Double Eyelid Surgery at Doohan Plastic Surgery - Problems with Double Eyelid Revision Surgery

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What are the extreme situations and problems that must be overcome in double eyelid revision surgery?!

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

What kinds of situations are there?

Please refer to the content below~

Problems handling a very high double eyelid scar line

In many cases, the existing scar line cannot be excised during surgery.

In principle, the existing double eyelid scar line should be excised, but if the scar line is too high to be removed, there are cases where the surgery must be performed by spreading out the scar rather than excising it.

When the double eyelid 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.

Although the existing double eyelid scar line can be excised, it may not be reduced as much as desired because the new line has to be placed high.

When the double eyelid scar line is very high but the scar is faint

Instead of excising the existing double eyelid scar line, it is dissected and spread out.

Then the existing scar line remains faintly, so a slight scar is 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 handling an excessively wide double eyelid scar line

After scar excision, there is the issue of reducing the double eyelid line and preventing deformity of the double eyelid shape.

Causes of a darkened double eyelid scar line include poor suturing, lack of excess skin causing the scar line to separate, and frequent rubbing of the eyes.

To solve the problem of a large double eyelid scar line, the scar must be excised while considering skin laxity, and rather than simple suturing, the tissue must be dissected and precisely layered and sutured to reduce the scar.

Also, deformity of the double eyelid must be prevented due to the excision of a wide scar tissue, and the more scar tissue that is removed, the greater the limit to how much the line can be reduced.

Problems when the double eyelid scar tissue is very thick after multiple revision surgeries

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

With repeated surgeries, the skin tissue becomes harder and the scar tissue thickens.

It is not easy to spread thick, hard tissue and recreate the line.

Because of the hard scar tissue, the line may not form properly.

To create a new line, the existing hard scar tissue must be excised as cleanly as possible, and the scar tissue under the skin must also be neatly removed.

Problems with excessively outerfold double eyelid lines

It is necessary to reduce the outerfold or change it into an infold, and this is one of the most difficult techniques in double eyelid revision surgery.

To reduce the double eyelid line, the inner double eyelid line must be properly narrowed.

When the double eyelid line is thick and the inner double eyelid line is also very wide, it becomes an outerfold.

Only by reducing the outerfold into an infold can a naturally balanced double eyelid line be created overall.

One of the most difficult techniques in double eyelid revision surgery is turning an outerfold into an infold.

If the line cannot be properly reduced into an infold, the desired double eyelid line cannot be created.

Problems when the inner corner surgery has been done too much

Excessive inner corner surgery has limitations in turning the line into an infold or a natural double eyelid line.

Because of unnecessary and excessive inner corner surgery, a severe outerfold double eyelid line, excessive exposure of the mucosa, or side effects that make the eyes appear too close together may occur.

In cases of excessive inner corner surgery, the priority is to create an infold double eyelid line as much as possible, and if that is still insufficient, inner corner restoration should be performed additionally after 6 months.

Problems when there is insufficient skin and ectropion occurs

If there is not enough skin, the double eyelid line cannot be reduced as much as desired, or ectropion may worsen.

In cases where the eyes do not close properly due to repeated double eyelid revision surgeries or excessive skin removal during surgery, the eyelids must be made to close again. However, if there is no tissue reserve, correcting ectropion is practically impossible.

Ectropion must be left as is, and only the thickness of the double eyelid line should be adjusted.

Reducing a thick line when there is insufficient skin is an extremely difficult surgery that requires maximizing tissue stretching and repositioning.

Problems with wrinkled eyelids that lack skin elasticity

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

Unlike younger people, older patients have wrinkles or skin texture on the eyelids, making it very difficult to create a natural, smooth double eyelid line.

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

Problems when ptosis correction is not possible

In cases where the levator palpebrae superioris has no function, further ptosis correction may be impossible, or ectropion may occur.

Even after multiple ptosis corrections, there are cases where the eyes still look sleepy.

If the levator palpebrae superioris has almost no function, even another ptosis correction may not be possible.

