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Duhan Plastic Surgery Clinic · 두한성형외과 DUHANISM · March 18, 2020
Double eyelid line # double eyelid line # double eyelid line # line reduction # line lowering # eye correction surgery # eye correction release # eye asymmetry # eye revision surge...
AI translation notice
This page is an English translation of a Korean Naver Blog archive entry. For exact wording and source context, verify against the Korean archive original and the original Naver post.
Clinic: Duhan Plastic Surgery Clinic
Original post date: March 18, 2020
Translated at: April 25, 2026 at 6:44 AM
Medical note: This translation does not guarantee medical accuracy or suitability for treatment decisions.
Large Double Eyelid Line
When the double eyelid line is large,
it is hardly ever suitable, no matter the case.
A natural line is appropriate when it is just slightly visible when the eyes are open.
A large double eyelid line is
one of the most common indications for revision double eyelid surgery
and is a representative example of an unattractive double eyelid.
Sausage Eyes
This refers to swelling on the lower side of the double eyelid line,
commonly called the sausage effect.
It gives the impression that the person had surgery only a few days ago,
and can make others feel somewhat uncomfortable.
The causes of the sausage effect include
thick skin and orbicularis oculi muscle,
a double eyelid line designed too high,
or a partially loosened double eyelid line.
Correction is done by partially removing the orbicularis oculi muscle and then tightening the skin.
When the Double Eyelid Line Is Too Thick
From a general standpoint,
a double eyelid line that is slightly visible looks natural and beautiful.
If the line is too thick,
the eyes can look drowsy,
and the other person may perceive the impression as strong and rough.
Causes include
a double eyelid line designed too high, adhesions from double eyelid scarring,
ptosis, or a lack of excess eyelid skin.
For correction,
the existing high double eyelid line must be flattened or removed through incision,
and a new line must be designed at an appropriate height.
However, the height of a new double eyelid line varies from person to person,
so it is important to design the most natural height for the individual,
taking into account excess skin and eye size.
Problems in Revision Surgery to Reduce the Double Eyelid Line
① Problem of handling a very high scar line
In many cases, the existing scar line cannot be excised during surgery.
In principle, the existing scar line should be removed, but if the scar line is so high that excision is impossible, surgery may have to be performed by flattening it rather than removing it.
◎ When the scar line is very high and the scar is dark
The new double eyelid line must be placed just below the existing scar so that the scar can be removed.
Although the existing scar line can be excised, the line must remain high, so it cannot be reduced enough to the desired extent.
◎ When the scar line is very high but 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.
② Problem of handling an excessively wide scar
After scar excision, there is the issue of reducing the double eyelid line while preventing distortion of the eyelid shape.
Causes of a dark scar line include improper suturing, lack of excess skin causing the scar line to spread, and frequent eye rubbing.
To solve the problems caused by a large scar line, the scar must be excised while considering the amount of excess skin, and rather than simple suturing, the tissue must be dissected and carefully layered and sutured to reduce scarring.
Also, the double eyelid shape must not be distorted by excising too much scar tissue, and the more scar tissue is removed, the greater the limit on how much the line can be reduced.
③ Problems when the scar tissue is very thick after multiple revision double eyelid surgeries
There is a problem in that it becomes very difficult to create a proper line because the scar tissue is hard and thick.
The more surgeries are repeated, the harder the tissue becomes and the thicker the scar gets.
Flattening thick, hard tissue and recreating a line is not easy.
A proper line may not form because of the hard scar tissue.
To create a new line, the existing hard scar tissue must be removed as cleanly as possible, and the scar tissue beneath the skin must also be neatly cleared away.
④ Problem with out-fold lines
The out-fold must be reduced or changed into an in-fold, which is one of the most difficult revision techniques.
To reduce the line, the inner line must be properly reduced.
If the line is thick and the inner line is also very wide, it becomes an out-fold.
Only by reducing the out-fold into an in-fold can a natural overall line be created.
One of the most difficult techniques in revision surgery is turning an out-fold into an in-fold.
If the line cannot be properly reduced into an in-fold, the desired line cannot be created.
④ Problems when there has been excessive inner canthoplasty
Excessive inner canthoplasty limits the ability to change the line into an in-fold or a natural line.
Because of unnecessary excessive inner canthoplasty, a severe out-fold line may occur, or side effects such as excessive exposure of the mucosa and eyes that appear too close together may develop.
In cases of excessive inner canthoplasty, the first step is to make the line as much of an in-fold as possible, and if that is still insufficient, inner canthoplasty restoration should be performed additionally after 6 months.
