Best Place for Eye Plastic Surgery, Duhan Plastic Surgery Clinic - Double Eyelids

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Purpose of double eyelid revision surgery

What is double eyelid surgery

The purpose is not simply to create a double eyelid crease.

The purpose of double eyelid surgery is

to make the eyes look bigger and brighter,

and to create bright, lively eyes

and a refined eye shape.

Surgery performed only to create a double eyelid crease

is likely to lead to unwanted results.

The purpose of double eyelid revision surgery is the same.

The goal is to correct the eye shape so that it looks bigger, brighter,

and more natural.

Dr. Shin Duhan

http://www.doublefold.co.kr

What is double eyelid revision surgery? It refers to surgery that corrects the double eyelid line and restores it to its original natural and clear double eyelid shape when the crease is too large, uneven, or has loosened.

When multiple double eyelid folds occur

This is when another line forms in addition to the existing incision line of the double eyelid.

It can occur below the incision line or above the incision line.

The causes of multiple double eyelids include

scar adhesion, sagging skin, sunken eyelids, and loosening of the crease,

and the correction method varies depending on the cause,

but in general, the other line besides the reference incision line should be removed to correct it.

When wrinkles appear below the double eyelid line ​ If there are multiple lines below the double eyelid line, the crease looks messy.

A beautiful crease should be small and clearly formed as a single line,

but if there are many fine wrinkles in addition to the double eyelid line, the eyes can look older and give a less favorable impression.

In such cases, correction can be performed with a partial incision method, or if that is not suitable, a full incision method should be used to remove a certain amount of skin and correct it.

Multiple double eyelid lines

This refers to cases where the double eyelid line appears as three folds.

In such cases, it should be reduced to a single line.

Usually, among the two lines, the upper line is removed,

and correction is made to match the lower single line.

Causes of multiple double eyelid lines

A case where the line loses its center of force as it loosens, creating one additional line above the incision line
A case where excessive fat removal causes another line to form above the incision line due to scar adhesion
A case where skin is pushed downward below the scar line, creating a new line
A case where excessive scarring at the suture site creates a line above the scar

How to correct multiple double eyelid lines - when scar adhesion is not severe

In the case of a triple line caused by loosening of the double eyelid crease, the existing line is firmly fixed with a partial incision method, allowing the double eyelid line above the incision line to naturally loosen.

♠ Partial incision method

​A surgical method used to restore a blurred line to its original clear line.

It is a method that can slightly enlarge a small double eyelid crease.

♠ Partial incision procedure

① Design the desired double eyelid line.

In many cases, the design is made along the existing scar line.

Sometimes the design is made to match the height and shape desired by the patient, or the surgeon determines the most suitable line and designs it accordingly.

The direction of the design line also changes depending on whether an out-fold or an in-fold is chosen.

② Mark three points on the intended incision site with design ink.

Lightly mark the inner, middle, and outer positions.

③ Under sedation anesthesia, while asleep for about 5 minutes, local anesthetic is injected into the three marked areas.

The local anesthetic is administered in a minimal amount so swelling is reduced as much as possible.

④ Make three very small incisions, about 2 mm each, at the marked areas.

If the incision is made too large, a lot of scarring remains, so surgery is performed with minimal incision to leave almost no scar.

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

The orbicularis oculi muscle is the muscle layer covering the eyelid and is tissue that interferes with double eyelid formation, so it must be removed to prevent the crease from loosening.

Along with removal of the orbicularis oculi muscle, the preseptal fat beneath the muscle layer is also removed.

⑥ If there is a large amount of orbital fat, pull the orbital fat through the outer incision and expose it.

Fat removal is mainly performed from the outer side.

⑦ Grasp the fat with a hemostat and cut off the base of the protruding fat with a scalpel.

Excessive fat removal can cause sunken eyelids, so it is better to remove only the amount that protrudes.

⑧ After fat removal, cauterize with an electric coagulator to prevent bleeding.

If hemostasis is not done properly, orbital bleeding may occur, causing severe bruising and swelling, so proper hemostasis is important.

⑨ Through the three incision sites, a very fine dissolvable suture is used to connect the upper eyelid levator muscle and the skin to create the double eyelid line.

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

Washing the face and wearing makeup are possible starting the next day.

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

If cold compresses are continued for more than 3 days, swelling may not go down as well, so it is best to do it for exactly 3 days only.

How to correct multiple double eyelid lines - when scar adhesion is severe ​​ Surgery is performed with a full incision method.

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

♠ Full incision method

Correction of ptosis with a thick double eyelid line is possible with the full incision method.

The full incision revision procedure is very difficult and requires extensive experience, high-level skill, and know-how.

It usually takes about 2 to 3 hours.

The surgery proceeds in 10 steps, and if even one step is omitted, the result may be less than expected.

Even if it takes a somewhat long time, better results can be obtained only when all of these processes are carefully checked and performed with great care.​​

♠ Full incision procedure

① Design the planned incision line, including the existing incision scar tissue.

