing too close together may occur, so caution is needed.

★ Even if the distance between the eyes is wide, if the inner corner of the eye has a sharp shape, Mongolian fold removal should not be performed.

The goal of Mongolian fold correction is to open up the inner corner and make it look clearer when the inner shape is round.

If the eye shape is already sharply open, surgery may make the eyes look even more severe, so caution is needed.

Precautions for epicanthoplasty (Mongolian fold removal)

★ It should be performed only when it suits the patient's eye shape.

During consultation, you should discuss with the specialist, carefully consider whether Mongolian fold removal is truly necessary, and then decide on surgery.

★ No matter what method is used, it is difficult to perform Mongolian fold removal without leaving any scar at all.

It is better to perform the surgery in a way that leaves as little scarring as possible, and it is desirable to hide the scar inside.

Because the scar is not visible on the outside, there is almost no visible trace of surgery.

Why DuHan Plastic Surgery’s epicanthoplasty (Mongolian fold removal) does not leave visible scars

Whenever the skin is incised, a scar inevitably forms.

The Mongolian fold is no exception; because it is treated with an incision, scarring is unavoidable.

If the surgery is done in a way that exposes the scar externally, the scar can look unsightly no matter how meticulously it is sutured.

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

Because the scar is not exposed externally, it is not visible.

In cases where the double eyelid line has unnecessary epicanthoplasty

Unnecessary epicanthoplasty can cause various problems.

Epicanthoplasty should only be done when it is truly necessary in eyes with a Mongolian fold, and unnecessary or excessive epicanthoplasty can cause side effects such as excessive exposure of the inner mucosa, a severe outfold line, the eyes appearing too close together, or a sharper look.

Unnecessary epicanthoplasty often makes the overall impression look worse, so caution is needed.

Problems caused by excessive epicanthoplasty

Excessive epicanthoplasty has limitations in changing the eye into an infold line or a natural line.

Because of unnecessary excessive epicanthoplasty, a severe outfold line, excessive mucosal exposure, or the eyes appearing too close together may occur.

In cases of excessive epicanthoplasty, it is first made as much as possible into an infold line, and if that is still insufficient, epicanthoplasty restoration is performed additionally after 6 months.

Epicanthoplasty restoration surgery

This refers to surgery to restore the original eye shape after unnecessary epicanthoplasty that was not actually indicated and instead made the overall impression worse.

Reasons why epicanthoplasty restoration surgery is needed

If epicanthoplasty was done because it was needed, then why would epicanthoplasty restoration surgery be necessary again? That is something to think about.

The reason epicanthoplasty restoration surgery exists is that some clinics recommend epicanthoplasty unconditionally without considering the postoperative eye shape.

If epicanthoplasty is performed even when it is not indicated, various problems can occur, so this should be kept in mind.

Problems that occur after unnecessary epicanthoplasty

① The distance between the eyes becomes shorter than normal, making the eyes appear too close together.

② If epicanthoplasty is performed when the inner eye corner is already sharp, the eye shape becomes too sharp and looks severe.

③ The inner mucosa of the eye is exposed too much and becomes unpleasant in appearance.

④ After epicanthoplasty, the inner line becomes thicker, and if an infold line is desired, it may become an unwanted outfold line.

⑤ Even after double eyelid revision surgery to reduce the inner line, if it is done together with epicanthoplasty, the line may not become smaller or may even become larger.

Examples of epicanthoplasty restoration surgery

Before epicanthoplasty restoration surgery, the situation that led to the need for restoration should not be created in the first place.

This means spending money to make the impression worse through unnecessary epicanthoplasty, and then spending even more money to reverse it with restoration surgery.

Epicanthoplasty is not a surgery to be done casually just because the surgeon recommends it.

You must carefully decide whether it is truly necessary for you.

DuHan Plastic Surgery’s epicanthoplasty restoration method

Restoration is performed by designing in the opposite direction of epicanthoplasty, using the V-Y advancement flap method or the Z-plasty method.

The method varies depending on the shape of the individual’s eye and the amount of available tissue.

Restoration surgery leaves more scarring than epicanthoplasty, so this must be taken into account.