⑤ Problem when lagophthalmos (rabbit eyes) occurs
If there is not enough skin, the line cannot be reduced as much as desired, or lagophthalmos may worsen.
When the eyes cannot close properly due to repeated revision double eyelid surgery or excessive skin removal during surgery, the eyes need to be able to close again, but if there is no excess tissue, correcting lagophthalmos is effectively impossible.
In such cases, lagophthalmos is left as is and only the line thickness is adjusted.
Reducing a thick double eyelid line when there is not enough skin is a very high-difficulty operation that is only possible by maximizing tissue expansion and rearrangement.
⑥ Problem of a wrinkled eyelid without skin elasticity
If there are many skin wrinkles, the line may not come out smoothly.
Unlike younger people, older patients develop wrinkles or skin texture changes on the eyelids, making it very difficult to create a natural and smooth double eyelid 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.
⑦ Problem when ptosis correction is not possible
In cases where the levator palpebrae superioris muscle has no function, no further ptosis correction is possible, or lagophthalmos may occur.
Even after ptosis correction has already been performed several times, some patients still look sleepy.
If the levator palpebrae superioris muscle has almost no function even after another correction attempt, correction may be impossible.
In such cases, ptosis correction is not performed, and only the line is revised.
If an excessive ptosis correction is attempted, lagophthalmos only becomes worse, and the ptosis itself is hardly corrected.
⑧ Problems in cases of overcorrection of eye shape correction
Reducing an overcorrected eye shape back to a normal size is much more difficult than ptosis correction.
If ptosis correction or eye-shape correction has been done too aggressively and the white of the eye is exposed, levator palpebrae superioris muscle release is needed to reduce the eye size again. However, if the levator is loosened, ptosis may develop months later and the eyes may open less.
Reversing overcorrection is much more difficult than ptosis correction, and future outcomes are harder to predict.
The degree of levator muscle release must be carefully controlled through extensive experience and expertise.
⑨ Problems when the patient comes in after having had double eyelid release surgery
When a patient comes in after having had double eyelid release surgery at another hospital, recreating the double eyelid line is often difficult or impossible.
One of the hardest problems to overcome in revision double eyelid surgery is when the patient has already had release surgery at another clinic.
For 9 out of 10 patients, revision double eyelid surgery is not possible.
The reason is that, in order to release the double eyelid line, the incision is made very low and thick tissue is placed over the incision so that no line forms in the incision area.
Because this tissue later turns into thick scar tissue, it is almost impossible to excise the scar tissue again and create a natural line.
Release surgery is a procedure that should be avoided as much as possible, even for the future.
Indications for Revision Double Eyelid Surgery
When the double eyelid line is too large
When the double eyelid line has loosened
When the double eyelid line is asymmetrical
When the eyes feel tired after double eyelid surgery
When there is a sausage-like swelling in the area below the double eyelid incision line
When the impression looks worse after double eyelid surgery
When you want to recover a beautiful and natural double eyelid
Revision Double Eyelid Surgery
This refers to surgery that corrects the double eyelid line and restores it to its original natural and clear shape when the line is too large, uneven, or loosened.
Purpose of Revision Double Eyelid Surgery
The purpose of revision double eyelid surgery is to correct the eye shape so that it looks larger, clearer, and more natural.
Features of Our Clinic
| We have accumulated extensive experience and know-how in revision double eyelid surgery. |
|---|
| We have a systematic system for revision double eyelid surgery. |
| Before revision double eyelid surgery, we perform various examinations and tests during consultation to predict the postoperative result. |
| We perform revision double eyelid surgery only when the examinations and tests show that there is sufficient room for improvement. If we determine that the patient cannot achieve the desired result, we make it a rule not to attempt revision double eyelid surgery. |
| We provide a clear explanation so that patients fully understand the revision double eyelid surgery process and progress, and we do not omit explanations about possible side effects that may occur after surgery. |
| We provide thorough aftercare after revision double eyelid surgery. |
| We make our best efforts and continue research so that those seeking revision double eyelid surgery will not need to undergo further surgery and will make this their last hospital visit. |
Examinations and Tests for Revision Double Eyelid Surgery
The most important test for determining whether revision double eyelid surgery is possible is the amount of excess skin.
Because revision double eyelid surgery requires at least some excision of the scar area before surgery, the amount of excess skin is an important indicator for estimating the prognosis of the surgery.
If there is no excess skin, surgery may not be possible.
If surgery is forced when there is insufficient excess skin, the result will be poor and lagophthalmos, where the eyes do not close properly, will worsen, so this is the most important test that must be done before revision surgery.