Before surgery, the design is made to create a new double eyelid line below the scar line and determine the skin excision width up to the scar line.

The excision width is measured from the new double eyelid line, so it extends to the existing scar line.

For example, if the existing scar line is 10 mm above the eyelashes and the new double eyelid line is set at 7 mm, the skin excision width is 3 mm.

The 기준 is determined based on the width at the center.

The new double eyelid line is determined by considering how much the line should be reduced and the amount of excess skin.

The average height of the double eyelid line in revision surgery is around 5 to 7 mm.

② Cut away the skin and scar tissue.

The scar tissue is excised along the design line.

The incision is made accurately with a scalpel, and then the tissue is excised with surgical scissors.

The lower excision line becomes the new double eyelid line, and the upper line must be naturally pulled downward after tissue dissection so that it can be sutured in place.

③ Dissect the orbicularis oculi muscle, orbital fat, and skin that are adhered to the levator muscle.

Because the skin above the incision line must be pulled downward, the stiff scar tissue that has become adhered must be dissected.

Scar tissue dissection is performed by dissecting between the orbital fat layer and the upper eyelid levator muscle, and in some cases between the muscle and fat for forward repositioning of fat.

Through this dissection process, the tissue can be advanced and repositioned downward, and it is an important preparatory step for obtaining a natural double eyelid line.

④ If there is contraction of the orbicularis oculi muscle, the muscle is incised or removed to release the contraction.

If scar tissue adhesion is very severe, in rare cases a vertical 1 to 2 mm incision may be made in the orbicularis oculi muscle to release the contracture.

⑤ To prevent readhesion, the orbital fat is repositioned up to the incision line.

Forward repositioning of orbital fat is a process to prevent re-adhesion of tissue.

If the fat is not repositioned, the tissue will adhere again, which can result in ptosis and make the eyes look sleepy and half-closed.

Sometimes a triple double eyelid may also occur, which becomes a cause of a distorted crease.

Another effect of orbital fat repositioning is that if the eyelid is sunken, it can correct the hollowing to some extent, so if fat grafting might otherwise be needed later, the surgery itself may improve it enough that fat grafting is no longer necessary.

⑥ Shorten the upper eyelid levator muscle to strengthen its function.

Levator shortening is one method for correcting ptosis.

It is simple and effective, and has the advantage of allowing correction with almost no tissue damage.

Rather than cutting the levator muscle, it is simply advanced and tied to the tarsal plate.

In double eyelid revision surgery, the effect of levator shortening is to make the eyes open wider so they can be corrected to look brighter, and by opening the eyes wider, the double eyelid line also becomes smaller.

⑦ After incising the orbicularis oculi muscle at the inner corner of the eye, orbital fat is inserted between the muscles to prevent readhesion.

In addition to forward fat repositioning, fat is inserted at the inner corner of the eye to prevent adhesion of the orbicularis oculi muscle.

The inner part of the eye is the area most prone to scar adhesion, and adhesion in this area can make the eyes appear half-closed, make it difficult to open them fully, and create discomfort when opening the eyes.

To prevent this, orbital fat, which can act as a lubricant, is placed between the orbicularis oculi muscle and the tarsal plate and fixed with sutures.

⑧ During suturing, layered suturing is used so that the repositioned structures do not shift.

The suturing method for double eyelid revision surgery is not simple.

The purpose of suturing is to close the open wound and create the double eyelid line.

Therefore, in order to obtain the double eyelid line as originally designed, the skin below the incision line must not be pulled upward.

To do so, the skin below the incision line must be firmly fixed to the tarsal plate, and the forward-repositioned fat must also be secured with sutures so it does not get pulled upward.

In addition, the orbicularis oculi muscle and skin above the incision line must be firmly sutured in layers so that the desired double eyelid line can be achieved.

⑨ To prevent hematoma and inflammation, a small amount of anti-swelling agent (hyaluronidase) is administered to the surgical site.

Hyaluronidase, an anti-swelling agent, is a medication that has the effect of dispersing fluid and quickly reducing swelling when administered.

However, if too much is used, it may cause excessive bruising, so it is used selectively only to reduce swelling.

⑩ Suture removal is kept relatively late, from 7 to 14 days depending on the patient’s condition.

The stitches are removed in two stages, on day 4 and day 7.

The reason stitches are removed late is that in double eyelid revision surgery, there is usually not enough excess skin, and because all tissues are advanced during the surgery, the suture line is under a lot of tension.

Therefore, if the stitches are removed on day 3 or 4, the tense suture line may open up or the scar line may widen, resulting in a larger scar, and the tissues may gradually be pulled upward, causing the double eyelid line to become larger as well.

So until the tissue stabilizes, the stitches should hold the tissue in place, which is why it is better to leave them in longer.

At many clinics, stitches are often removed early for fear of leaving stitch marks, but that applies only to the first double eyelid surgery.

It does not apply to double eyelid revision surgery.

