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Duhan Plastic Surgery Clinic · 두한성형외과 DUHANISM · March 30, 2020
Ptosis #Ptosis eye correction #ptosis revision surgery #eye correction #ptosis surgery #pseudoptosis #false ptosis #eye plastic surgery #double eyelids #ptosis correction #double e...
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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 30, 2020
Translated at: April 25, 2026 at 6:43 AM
Medical note: This translation does not guarantee medical accuracy or suitability for treatment decisions.
What causes an asymmetrical double eyelid line?
When the height of the double eyelid crease differs
When one eye has ptosis
When one double eyelid line has loosened
When the skin on one side has loosened
When there is a lack of orbital fat, causing the eyelid to sink inward and the crease to be pulled upward
When it is pulled upward due to scar adhesion
When the skin on one side has loosened?
If the height of the double eyelid crease is the same but asymmetry occurs because of sagging skin, the drooping side is corrected by removing the excess skin with a full incision method.
What if both sides are asymmetrical and both lines look awkward?
If the left and right sides are asymmetrical and both lines are unattractive and awkward, both sides need revision surgery.
The line is designed at the same height on both sides, the existing scar line is removed, and the line is completely repositioned to create a new crease.
What if one double eyelid line has loosened?
If one side of the crease has loosened, the loosened double eyelid line is corrected using a partial incision method or a full incision method.
If the skin is very thick or the scar is not severe, partial incision correction is generally preferred first.
If it still loosens afterward, it is corrected with a full incision method.
What if one eyelid has sunk inward, pulling the crease upward and causing asymmetry?
When the eyelid sinks inward because of a lack of orbital fat, the crease is pulled upward and appears larger.
In such cases, it can be corrected simply with micro fat grafting without revision surgery.
Micro fat grafting is a simple procedure that injects fat with a syringe.
Correction for pseudoptosis with a thick crease?
Full incision method
To correct pseudoptosis with a thick crease, the full incision method is used.
The full-incision revision process is
very demanding and requires extensive experience, high-level skill, and know-how.
It usually takes about 2 to 3 hours.
The operation proceeds in 10 steps,
and if even one step is omitted, the result may fall short of expectations.
Even if it takes quite a long time, carefully checking each step and performing the surgery with great care is necessary to achieve better results.
Dr. Shin Duhan
What are the two goals of full-incision surgery for pseudoptosis?
The goals of correcting thick-crease pseudoptosis are broadly divided into two.
First: to reduce a large, unattractive double eyelid crease and create a natural, thinner crease
Second: to make eyes that look half-closed and sleepy open wider and appear more refreshed
With these two goals, double eyelid revision surgery is performed as described below.
What is the full-incision procedure for pseudoptosis?
Step 1 - The incision line is designed to include the existing scar tissue from the incision.
Before surgery, the design creates a new double eyelid line below the scar line and determines the width of skin to be removed up to the scar line.
For example, if the existing scar line is 10 mm above the eyelashes and the new crease is set at 7 mm, the skin excision width becomes 3 mm.
Determining the new double eyelid line is based on how much the crease should be reduced and how much extra skin is available.
The average height of the revision line is around 5 to 7 mm.
Step 2 - The skin and scar tissue are removed.
Scar tissue is excised along the design line.
The incision is made precisely with a scalpel, and the tissue is then removed with surgical scissors.
The lower excision line becomes the new double eyelid crease, and the upper line must be naturally pulled downward after tissue dissection so that it can be sutured.
Step 3 - The orbicularis muscle, orbital fat, and skin that are adherent to the levator muscle are dissected.
Because the skin above the incision line must be pulled downward, the firm scar tissue that has adhered there must be released.
Scar dissection is performed by separating the area between the orbital fat layer and the levator muscle, and in some cases the space between the muscle and fat is also dissected for forward repositioning of the fat.
This dissection process allows the tissue to be moved forward and repositioned downward, and it is an important preparatory step for achieving a natural double eyelid crease.
Step 4 - If there is contraction of the orbicularis muscle, the muscle is incised or excised to remove the contraction.
In rare cases where scar adhesion is severe, the orbicularis muscle is vertically incised by about 1 to 2 mm to release the contraction.
Step 5 - To prevent readhesion, the orbital fat is repositioned up to the incision line.
Forward repositioning of the orbital fat is a process that helps prevent the tissue from re-adhering.
If the fat is not repositioned, the tissues may adhere again, which can lead to ptosis and a half-closed, sleepy-looking eye.
Sometimes a triple crease may occur, which can ruin the double eyelid line.