The second important test for determining whether revision double eyelid surgery is possible is the levator palpebrae superioris muscle (eyelid-lifting muscle) function test.
In severe ptosis, the key issue is how much function remains in the levator palpebrae superioris muscle.
The levator palpebrae superioris muscle is the muscle that lifts the eyelid upward.
A certain degree of function in this muscle is necessary to predict the success of revision surgery.
In patients with ptosis, if the levator function is significantly reduced, surgery may not be possible.
As a rule, surgery should not be performed when the function of the levator palpebrae superioris muscle has dropped below a certain threshold.
● Other examinations and tests
→ Measurement of eyelid skin thickness
→ Test for the presence of eyelash eversion
→ Examination of the scarring and degree of scar adhesion in the existing double eyelid line
→ Selection of the method that can maximize patient satisfaction and provide the best procedural effect
→ Measurement of the height and symmetry of the existing double eyelid line (scar line)
→ Measurement of the amount and presence of orbital fat, and the thickness and presence of the orbicularis oculi muscle
→ Measurement of the degree of ptosis by measuring the palpebral fissure height (the vertical size when the eyes are naturally looking straight ahead at eye level)
→ Measurement of the horizontal eye length and the distance between the eyes (determining the presence of an epicanthal fold)
→ Measurement of the presence of strabismus
● Surgical plan for revision double eyelid surgery based on the above test results
① Set the height of the new double eyelid line and determine the design shape
② Set the width of skin (scar) excision
③ Set the width of levator palpebrae superioris shortening
④ Determine whether orbicularis oculi muscle excision is needed
Based on the above test results, we predict the postoperative outcome and assess the likelihood of surgical success.
Surgery is recommended only when it is judged to be possible.
If surgery is not possible, we explain the reason it cannot be performed or the realistic extent to which surgery can be done.
Revision Double Eyelid Surgery from an Out-line to an In-line
An out-fold refers to a line where the inner line remains visible all the way to the end.
A thin out-fold line may suit some people depending on the individual,
but in the case of a severe out-fold, it can cause an awkward eye shape,
so it must be corrected into an in-fold line.
Surgery that changes an out-fold line into an in-fold line
is the core of revision double eyelid surgery and the peak of the surgeon’s skill.
If the inner line cannot be properly adjusted as desired,
the overall line becomes awkward and it is difficult to achieve the desired result.
Changing an out-fold line into an in-fold line
when there is no excess skin or when scarring is severe
is the most difficult surgery among revision double eyelid procedures.
Causes of a Thick Out-line
□ When the double eyelid line is designed too high overall
□ When the inner design line is set too high
□ When unnecessary inner canthoplasty or excessive inner canthoplasty has been performed
□ Excessive skin excision
How to Revise a Thick Out-line into an In-line
In most cases, it can be done with full incision.
In some cases, buried suture or partial incision methods are possible, but only when adhesions are weak and partly loosened.
When adhesions are strong or the scar line is dark, correction with buried suture or partial incision is almost impossible.
The method involves full incision, precise dissection between the orbital fat and the levator palpebrae superioris muscle, repositioning the inner orbital fat, and also dissecting and flattening the inner scar line.
This surgical method requires a very high level of skill and accumulated experience.
Examples of Applying Revision from a Thick Out-line to an In-line
Among revision double eyelid surgery techniques, changing an out-fold into an in-fold is the most difficult.
Revision double eyelid surgery is performed at many hospitals, but the results are generally not very good.
Please note that in our country, there are not many doctors who can consistently produce results that leave revision double eyelid surgery patients satisfied.
To achieve a good result, one must accurately understand what went wrong in the first surgery and how it should be improved.
During consultation, we use various examinations and tests to predict the postoperative outcome, and we perform surgery only when there is a sufficient chance of improvement after surgery.
The biggest key factors in revision double eyelid surgery are the amount of excess skin and the location and darkness of the scar line.
The purpose of revision double eyelid surgery is broadly twofold.
Restoring a larger, clearer eye shape and restoring a natural double eyelid line.
After revision double eyelid surgery, the double eyelid line is made thinner and more natural.
Revision Surgery for Sausage Eyes and Revision Eye-Shape Correction
This refers to a swollen appearance that looks as if it were done only a few days ago,
with puffiness that rises in a sausage-like shape below the double eyelid line.
In most cases, correction is only possible with full incision,
and part of the orbicularis oculi muscle below the incision line must be removed to reduce muscle thickness.
The sagging skin is pulled upward, tightened, and fixed in place.
