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Correcting a Thick Line: Extreme Revision

Extreme Reoperation

This is a procedure that restores the eye shape to a normal appearance through revision surgery in an extremely severe condition, or when it is judged that further surgery is no longer possible.

It is a procedure that aims to restore an eye shape that is in such poor condition that normal restoration of the double eyelid is difficult or nearly impossible, bringing it close to normal.

The goal of extreme revision surgery is to restore to a normal eye shape eyes that have had multiple revisions,

have had foreign substances such as fillers injected into the eyelids,

have undergone fat grafting that created severe contour irregularities and adhesions,

or have severe ptosis.

Director Shin Duhan

Examples of extremely damaged double eyelids

Differences Between Extreme Revision and General Revision

In general revision surgery, depending on the condition, some surgical steps may be simple or omitted. However, in extreme eye (double eyelid) revision surgery, when there is not enough excess skin or the existing scar line is too high and too pronounced, making revision almost impossible, the scar is not excised; instead, subcutaneous dissection is performed and a new line is created beneath it.

To release scar adhesions, all available techniques are mobilized, including multiple layers of tissue dissection and repositioning, insertion of micro-fat tissue, shortening of the upper eyelid levator muscle, and dissection and excision of the orbicularis oculi muscle below the incision line. In other words, it refers to concentrating all revision techniques to restore a natural and beautiful double eyelid.

Plan for Extreme Revision

① If there is not enough tissue or skin, the limit of how much it can be expanded is measured and then expanded.

② If the function of the upper eyelid levator muscle is almost absent, the limit of how much it can be lifted is calculated.

③ If the skin is very thick, a plan is made to excise the orbicularis oculi muscle to create thinner tissue.

④ If scar adhesions are very severe and cannot be flattened, a plan is made to insert micro-fat after scar dissection.

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

⑥ If the scar line is very high, a plan is made to flatten it rather than excise it.

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

⑧ If eyelash eversion is severe, a plan is made to correct the eversion by dissecting beneath the eyelash roots.

Before-and-after results of extreme revision surgery

Even very difficult and challenging revision cases can produce good results if surgery is performed according to principles with a sufficient plan.

However, surgery is not possible in every case.

If there is too little excess skin or scar adhesions are extremely severe, there are limits to surgery, and sometimes surgery may not be possible at all.

If the preoperative examination determines that revision surgery will be difficult, it is our principle not to proceed with a surgical plan at all.

Extreme situations and problems that must be overcome in double eyelid revision surgery

Reoperation problem

Double eyelid revision surgery is a very complex and difficult procedure.

What kinds of situations are there?

Director Shin Duhan

Problems in dealing with a very high scar line

★ In many cases, surgery is performed without excising the existing scar line.

In principle, the existing scar line should be excised, but if the scar line is too high to be excised, there are cases where surgery must be performed by flattening it without excision.

① When the scar line is very high and the scar is dark

A new double eyelid line must be created just below the existing scar, and the scar must be excised.

The existing scar line can be excised, but because the line must be set high, it cannot be reduced as much as desired.

② When the scar line is very high but the scar is faint

Instead of excising the existing scar line, it is dissected and flattened.

Then the existing scar line remains faintly, so a slight scar may be visible when the eyes are closed.

However, the advantage is that a new double eyelid line can be created where desired, allowing the line to be reduced sufficiently.

Problems in handling an excessively wide scar

★ There are issues with reducing the line after scar excision and with preventing distortion of the double eyelid shape.

Causes of scar line thickening include improper suturing, lack of excess skin causing the scar line to spread, and frequent rubbing of the eyes.

To solve the problem of a large scar line, the scar must be excised while considering the available skin reserve, and rather than simple suturing, the tissue must be dissected and meticulously layered and sutured to reduce scarring.

In addition, it is necessary to prevent distortion of the double eyelid caused by excision of a wide scar tissue, and the more scar tissue is excised, the greater the limit on how much the line can be reduced.

Problems when scar tissue becomes very thick after multiple double eyelid revisions

★ There is the problem that it is very difficult to create a proper line because of hard and thick scar tissue.

The more surgeries are repeated, the harder the skin tissue becomes and the thicker the scar tissue gets.

Flattening thick, firm tissue and creating a new line again is not easy.

A proper line may not form because of the hard scar tissue.

The existing hard scar tissue must be excised as cleanly as possible, and the scar tissue beneath the skin must also be thoroughly cleared away in order to create a new line.

Problems with an excessively wide outfold line

★ The outfold must be reduced or changed to an infold, which is one of the most difficult revision techniques.