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

If an excessive ptosis correction is attempted, ectropion will only worsen and the ptosis will hardly be corrected.

Problems when eye correction has been done too much

Lowering an overcorrected eye shape back to a normal size is much more difficult than ptosis correction.

If ptosis correction or eye correction has been overdone and the white of the eye is exposed, levator palpebrae superioris relaxation surgery must be performed to reduce the size of the eyes again. However, if the levator muscle is relaxed carelessly, ptosis may be induced a few months later and the eyes may not open well.

Surgery to bring down an overcorrected result is much more difficult than ptosis correction, and the later outcome is difficult to predict.

The degree of levator palpebrae superioris relaxation must be carefully controlled through extensive experience and skill.

Problems when a releasing surgery has already been performed before coming to the clinic

When a patient visits after having had a releasing surgery at another hospital, it is often difficult or impossible to recreate the double eyelid line.

One of the most difficult problems to overcome in double eyelid revision surgery is when the patient comes after a releasing surgery at another hospital.

9 out of 10 people cannot undergo double eyelid revision surgery.

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 area so that no double eyelid line forms there.

This tissue later turns into thick scar tissue, so excising the thick scar tissue again and creating a natural double eyelid line is almost impossible.

Even for the future, releasing surgery is a procedure that should be avoided as much as possible.

What is the difference between extreme double eyelid revision surgery and ordinary double eyelid revision surgery?

Ordinary double eyelid revision surgery may involve simpler steps depending on the condition, and some steps may be omitted. However, in extreme double eyelid revision surgery, when there is not enough skin or the existing scar line is too high and too dark, making revision surgery almost impossible, the scar is not excised; instead, subcutaneous dissection is performed and a new line is created underneath.

It refers to the full integration of all revision techniques for restoring a natural and beautiful double eyelid by mobilizing all available methods, such as multi-layer tissue dissection and repositioning, insertion of micro-fat tissue, levator palpebrae superioris shortening, and dissection and excision of the orbicularis oculi muscle below the incision line, in order to spread out scar adhesion of the double eyelid.

Examples of extreme damage to double eyelids?

What is the plan for extreme double eyelid revision surgery?

01. If there is not enough tissue or skin, the limit of how much can be stretched is measured and stretched accordingly.
02. If the levator palpebrae superioris has almost no function, the maximum amount it can be lifted is calculated.
03. If the skin is very thick, a plan is made to excise the orbicularis oculi muscle in order to create thinner tissue.
04. If the double eyelid scar is severely adherent and cannot be spread out, micro-fat grafting is planned after scar dissection.
05. If the sausage phenomenon is severe, the plan is to eliminate it through incision line dissection and partial excision of the orbicularis oculi muscle.
06. If the double eyelid scar line is very high, the plan is to spread it out instead of excising it.
07. In the case of a very dark, sunken scar line that cannot be excised, a plan is made to fill the depressed area.
08. If eyelash eversion is severe, sub-bulbar dissection at the lash root is planned to correct the eversion.

Examples of extreme double eyelid revision surgery applied

What should be kept in mind during extreme double eyelid revision surgery?

Surgical results are not a matter of luck.

Consistent and safe results are proportional to the surgeon’s skill and ability.

The more times double eyelid revision surgery is performed, the lower the limit and the likelihood that surgery is possible become.

Double eyelid revision surgery must be decided carefully.

Even for a board-certified plastic surgeon, not just anyone can perform double eyelid revision surgery, and the results vary greatly depending on the surgeon.

Never think lightly of double eyelid revision surgery, and if you assume the surgery can be finished quickly and simply, you are likely to be disappointed.

Our clinic has more than 20 years of accumulated know-how and extensive experience over many years in double eyelid revision surgery.

It is by no means an easy procedure.

Whether it is the non-incisional method or the incisional method, the eyelid tissue has already been deformed and damaged, so surgery must be performed with a prediction of the outcome based on sufficient experience.

It is not a procedure anyone can do.

Double eyelid revision surgery is performed at many hospitals, but the results are generally not that good.

