Duhan Plastic Surgery Eye Revision Surgery - Double Eyelid Revision Methods

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Surgical Methods for Double Eyelid Revision

Thick Double Eyelids

Correction of a Thick Double Eyelid Line

Thick double eyelids are the most common indication for revision surgery.

A double eyelid line that is excessively thick looks artificial and awkward, giving the impression that the surgery was done very recently.

A natural and appropriate height is one where the line is only slightly visible when the eyes are open.

Causes of a Thick Double Eyelid Line

◎ The original surgery was designed too high

◎ The skin is thick

◎ Ptosis is present

◎ Protruding eye shape

◎ Adhesion of the scar line

◎ Excessive skin removal

Surgical Method for a Thick Double Eyelid Line

① The scar tissue is excised.

② The tissue is carefully dissected between the levator palpebrae superioris and the orbital fat so that the tissue can be repositioned.

③ The tissue is dissected and fat is advanced to prevent adhesion of scar tissue.

④ To prevent the skin below the excision line from being pulled upward, the skin below the excision line is firmly fixed to the tarsal plate.

⑤ Levator shortening is performed so that the eyes open slightly larger.

As the eyes open wider, the double eyelid line becomes smaller.

⑥ Firm layered suturing is performed through the tissue to complete tissue repositioning and prevent the tissue from being pulled upward.

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

Surgical Methods for Double Eyelid Revision

Asymmetrical Double Eyelids

Correction of an Asymmetrical Double Eyelid Line

Double eyelids with a large difference in line height look awkward and give a poor impression.

In cases of asymmetry, the basic principle is to correct the line on the side that is unsatisfactory, using the more satisfactory double eyelid as the reference. If neither side is satisfactory, both sides must be corrected.

Causes of an Asymmetrical Double Eyelid Line

◎ The height of the double eyelid line differs between the two eyes

◎ Ptosis is present in one eye

◎ One double eyelid line has loosened

◎ The skin on one side has sagged

◎ The orbital fat is insufficient, causing the eyelid to sink and the line to be pulled upward

◎ The line has been pulled upward due to scar adhesion

Surgical Method for an Asymmetrical Double Eyelid Line

If there is a difference in height between the original double eyelid lines, the height must be adjusted. If the surgery was done with the buried suture method, the height of the other line is adjusted to match the preferred side using the same buried suture method or a partial incision method.

If the newly created line has stronger support, the existing buried suture line usually loses strength and disappears on its own.

Surgical Methods for Double Eyelid Revision

Loosened Double Eyelids

Correction of a Loosened Double Eyelid Line

This refers to a line that has become blurred, thin, or disappeared.

In cases where the line has loosened, the goal is to restore the original line.

If the original line is not satisfactory, a new line is created again.

Causes of a Loosened Double Eyelid Line

○ Thick skin

○ Excess orbital fat

○ Thick orbicularis oculi muscle

○ Inadequate formation of scar tissue

○ Habitually rubbing the eyes frequently

○ When buried suture surgery is performed aggressively even though it is not indicated

Surgical Method for a Loosened Double Eyelid Line

When the line has loosened, the correction method should differ depending on whether loosening occurred after incisional surgery or after buried suture surgery.

If loosening occurred after buried suture surgery, the first choice is usually to correct it with a partial incision method. If it is judged that partial incision correction will not work well, the line is recreated with a full incision method.

To prevent loosening, scar tissue and fat tissue beneath the line must be completely removed, and the sutures must be firmly fixed to the tarsal plate.

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Surgical Methods for Double Eyelid Revision

Changing an Outfold to an Infold

Severe Outfold Line - Creating an Infold Line

An outfold refers to a line where the inner line remains visible all the way to the end.

A thin outfold line may suit some people, but a severe outfold creates an awkward eye shape, so it should be corrected to an infold line.

Surgery to change an outfold line into an infold line is the core of double eyelid revision surgery and represents the peak of the surgeon's skill.

If the inner line cannot be refined as desired, the overall line becomes awkward and it is difficult to achieve the desired result.

Changing an outfold line into an infold line when there is little skin excess or severe scarring is one of the most difficult procedures among double eyelid revision methods.