To reduce the line, the inner line must be properly reduced.

When the line is thick and the inner line is also very wide, it becomes an outfold.

The outfold must be reduced to an infold in order to create an overall natural line.

One of the most difficult revision techniques is turning an outfold into an infold.

If the line cannot be properly reduced to an infold, the desired line cannot be created.

Problems when the epicanthoplasty is excessively wide

★ Excessive epicanthoplasty has limits when changing to an infold line or a natural line.

Because of unnecessary and excessive epicanthoplasty, a severe outfold line, excessive exposure of the mucosa, or side effects such as eyes appearing too close together may occur.

In cases of excessive epicanthoplasty, the first step is to create as much of an infold line as possible, and if that is still not enough, epicanthoplasty restoration should be performed additionally after 6 months.

Problems when the skin is insufficient and lagophthalmos occurs

★ If there is not enough skin, the line may not be reduced as much as desired, or lagophthalmos may worsen.

In cases where the eyes do not close properly due to multiple revisions or excessive skin removal during surgery, the eyes must be able to close again, but if there is no tissue reserve, correcting lagophthalmos is essentially impossible.

Lagophthalmos must be left as is, and only the thickness of the line should be adjusted.

Reducing a thick line in a state of insufficient skin is among the very difficult surgeries that can only be performed by maximizing tissue expansion and repositioning.

Problems with wrinkled eyelids that lack skin elasticity

★ When there are many skin wrinkles, the line may not come out smoothly.

Unlike younger people, older patients develop wrinkles on the eyelids and skin texture, making it very difficult to create a natural and smooth line.

The key is to create the line while minimizing wrinkle formation, but in many cases the wrinkles cannot be completely smoothed out, so surgery must be performed with some limitations in mind.

Problems when ptosis correction is not possible

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

Even after ptosis correction has been performed multiple times, there are cases where the eyes still look sleepy.

If the function of the upper eyelid levator muscle is almost absent even after another ptosis correction, correction may be impossible.

In such cases, ptosis correction is not performed and only the line is corrected.

If excessive ptosis correction is attempted, lagophthalmos only becomes worse and the ptosis is barely corrected.

Problems when eye-opening correction has been overdone

★ Reducing an overcorrected eye shape back to a normal size is much more delicate than correcting ptosis.

If ptosis correction or eye-opening correction has been overdone and the whites of the eyes are exposed, upper eyelid levator relaxation must be performed to reduce the eye size again. However, if the levator is relaxed, ptosis may be induced several months later and the eyes may not open as well.

Reversing overcorrection is much more delicate than ptosis correction, and it is difficult to predict the outcome later.

The degree of upper eyelid levator relaxation must be carefully controlled through extensive experience and know-how.

Problems when a patient visits after having a release procedure

★ When a patient visits after having a release procedure at another hospital, recreating the line is often difficult or impossible.

One of the most difficult problems in double eyelid revision surgery is when the patient comes in after having had a release procedure at another hospital.

In 9 out of 10 cases, revision surgery is impossible.

The reason is that, to release the line, the incision is made very low and thick tissue is placed over the incision line so that no line forms there.

Over time, this tissue turns into thick scar tissue, so it is almost impossible to excise that thick scar tissue again and create a natural line.

For the future as well, release procedures are surgeries that should be avoided as much as possible.

http://www.doublefold.co.kr

Choices when surgery is very delicate or difficult during consultation

After coming in for consultation and examination, there are cases where, from the surgeon’s point of view, the eye shape is very delicate or there is no confidence that a satisfactory result can be achieved.

In such cases, it is not possible to simply give a confident answer, but if the doctor says it is difficult, trust in the clinic may decline or the doctor may be mistaken for being unskilled.

From the surgeon’s point of view, if one gives an honest and firm medical opinion by accurately assessing the patient’s condition and explaining what is difficult and that the outcome may be poor, some people accept it, but more people react negatively.

If a patient is swayed by exaggerated consultation and undergoes surgery, the situation may become even more desperate.

From the patient’s perspective, it is very important to distinguish between a consultation that contains no exaggeration and a surgeon who speaks with conviction.

There are various possible outcomes after revision surgery.

Some people think that if they meet a highly skilled doctor for revision surgery, they will always get good results.

This is a very dangerous way of thinking.

Even for a skilled doctor, there are cases that improve through surgery, cases that cannot improve, and cases where the result is unsatisfactory.