Double eyelid revision surgery is a procedure that can only be done after a lot of experience and know-how have been accumulated.

Because people choose it based on low cost or advertisements and proceed with double eyelid revision surgery, the results can be hit or miss, and in severe cases some people undergo 7 to 8 revision surgeries.

Above all, we prioritize surgical effectiveness and safety.

In addition, extreme double eyelid revision surgery is performed using techniques that minimize side effects, and we confidently state that we have produced safe and consistent results.

Severe side effects such as thick lines, ptosis, eversion, and asymmetry are side effects caused by inexperienced doctors.

For each patient, appropriate surgery must be performed by considering factors such as skin tension and the musculoskeletal structure.

For any surgery, creating high safety and precise results is something that is achieved through the surgeon’s ability.

There are also patients for whom revision surgery is impossible due to insufficient skin laxity and various other problems.

After consultation, whether surgery is possible is determined precisely. At our clinic, we only perform surgeries whose safety and effectiveness have been verified, and for any surgery, we proceed only when the post-surgery effect and satisfaction for the patient are expected to be at least 80 points.

People who have failed multiple times with double eyelid surgery worry about the outcome, but the result depends on the surgeon’s ability.

What are the requirements for success in extreme double eyelid revision surgery?

① You must be operated on by a board-certified plastic surgeon.

You should have surgery only after confirming whether the surgeon holds a board certification in plastic surgery.

There are many hospitals that are only branded as plastic surgery clinics, while in reality non-specialists provide the treatment.

It is important to identify this well and avoid being operated on by a non-specialist.

② The surgeon must have extensive experience in double eyelid revision surgery.

Even among board-certified plastic surgeons, their specialties vary somewhat.

If you are considering double eyelid revision surgery, asking a specialist who focuses on double eyelid revision surgery can lead to better results.

Double eyelid revision surgery is one of the most difficult cosmetic procedures.

Being operated on by a specialist with proven know-how and accumulated experience in double eyelid revision surgery can restore a more beautiful and natural eye shape.

③ You should not think of double eyelid revision surgery as something easy.

If you think of double eyelid revision surgery as easy, the probability of failing again is very high.

Compared with the first surgery, double eyelid revision surgery is several times more complicated and difficult and is among the highest-difficulty cosmetic procedures.

We recommend thinking carefully before deciding on double eyelid revision surgery.

④ You must accurately identify the cause of failure in the double eyelid revision surgery.

Patients themselves must understand the cause of the failure of the first surgery well.

Through consultation, you must be able to clearly understand why your first surgery with the surgeon was unsuccessful and through what process double eyelid revision surgery became necessary, so that you can approach surgery with trust and obtain good results.

⑤ The double eyelid revision surgery time should not be too short.

Double eyelid surgery usually takes about 30 minutes to 1 hour.

Incisional double eyelid revision surgery cannot be completed in a short time.

Unlike the first double eyelid surgery, revision surgery proceeds from releasing the original double eyelid, to dissecting scar tissue, repositioning tissue, and performing delicate layered suturing.

Therefore, the surgery time inevitably becomes longer, and only when every step is carried out according to the principles and rules can good results be achieved.

⑥ Right after double eyelid revision surgery, the eyes should open well and easily.

Most patients have a large double eyelid line and sleepy pseudo-ptosis.

The goal of double eyelid revision surgery is to make the double eyelid line as thin as possible and to make sleepy eyes open clearly and comfortably.

If the surgery has gone smoothly, in most cases the eyes should open clearly as soon as the operation is finished; that is a successful surgery.

The immediate postoperative appearance should not look unnatural, and then after the swelling goes down it will usually look natural.

⑦ Right after double eyelid revision surgery, the thick front line should be reduced.

The highlight of double eyelid revision surgery is naturally converting a severe outerfold line into an infold.

Right after surgery, the inner line corresponding to the first and most important step must form properly so that the outer line continues naturally, leading to a good prognosis.

If the line is still thick immediately after surgery and the inner line has not narrowed properly, it cannot be considered to have a good prognosis.