Causes of an Outfold

○ The double eyelid line was designed too high overall

○ The inner design line was set too high

○ Unnecessary epicanthoplasty or excessive epicanthoplasty was performed

○ Excessive skin removal

Surgical Method for Severe Outfold Line - Infold Line

In most cases, this is only possible with a full incision.

It may also be possible with the buried suture method or partial incision method, but only when adhesion is weak and partly loosened.

If the adhesion is strong or the scar line is pronounced, correction with the buried suture method or partial incision method is almost impossible.

The method involves performing a full incision, precisely dissecting between the orbital fat and the levator palpebrae superioris, then repositioning the inner orbital fat and dissecting and flattening the inner scar line.

This is a procedure that requires highly advanced skill and extensive accumulated experience.

Surgical Methods for Double Eyelid Revision

Correction of Sausage Double Eyelids

A thick sausage-like appearance below the incision line

This refers to a swollen appearance in which the area below the double eyelid line bulges like a pouch, looking as though the surgery was done only a few days ago.

Causes of a Thick Sausage-like Appearance Below the Incision Line

○ The line was made too high

○ The skin and orbicularis oculi muscle are thick

○ During buried suture surgery, the sutures for the double eyelid line were placed below the height of the incision line

○ The sutured area loosened and the double eyelid line was pushed downward

Surgical Method for a Thick Sausage-like Appearance Below the Incision Line

Sausage-like appearance after full incision surgery

This usually can only be corrected with a full incision. Some of the orbicularis oculi muscle below the incision line must be removed to reduce muscle thickness, and the sagging skin is pulled upward, tightened, and fixed.

Sausage-like appearance after buried suture surgery

This occurs because the line was designed too high and then partially sagged after surgery. The partially loosened line is pulled upward and firmly, tightly fixed again.

The correction can be done with a partial incision method or a full incision method.

Surgical Methods for Double Eyelid Revision

Correction of Triple Double Eyelids

Triple double eyelid line

This refers to a case where three lines appear.

In such cases, they must be consolidated into one line.

Usually, the upper line among the two lines is removed and the correction is made by matching to the lower single line.

Causes of a Triple Double Eyelid Line

○ As the line loosens, it loses its center of tension and another line forms above the incision line

○ Excessive fat removal causes another line to form above the incision line due to scar adhesion

○ Skin slides downward below the scar line, creating a new line

○ Excessive scarring at the suture site causes a line to form above the scar

Surgical Method for a Triple Double Eyelid Line

When scar adhesion is not severe

In cases of a triple line that occurred as the original line loosened, the existing line is firmly fixed with a partial incision method so that the line above the incision line naturally loosens.

When scar adhesion is severe

The surgery is performed with a full incision method.

The correction is done by making a full incision, removing the scar tissue, dissecting it, and repositioning the orbicularis oculi muscle and orbital fat.

Surgical Methods for Double Eyelid Revision

Correction of Eyelash Eversion

Eyelash eversion

This refers to a case where the skin below the incision line is pulled upward tightly, exposing the mucosal surface beneath the eyelashes.

If the mucosa is excessively exposed, it gives a poor impression, so correction is recommended.

Causes of Eyelash Eversion

○ Excessive skin removal

○ Suturing under excessive tension because the skin was pulled too far upward during suturing

○ There was not enough skin slack, so the skin below the incision line was pulled upward

○ Severe scar-line adhesion

Surgical Method for Eyelash Eversion

Correction is possible only through a full incision.

If surgery is delayed, the everted shape may become fixed and correction may no longer be possible.

In cases of eyelash eversion, surgery should be performed as soon as possible for the correction to be effective, but if correction is done months or years later, proper correction may not be possible.

In other words, surgery should be performed before the shape becomes fixed for correction to be possible to any extent.

The scar line is incised, the skin below the incision line is lifted and dissected downward to release the tension of the skin that had been pulled tightly upward.

Usually, dissection extends to near the eyelashes, and in some cases, part of the orbicularis oculi muscle is removed.

After adjusting the relaxed skin to an appropriate height, it is fixed with sutures so it does not move, and the skin is closed.

Surgical Methods for Double Eyelid Revision

When the Double Eyelid Scar Line Is Dark

When the Double Eyelid Scar Line Is Dark

When surgery is performed with an incision method, scarring will necessarily occur at the surgical site.