Another effect of repositioning orbital fat is that if the eyelid has sunken inward, the hollowing can be partially corrected. In some cases, even if fat grafting would otherwise be needed later, the surgery itself can improve the condition enough that fat grafting is not necessary.
Step 6 - The levator muscle is shortened to strengthen its function.
Levator shortening is one method for correcting ptosis.
It is simple, effective, and has the advantage of correcting the condition with minimal tissue damage.
The levator is not cut away; instead, it is simply advanced and attached to the tarsal plate.
In double eyelid revision surgery, levator shortening has two effects: it helps the eyes open wider so they appear more refreshed, and by opening the eyes wider, it also reduces the double eyelid crease.
Step 7 - After the medial orbicularis muscle is incised, orbital fat is inserted between the muscles to prevent readhesion.
Along with forward repositioning of fat, fat is inserted into the inner corner of the eye to prevent scar tissue from adhering.
The inner corner of the eye is the area where scar adhesion most easily occurs. Adhesion in this area can make the eyes look half-closed and make it difficult to open them comfortably.
To prevent this, orbital fat that can act like a lubricant is placed between the orbicularis muscle and the tarsal plate and secured with sutures.
Step 8 - During suturing, layered closure keeps the repositioned structures from shifting.
The suturing method for revision surgery is not simple.
The purpose of suturing is to close the open wound and create the double eyelid crease.
To obtain the crease exactly as designed, the skin below the incision line must not be pulled upward.
To do that, the lower skin at the incision line must be firmly fixed to the tarsal plate, and the advanced fat must also be secured with sutures so that it does not get pulled upward.
In addition, all of the orbicularis muscle and skin above the incision line must be firmly layered with sutures passing through them in order to achieve the intended double eyelid crease.
Step 9 - A small amount of anti-swelling medication (hyaluronidase) is administered to the surgical area to prevent hematoma and inflammation.
The anti-swelling agent hyaluronidase is a medication with the effect of dispersing fluid, and it quickly reduces swelling once administered.
However, excessive use can cause more bruising, so it is used only in a limited way to reduce swelling.
Step 10 - Suture removal is divided into two sessions, on day 4 and day 7.
Sutures are usually removed around 7 days after surgery.
The reason for removing them later is that in revision surgery, there is often not enough excess skin, and because the surgery involves advancing and repositioning all tissues, a lot of tension is placed on the suture line.
Therefore, if sutures are removed on day 3 or 4, the tense suture line may open, or the scar line may widen and result in a larger scar, while the tissue may gradually be pulled upward and make the double eyelid crease larger as well.
For that reason, the sutures should remain in place until the tissue stabilizes.
To prevent the suture marks from making the scar look messy, most sutures are removed on day 4 and only the remaining 3 to 4 sutures are left, so little to no suture marks remain.
Steroid medication is administered for about 1 to 2 days to quickly reduce early inflammation and swelling.
After surgery, artificial tears are prescribed for about 1 to 3 months to prevent dry eyes.
If all of the above principles are followed with skilled technique, a satisfactory result can be achieved.
Examples of full-incision surgery
Please refer to the photos below~^^
What is lateral canthoplasty?
These days, complications from lateral canthoplasty at other hospitals are frequently reported.
Lateral canthoplasty refers to a procedure that opens the outer corner of the eye, the opposite of epicanthoplasty.
What are the complications of lateral canthoplasty?
◇ Eversion and upward pulling of the eyelid
◇ Distorted scar at the outer corner of the eye
◇ Exposure of the mucosa and drooping of the eyelid
◇ Excessive exposure of the lower white of the eye
◇ Distortion of the eye shape and twisting of the outer canthus
◇ Dry eye and tearing
Examples of lateral canthoplasty complication cases at other hospitals
The following lateral canthoplasty photos are materials from patients who came to our clinic for double eyelid revision surgery after undergoing lateral canthoplasty at other hospitals, in order to show the severity of lateral canthoplasty complications.
Please take note.
What is our clinic’s lateral canthoplasty revision method?
Our clinic’s combined lateral and lower canthoplasty is based on more than 20 years of extensive clinical experience and know-how. If the outer eye corners are raised and the horizontal length of the eyes is short, combining lateral and lower canthoplasty can create a larger and gentler impression.
However, with combined lateral and lower canthoplasty, there are eyes that can show significant improvement and eyes that may not, depending on the eye shape, the shape of the eyeball, and the structure.
In combined lateral and lower canthoplasty, the adherent tissue is sufficiently removed through skin dissection, so it does not reattach, and the surgery delicately sutures from the inner conjunctiva of the eye through the ligament-fascia layer, muscle layer, and skin layer in anatomical order.
This surgical method compensates for the disadvantage of previous lateral canthoplasty, which was reattachment.