At our clinic, if the epicanthoplasty is severe and restoration is desired, it may sometimes be possible to perform the procedure in one stage if the current double eyelid is natural and there is enough skin at the front. However, if there is not enough skin and the double eyelid is awkward and large, staged reconstructive plastic surgery may be necessary.

In general, if the thickness (width) of the double eyelid is around 6 mm or more than that, or if the fixation point of the double eyelid is very high, it may take a long time before it looks natural.

It can be reconstructed to match the shape of your own eyes.

Even if Mongolian fold reconstruction surgery is performed, it cannot make the eyes exactly the same as before, and because the skin around the eyes must be gathered toward the eye area during reconstruction, care must be taken so that the scar does not spread below the inner corner of the eye.

The scar does not occur because it is sutured from inside the skin.

In cases where the double eyelid line has outer canthoplasty

Among plastic surgeries, this is one of the procedures that absolutely should not be performed.

It is even stated in plastic surgery textbooks that it is better not to do this surgery.

Outer canthoplasty is a surgery that can cause various side effects such as mucosal exposure, eyelid eversion, a severe eye shape, and significant scarring.

The rate of side effects from outer canthoplasty is over 90%, and because it can cause irreversible and serious complications, caution is needed.

Outer canthoplasty surgery

These days, there are frequent cases of patients complaining of side effects from outer canthoplasty performed at other clinics.

Outer canthoplasty refers to surgery that opens up the outer corner of the eye, opposite to epicanthoplasty.

Types of side effects from outer canthoplasty

◎ Eyelid eversion and lifting

◎ Distorted scars at the outer corner of the eye

◎ Mucosal exposure and eyelid drooping

◎ Excessive exposure of the lower white part of the eye

◎ Deformation of the eye shape and twisting of the outer canthus

◎ Dry eye and tearing

Examples of side-effect correction surgery after outer canthoplasty at other clinics

DuHan Plastic Surgery’s outer canthoplasty restoration method

If the outer eye corner is raised and the horizontal length of the eye is short, performing outer canthoplasty together with lower canthoplasty can create a larger and gentler impression.

However, in the case of outer and lower canthoplasty, the effect can vary depending on the shape and structure of the eye and eyeball, so some eyes benefit significantly while others do not.

In outer and lower canthoplasty, the tissue that tends to reattach is sufficiently removed through skin dissection, so it does not reattach, and the surgical site is delicately sutured according to the anatomical structure from the inner conjunctiva of the eye to the ligament-fascial layer, muscle layer, and skin layer.

This surgical method compensates for the drawback of previous outer canthoplasty, namely reattachment.

Because the skin and mucosa are sutured separately, it does not form a “D” shape, and there is no concern about reattachment.

Also, unlike other clinics, it is not done with skin incision alone; it is firmly fixed to the periosteum so it does not loosen, and it is a safe surgery that can also be restored later.

The sutured area is naturally hidden along the eye corner line to minimize visible scars, and thanks to years of experience in double eyelid revision surgery, delicate and precise suturing leaves almost no scar.

Through numerous surgical cases, patient safety and satisfaction have been improved.

Our clinic does not perform surgery that makes everyone have the same eyes.

With 1:1 customized design, we tailor the design to the patient’s eyes and create a natural eye shape that harmonizes with the existing double eyelid line.

Restoration must be performed with the scar in mind

Sometimes the result is good,

and sometimes it is the opposite.

Restoration should also be decided carefully after an accurate examination.

You may create something from something,

but you cannot create something from nothing.

Epicanthoplasty removes tissue by excising the skin,

and restoration tries to return it to the original state after excision,

so even by common sense, you can feel that this is a surgery that may not go well.

There are clinics that say they perform restoration surgery,

but good results are not common.

There is a high possibility of leaving more severe scars and causing distorted shapes,

so restoration surgery is a very difficult procedure, among the highest level of difficulty.

When meeting a skilled specialist for double eyelid revision surgery,

some people think good results are guaranteed,

but that is a very dangerous way of thinking.

Sometimes the result may appear unsatisfactory.

Before surgery, you must keep in mind these three possibilities: whether the surgery is possible, how much improvement can be achieved if it is possible, or whether it is impossible. You should receive a consultation and make your judgment based on that.

In revision surgery,

sufficient clinical experience and the surgeon’s skill must be supported.

Revision surgery is being performed at many clinics,

but in most cases the results are not very good.