If the scar line is faint and light, there is no problem, but if it is dark and deeply indented, it can be unpleasant even when the eyes are closed.

In such cases, it is necessary to make the scar line lighter so that it is less visible when the eyes are closed.

Causes of a Dark Double Eyelid Scar Line

○ The scar widens due to excessive skin removal

○ The scar becomes darker because leftover skin was not removed and the skin covers the incision line

○ A sunken scar occurs due to excessive removal of the orbicularis oculi muscle beneath the skin

○ There is little skin slack, so the scar line gradually widens or becomes distorted

○ Habitually rubbing the eyes after surgery

○ A constitutional tendency to form scars easily

Surgical Method When the Double Eyelid Scar Line Is Dark

The edges of the scar line are precisely designed, only the scar portion is excised and removed, and the normal skin is meticulously sutured together along with the orbicularis oculi muscle beneath the skin.

If there is little skin slack, it may be necessary to delay stitch removal, so it is also important to remove the stitches only after confirming that the area has healed sufficiently to avoid widening of the scar.

If there is a thick so-called sausage-like swelling below the incision line, part of the orbicularis oculi muscle layer beneath the skin is removed and the skin is pulled upward and smoothed out for correction.

Postoperative Precautions When the Double Eyelid Scar Line Is Dark

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

○ Clean the scar area well with antiseptic so that foreign substances or dead skin do not remain there.

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

○ If you rub your eyes, the double eyelid line may change or the scar may become messy, so do not rub them at all.

Pre- and Postoperative Care for Double Eyelid Revision

Before Double Eyelid Revision Surgery

① Before surgery, through 충분한 상담, you should understand the cause of the failed double eyelid surgery and the surgical process yourself.

② Do not consume any alcohol the day before surgery.

This is because alcohol reduces the effect of anesthetic drugs, which may cause problems with anesthesia during surgery.

③ Whenever possible, avoid surgery during the menstrual period.

This is because excessive bleeding during surgery can interfere with the procedure and cause significant bruising.

After Double Eyelid Revision Surgery

① The usual follow-up schedule is two visits: the day after surgery and one week later.

② Day 1 after surgery - At the hospital, the surgical area is disinfected, you receive an injection to reduce swelling, and your recovery is checked.

③ Day 4 after surgery - Your progress is checked, and the continuous sutures are removed.

④ Day 7 after surgery - Your recovery is checked to see whether the surgery went well or there are any problems, and the remaining stitches are removed.

⑤ One month after surgery - The double eyelid line is checked to see whether it is settling in well.

Things You Should Do at Home After Double Eyelid Revision Surgery

Cold Compress

Apply a cold compress using the cooling pack provided by the hospital.

Do this for 3 days, 2 hours per day.

The 2 hours can be done continuously, or divided into 20 to 30 minute sessions.

Usually, it is convenient to do it before sleeping.

Disinfection and Eye Drops

Disinfect the surgical area with the prescribed medication.

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

To prevent dry eye, use the artificial tears and eye drops prescribed by the hospital.

Scar Care

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

The scar-preventing ophthalmic ointment helps reduce scarring and calm the redness phase, 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, wash your face with a wet towel instead.

Swelling After Double Eyelid Revision Surgery

There are individual differences, but in most cases some swelling subsides in about 7 to 14 days, while the period for the result to settle completely is between 1 and 3 months.

If levator shortening is performed during double eyelid revision, temporary lagophthalmos, where the eyes do not close fully, may occur.

Depending on the degree of ptosis and the extent to which the levator has been shortened, this usually takes about 15 days, and in very rare cases can take more than 6 months.

On average, it progresses for about 1 to 3 months and then the eyes close naturally.

During this period, use the eye drops prescribed by the hospital to prevent dry eye.

Management of Lagophthalmos After Double Eyelid Revision

If levator shortening is performed to make the eyes open wider, temporary lagophthalmos, where the eyes do not close fully, may appear.

Depending on the degree of ptosis and the extent of levator shortening, it usually takes about 15 days, and in some cases as long as more than 6 months.

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

During this period, use the artificial tears (eye drops) prescribed by the hospital to prevent dry eye.

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Success Cases of Reconstruction Surgery for Damaged, Failed Double Eyelids by Director Shin Duhan of Duhan Plastic Surgery

Please refer to the photos below~

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