Because the skin and mucosa are sutured separately, the result does not form a C-shape and there is no concern about reattachment.
Also, unlike at other hospitals, it is not performed by skin incision alone; by firmly fixing it to the periosteum, it does not loosen and is a safe procedure that can also be reversed later.
The sutured area is naturally concealed along the outer eye corner line to minimize visible scarring, and due to years of know-how in double eyelid revision surgery, delicate and precise suturing leaves almost no scar.
Through many surgical cases, we have increased patient safety and satisfaction.
Our clinic does not perform one-size-fits-all surgery.
With 1:1 customized design, we tailor the procedure to each patient’s eyes and create a natural eye shape that harmonizes with the existing double eyelid line.
Advantages and pride of the Double Eyelid Revision Clinic at Duhan Plastic Surgery
Experienced medical staff and safety
Dr. Shin Duhan, who has focused on more than thousands of double eyelid revision cases, more than one per day, works as a team with experienced nurses.
1:1 customized surgical planning
Based on each person’s double eyelid condition, we consider gender, overall facial harmony, and the patient’s own wishes.
The proportion of correcting from an out-fold to an in-fold and performing epicanthoplasty or lateral canthoplasty at the same time as double eyelid surgery continues to increase.
If double eyelid revision surgery is performed together with epicanthoplasty or lateral canthoplasty for eyes that need it, the effect is amplified.
The height of the double eyelid crease and the crease shape (in-fold, in-out fold, out-fold, etc.) reflect the patient’s preferences, and the current trend in double eyelid lines is ‘naturalness.’
Double eyelid revision surgery without complications
People undergoing double eyelid surgery worry whether the line will loosen or whether scars will remain.
Complications are reduced by Dr. Shin Duhan’s analysis and the ability to precisely create the crease based on that analysis.
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 surgery, but even if the surgery name and method are the same, the results are not necessarily the same.
With more than 20 years of extensive experience, we provide the best beautiful line for each individual patient.
Double eyelid surgery is often thought of as a simple procedure, but revision surgery is quite demanding.
Double eyelid revision surgery includes the detailed process of redesigning a new line and completely separating and dissecting the previously adherent double eyelid tissue.
With this careful dissection process, there are no later issues such as a bumpy line or adhesion that causes the crease to curl upward.
With skill in neatly organizing all layers of tissue, including the skin, fat, and muscle layers, we can produce results that are hard to imitate even in extremely difficult revision cases.
Performing eye correction at the same time as double eyelid revision surgery
At the Double Eyelid Revision Clinic of Duhan Plastic Surgery, eye correction is included in double eyelid surgery, so we can correct sleepy-looking eyes or dull eyes where the pupil is hidden.
By tying and shortening the levator that opens the eye, we adjust how much of the pupil is visible and make the eye area look clearer.
Research, lectures, and educational activities on double eyelid revision surgery
The most trustworthy answer comes from extensive clinical experience.
Double eyelid revision surgery is like a luxury item perfected through years of experience.
Through this accumulated experience, we also carry out research and educational activities.
Increasing consultations about double eyelid revision surgery
As newly established clinics have been indiscriminately performing double eyelid surgery, requests for double eyelid revision surgery have also increased, which is truly unfortunate.
If double eyelid revision surgery fails after being performed multiple times, the amount of available skin decreases, making later revision surgery even more difficult and extreme.
Not only is the first choice important in double eyelid surgery, but when considering revision surgery, it should be approached carefully with the mindset that it may be the last opportunity.
Craftsmanship for a refined and beautiful face
Among plastic surgeons, the doctor who performs double eyelid surgery must have the sensibility of a designer as well as that of a doctor.
If one insists only on a uniform double eyelid line instead of what is truly beautiful, a perfect line suited to each patient cannot be created.
Without an eye for aesthetics, or without the skill to reproduce what one sees, no masterpiece can be created.
We do our best down to the last stitch to bring beauty and satisfaction to each patient.
Honest surgery with sincerity
We recommend procedures that are likely to achieve more than an 80% satisfaction rate, but we do not perform unnecessary surgery even if requested.
We aim to be a clinic that treats honestly based on skill and results.
A trustworthy premium clinic
There is a reason why a craftsman’s work is expensive.
It is because they create something beautiful and valuable.
The Double Eyelid Revision Clinic at Duhan Plastic Surgery has pride and confidence in its procedures.
Proper surgery will become a turning point that helps you build confidence for the rest of your life.
We will be a clinic that, unlike places that offer low prices and recommend surgery while having multiple doctors take turns performing it, delivers satisfying results even if the cost is higher.
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