Revision surgery can only be performed when a great deal of experience and know-how has been accumulated,

so it is not a procedure that just anyone can do.

There are not many people in our country who can consistently produce results that satisfy patients after revision surgery, so please keep this in mind.

You must accurately understand what went wrong with the initial surgery, and how it should be improved

in order to achieve good results.

If there is enough extra skin, revision surgery is certainly possible.

The purpose of revision surgery is largely twofold.

Restoring a larger, clearer eye shape and

restoring a natural double eyelid line.

Director Shin Du Han

DuHan Plastic Surgery procedure

1. Before visiting, make a consultation appointment in advance by phone or online.

If you make an appointment in advance and come in, you can receive counseling more comfortably.

2. After making an appointment and visiting, if you decide to proceed with surgery after the consultation, schedule the surgery date.

The surgery appointment can also be made later by phone or online.

3. Precautions before surgery

Once the surgery date is confirmed, those taking steroids or anticoagulants (aspirin), etc., should temporarily stop taking the medication starting 7 days before surgery.

As much as possible, do not drink alcohol the day before surgery.

Alcohol reduces the effect of local anesthesia, so anesthesia may not work well during surgery or may wear off quickly.

For women, avoid the menstrual period if possible.

This may not matter for minor surgery, but in larger surgeries, bleeding during the operation may increase, so caution is needed.

4. On the day of surgery

○ Arrive 30 minutes before the scheduled surgery time and listen to an explanation of the precautions to be observed during surgery.

○ Change into surgical clothing and receive an IV drip for preoperative treatment.

In the case of local anesthesia, an intravenous injection is administered for painless anesthesia.

About 5 minutes after the intravenous injection, the patient enters a sedated state, and for patients undergoing double eyelid surgery or nose surgery, local anesthesia is administered to the surgical area while in that sedated state.

When the patient wakes up about 5 minutes later, the anesthesia is completely finished.

The patient does not feel any pain during anesthesia.

○ When the surgery is finished, the patient receives antibiotic and anti-inflammatory intramuscular injections and rests in the recovery room for about 30 minutes.

For double eyelid or nose surgery, cold compresses are applied with a cool pack.

○ If the surgery was performed under general anesthesia, the patient rests in the recovery room for 1–2 hours and goes home once dizziness from the anesthetic has completely disappeared.

○ When going home, the attending surgeon gives postoperative instructions, the patient reserves a follow-up date, receives the prescription, purchases medicine at the pharmacy, and takes it.

5. Return on the scheduled date for a postoperative checkup and examination.

As the saying goes, the eyes are the window to the soul, and they are a very important part of the face.

Double eyelid surgery is the most basic and common procedure among plastic surgeries.

A person’s eye shape plays a major role in first impressions.

Double eyelids make the eyes more beautiful, and eye shape surgery makes the overall impression more beautiful as well.

The most important purpose of double eyelid surgery is, naturally, to create beautiful eye shape.

If surgery is done only to create a double eyelid line, it can actually damage the impression.

That is why double eyelid surgery is also called ptosis correction surgery.

Human eye shapes vary tremendously, so not everyone can be operated on with the same method and design.

The design must be tailored to each individual’s characteristics, and the height of the double eyelid must be precisely determined during surgery.

In addition, the design must anticipate how the line will look after it has fully settled 3–4 months later.

After final settling, the ideal double eyelid line is one that is almost invisible when the eyes are open, or only barely visible by about 1 mm.

However, some people end up with eyes that look half-closed after surgery.

No matter how pretty the double eyelid line is, if the way the eyes open is not clear and open, that is also an incorrect double eyelid.

Also, a surgery is wrong if incision marks are visible when the eyes are closed.

If incision marks are visible after incisional surgery, that is not acceptable.

A beautiful double eyelid shape should give the impression that the eyes are large and beautiful when others see them.

Very few people have all of these conditions.

That is how difficult and delicate double eyelid surgery is.

Even though eye surgery is the procedure plastic surgeons perform most often, it is also the most delicate because every person’s eye shape and characteristics are different, so many variables must be considered during surgery.

If an experienced and capable doctor can immediately correct an unwanted result after surgery and achieve a satisfactory outcome, there is no problem.

In other words, double eyelid surgery is the creation of beautiful eye shape.

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