To minimize stitch marks, most of the stitches are removed on day 4, leaving about 3 to 4 stitches, and the remaining stitches are removed on day 7. This helps minimize stitch marks and prevents the scar from widening while also minimizing distortion of the double eyelid line.

Steroid medication is administered for about 2 days to quickly reduce early inflammation and swelling.

After surgery, artificial tears are used for about 1 month to prevent dry eyes.

If all of the above principles are followed with skilled technique, satisfactory results can be obtained.

Examples of corrective surgery for multiple double eyelid lines

How to correct multiple double eyelid lines - multiple double eyelids with sunken eyelids

When the eyelid is sunken, the skin is pulled upward and the crease becomes larger, or a triple double eyelid may form.

Sometimes multiple wrinkles may also appear.

In such cases, it can be simply corrected with micro fat grafting.

♠ Causes of multiple double eyelid lines with sunken eyelids

A case where the line loses its center of force as the eyelid becomes sunken, creating one additional line above the incision line
Also occurs when excessive fat removal causes the eyelid to become sunken
Also occurs when eyelid fat gradually decreases congenitally

♠ How to correct multiple double eyelid lines with sunken eyelids

They are corrected with micro fat grafting.

Fat is harvested from the lower abdomen with a syringe, purified, and then grafted into the sunken eyelid with a syringe.

A major advantage is that it can be corrected simply without an incision.

It is applied only when the eyelid is sunken.

If it cannot be corrected with fat grafting, a full incision method must be used.

♠ Micro fat grafting for multiple double eyelid lines with sunken eyelids

① Fat is harvested from areas where body fat is accumulated, such as the lower abdomen, waist, or thighs.

For wrinkle correction, a large amount of fat is not needed, so harvesting from the lower abdomen is preferable.

• Because local anesthesia (pain-free sedation anesthesia) is used, there is no pain at all.

• A thin liposuction cannula is used to collect the fat into a syringe.​

② The harvested fat is placed in a centrifuge to remove impurities such as local anesthetic, serum, and red blood cells.

The purpose of centrifugation is to remove impurities contained in the fat, increase the fat concentration, and improve the fat survival rate.

③ After centrifugation, water and oil are removed in a second concentration process.

Removing water and oil yields nearly 100% concentrated fat.

④ The purified fat is transferred into a thin 1 cc syringe and grafted into the desired area.

The fat is transferred again into a thin 1 cc syringe and grafted into the desired area.

The clinic uses its own micro-needle (micro grafting cannula) developed in-house.

The micro needle is a special grafting cannula used only by this clinic, allowing ultra-precise grafting.

For grafting, subcutaneous tunneling should be performed in advance so the fat can be grafted accurately into the wrinkle area and correct the wrinkles effectively.

The micro fat grafting cannula is inserted along the planned eyelid line for precise grafting.

The graft must be placed into the orbital fat layer to create a smooth contour and a high survival rate.

After fat grafting, normal daily activities are possible immediately, and washing the face and wearing makeup are possible from the next day.

♠ Examples of micro fat grafting applied to multiple double eyelid lines with sunken eyelids

Double eyelid revision surgery accounts for a large portion of plastic surgery procedures.

Double eyelid revision surgery accounts for a large portion of plastic surgery procedures.

Since eye plastic surgery is the most commonly performed procedure in plastic surgery, there are inevitably many possibilities for various problems to occur.

In addition to board-certified plastic surgeons, cosmetic surgery is also being performed by non-specialists, so concerns about side effects naturally grow.

Unfortunately, these issues are also problems with the medical system itself.

It is wrong in itself to entrust patient care to people who do not hold specialist certification, and because each specialty does not have a clearly defined exclusive field and some areas overlap with other specialties.

For example, eye clinics performing double eyelid surgery, and ENT clinics performing rhinoplasty to raise the nose bridge.

The principle is that cosmetic surgery should be performed in plastic surgery.

If cosmetic surgery is performed by a board-certified plastic surgeon, the risk of complications will be much lower.

Because cosmetic surgery is performed countless times by unqualified doctors, many victims continue to appear, and patients who develop complications cannot trust the doctor who performed the first surgery and end up suffering the pain of having to visit another plastic surgeon to repeat the unsatisfactory cosmetic procedure.

http://www.doublefold.co.kr

The first thing to consider is not the cost before undergoing plastic surgery, but whether the doctor you want to see holds board certification in plastic surgery before proceeding with surgery.

Most people mistakenly assume that if a clinic has a plastic surgery signboard, the doctor is a board-certified plastic surgeon, and the number of people experiencing dissatisfaction or complications after surgery continues to increase.

For people who need revision surgery, it is sometimes difficult and unfortunate for the specialist to correct painful and unattractive double eyelids again.

Even as a specialist who must perform revision surgery, there are times when one truly does not want to operate.

This is because the patient’s eye condition may be so severe that it seems impossible to address.

Rather than undergoing revision surgery, it is more important not to create a situation that requires revision surgery in the first place.

​http://www.duhans.com​