⑧ After double eyelid revision surgery, there should be a slight amount of ectropion for a certain period.

A surgery where the eyes close properly right after surgery is considered an incorrect surgery.

Most double eyelid revision surgeries are performed when there is not enough skin laxity.

In such a state, if the surgery is performed and the eyes need to close well, the skin must stretch somewhere, and in most cases the skin stretches below the incision line.

If that happens, the double eyelid line becomes larger again.

During the adaptation period, the skin above the incision line gradually stretches, and after some time the eyes close naturally.

When there was not enough skin reserve, recovery from ectropion is slow; conversely, if there is sufficient skin reserve, recovery from ectropion is faster.

⑨ The stitches should be removed a little later after double eyelid revision surgery.

Usually, stitches are removed in two stages, on day 4 and day 7, depending on the amount of skin laxity.

Unlike the first double eyelid surgery, where all stitches are removed around 3 to 4 days after surgery, in double eyelid revision surgery the final stitch is removed around day 7.

If stitches are removed too early after double eyelid revision surgery, the scar becomes wider and the tissue above the incision line can be pulled upward again, resulting in a surgery that makes little or no difference.

Because revision surgery involves suturing tissues that lack sufficient tissue, the stitches must hold the tissues in place until they settle into their new position.

If the stitches are removed before the tissues have settled, the tissues that have not yet settled may be pulled upward again, leading to a failed surgery.

Choices when consulting about double eyelid revision surgery if the surgery seems very difficult or challenging

After visiting for a consultation and being examined, there are cases where, from the surgeon’s perspective, the eye shape is very challenging or there is no confidence that a satisfactory result can be achieved.

In such cases, one cannot always say with full confidence that it is possible, but at the same time, if one answers that it is difficult, trust in the hospital may decline or the doctor may be mistaken for being unskilled.

From the surgeon’s perspective, if they wish to provide an honest and principled consultation and accurately judge the patient’s condition by explaining exactly what is difficult and that the result may not be good, some people will accept it, but more people will take it negatively.

If patients are swayed by exaggerated consultations and undergo surgery, they may end up in a much more hopeless situation.

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 prognoses for double eyelid revision surgery.

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

This is a very dangerous way of thinking.

Even a skilled doctor may improve the condition in some cases, while in other cases improvement may not be possible, and sometimes the results may be insufficient.

Before surgery, you should keep the above three possibilities in mind and seek consultation, then make a realistic judgment by confirming whether surgery is possible, how much improvement is possible if it is, or whether it is impossible.

Cases where double eyelid revision surgery is difficult or impossible

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

Examples include insufficient skin laxity, scar lines that are too dark to release adhesions, skin and muscle that are excessively thick, tissue that has become hard and thick after multiple revision surgeries, severe sausage-eye appearance with a high likelihood of recurrence because it will be pushed down again even after surgery, and severe ptosis.

When surgery is very delicate and difficult, patients themselves must understand the limits, but there are people who do not want to accept those limits.

If you undergo surgery with only vague hope, you are essentially bringing about your own great trouble.

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

Features of the Double Eyelid Revision Clinic at Doohan Plastic Surgery

1. We have accumulated more than 20 years of rich clinical experience and know-how in double eyelid revision surgery.

2. We have a systematic system for double eyelid revision surgery.

3. Through preoperative consultation, we perform various tests and evaluations to predict the postoperative outcome.

4. Surgery is performed only when the examinations and tests indicate 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 surgery.

5. Through examinations, we identify what was wrong with the previous surgery, provide a thorough and clear explanation, and suggest the surgical method that will yield the best result.

6. We explain the surgical process and recovery in a way that ensures a clear understanding, and we do not omit explanations of possible postoperative side effects.

7. We provide thorough postoperative care after surgery.

We closely observe the postoperative course to check whether recovery is proceeding properly.

8. We make every effort and conduct research so that those who want double eyelid revision surgery can make our clinic the last hospital they need to visit, so that they will not need further surgery.