Causes of Sausage Eyes
○ When the double eyelid line is made too high
○ When the skin and orbicularis oculi muscle are thick
○ When buried sutures for the double eyelid line are placed below the incision line height
○ When the sutured area loosens and the double eyelid line is pushed downward
Sausage Eyes After Buried Suture Method
This occurs because the line was designed too high, and after surgery the line partially sags downward. It can be corrected by pulling the partially loosened line upward and securely tightening it again.
Surgery is performed with a partial incision or full incision method.
Examples of Applying Revision for Sausage Eyes and Eye-Shape Correction
Sausage eyes can be corrected through revision double eyelid surgery.
Thick sausage-like double eyelids occur when the skin is thick and the line is designed too high, causing the skin to shift downward.
Surgery must remove the existing scar line and create a new line below it.
Some of the orbicularis oculi muscle beneath the skin, which causes the sausage effect, must be removed to make it thinner.
If ptosis is present, revision surgery also opens the eyes more and corrects the sleepy appearance.
The surgery takes about 2 to 3 hours, the recovery period is about one week, and stitches are usually removed about one week after surgery.
Revision Surgery for a Thick Double Eyelid Line
A double eyelid with an excessively thick line looks artificial,
awkward,
and gives the impression that the surgery was done not long ago.
It also often causes ptosis, making the eyes look sleepy.
Causes of a Thick Double Eyelid Line
◆ When the initial surgery was designed too high
The average natural height of a double eyelid for Korean people is 6 to 8 mm.
However, eye size and shape differ from person to person, so the height of the double eyelid line must also be adjusted accordingly.
The design standard should always be to temporarily create the line while seated and first find the line that best suits the person’s eye shape.
However, a design made while lying down makes it difficult to find a suitable line, and because the design is based on the tarsal plate, there is a higher chance of creating a large double eyelid line.
◆ When the skin is thick
Even if the double eyelid line is placed at the same height as other people’s, thick skin can make the line look thicker and awkward.
When the skin is thick, it often needs to be set slightly lower than the average height.
◆ When there is ptosis
If there is ptosis that makes the eyes look drowsy, the double eyelid line will look larger even if it is at the same height as other people’s.
The reason is that the eyes cannot open widely.
In such cases, the double eyelid line should be set lower, or ptosis correction should be performed together.
◆ Protruding eye shape
If the eyes are protruding, the line height should be set a little lower than in normal cases.
This is because protruding eyeballs make the line appear larger.
It is important to temporarily create the line while seated and find the most natural double eyelid line for the individual’s eye shape.
◆ Sunken eyelids
If the eyes are sunken, the double eyelid line is pulled upward and becomes higher.
This happens because the line is pulled up together with the skin as the eye sinks.
In such cases, the line should be set lower than normal, or fat grafting should be performed first before double eyelid surgery to create a normal eye shape, and then double eyelid surgery should be done several months later to achieve a satisfactory result.
Why It Is Difficult to Reduce a Thick Double Eyelid Line with a General Method
In the case of a high double eyelid line, the incision line is usually 8 mm or more above the eyelashes.
This usually needs to be reduced to a line of about 5 to 6 mm, and to do that, about 2 to 3 mm of skin, including the existing scar line, is typically removed.
You must understand what happens if the skin is excised and simply sutured.
If only excision and simple suturing are done, the skin below the excision line will pull the skin above the excision line upward and adhere, creating another large double eyelid line of 8 mm or more, causing the surgery to fail completely.
Therefore, the key to the surgery is to pull the skin above the excision line downward.
To do this, tissue must be repositioned, and for tissue repositioning, precise dissection between the levator palpebrae superioris muscle and orbital fat must be performed so the tissue can be rearranged and the double eyelid line reduced.
How to Reduce a Thick Double Eyelid Line - Full Incision Method
Excise the scar.
Precisely dissect between the levator palpebrae superioris muscle and the orbital fat so that tissue repositioning can occur.
After dissecting the tissue, advance the fat forward to prevent scar tissue adhesion.
To prevent the skin below the excision line from being pulled upward, firmly fix the skin below the excision line to the tarsal plate.
Perform levator palpebrae superioris shortening to allow the eyes to open slightly more widely. The more widely the eyes open, the more the double eyelid line is reduced.
Complete tissue repositioning with firm layered suturing through the tissue, preventing the tissue from being pulled upward.
Remove the stitches a little later so the scar does not widen and the repositioned tissue can stabilize.
Examples of Thick Double Eyelid Line Correction Using the Full Incision Method
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