Before surgery, you should keep the three cases above in mind during consultation and make a realistic judgment by checking whether surgery is possible, how far improvement can be achieved if it is possible, or whether it is impossible.

Cases where revision surgery is difficult or impossible

There are many cases in which revision surgery is impossible or difficult.

Examples include insufficient excess skin, scar lines that are too pronounced to release adhesions, excessively thick skin and muscle, tissue that has become hard and thick after multiple revisions, severe sausage-like appearance with a high chance of recurrence even after surgery, and severe ptosis.

When surgery is very delicate and difficult, the patient must understand the limitations themselves, but some people refuse to accept those limits.

If you undergo surgery with only vague hope, you are inviting yourself into a deep pit.

You must carefully assess the limits and prognosis of your current condition before deciding on surgery.

The Advantages and Pride of the Double Eyelid Revision Clinic at Duhan Plastic Surgery

Director Shin Duhan

Medical staff with rich experience and stability	Director Shin Duhan, who has focused on thousands of double eyelid revision cases at a rate of more than one case per day, and experienced nurses work as a team to provide treatment.
1:1 customized surgical planning	Based on each individual’s double eyelid condition, gender, overall facial harmony, and personal wishes are all considered. The rate of performing epicanthoplasty or lateral canthoplasty at the same time as double eyelid surgery, with correction from out-line to in-line, is steadily increasing. If epicanthoplasty or lateral canthoplasty is appropriate for the eyes, combining it with double eyelid revision doubles the effect. The height of the double eyelid line and the line shape (in-line, in-and-out line, out-line, etc.) reflect the patient’s preferences, and the current trend in double eyelid lines is “naturalness.”
Double eyelid revision without side effects	People undergoing double eyelid surgery worry about whether the line will loosen or whether scars will remain. Side effects are reduced through Director Shin Duhan’s analysis and the ability to precisely create the line exactly as analyzed. In addition, delicate incision and suturing mean there is no need to worry about asymmetry.
Results that are hard to imitate	There are many clinics that perform double eyelid revision, but having the same surgery name and method does not mean the results will be the same. With over 20 years of rich 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 delicate. Double eyelid revision includes the detailed process of newly designing the line and completely separating and dissecting the previously adhered double eyelid tissue. Thanks to this meticulous dissection process, there are no side effects such as the line becoming uneven later or adhering and curling upward. With the skill to neatly organize all tissues in the skin layer, fat layer, and muscle layer one by one, we can achieve surgical results that are hard to imitate even in extreme revision cases.
Performing double eyelid revision and eye correction at the same time	In the Double Eyelid Revision Clinic at Duhan Plastic Surgery, eye correction surgery is included in double eyelid surgery, helping to correct sleepy eyes or eyes whose pupils are obscured and appear dull. By shortening the upper eyelid levator muscle that opens the eyes, we control how much of the pupil is exposed and make the eye shape look clearer.
Research, lectures, and educational activities on double eyelid revision	The most trustworthy answers come from rich clinical experience. Double eyelid revision is like a premium product perfected over time through experience. Through this accumulated experience, we also carry out research and educational activities.
Increase in consultations for revision surgery	As new clinics spring up and perform double eyelid surgery indiscriminately, requests for revision surgery are also increasing, which is truly regrettable. If revision surgery fails after being performed multiple times, the excess skin reserve decreases, making subsequent revision even more difficult and extreme. Double eyelid surgery is not only about the first choice; when considering revision, it should be approached carefully as if it were the last chance.
Craftsmanship for a more complete and beautiful face	Among plastic surgeries, a doctor who performs double eyelid surgery must possess a sense like that of both a doctor and a designer. If one insists only on a uniform double eyelid line without understanding what makes a beautiful line, the perfect line suited to each patient cannot be achieved. If there is no eye for aesthetics, or even if there is one but no skill to recreate it, a masterpiece cannot be produced. We do our utmost down to the last stitch to provide beauty and satisfaction to each and every patient.
Honest surgery with sincerity	We recommend surgery when it is likely to yield more than 80% satisfaction, but we do not perform unnecessary surgery, even if requested. We aim to be a clinic that provides honest care based on skill and results.
A reliable premium clinic	There is a reason why a craftsman’s work is expensive. It is because it creates something beautiful and valuable. The Double Eyelid Revision Clinic at Duhan Plastic Surgery has pride and confidence in its surgery. Proper surgery will become an opportunity to gain confidence throughout life. Rather than a clinic that recommends surgery at a low price and has multiple doctors take turns performing it, we will be a clinic that delivers higher-priced but satisfying results.

​http://www.duhans.com​