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If you had double eyelid revision surgery

but got an unwanted result,

there can be various causes.

What are the main symptoms that appear after failed double eyelid revision surgery?

1. Surgery was done to make a large line smaller, but the line barely changed or stayed the same.

2. Swelling does not go down easily and feels unnatural. - sausage-eye phenomenon

3. It feels awkward to open the eyes, and the eyelids feel heavy.

4. When opening the eyes, there is a pulling sensation and a stiff feeling.

5. The line is severely asymmetrical.

6. The eyelashes evert and do not recover.

7. It feels awkward to open the eyes, but the eyes close well.

8. The scar line at the incision site is too dark.

What causes failed double eyelid revision surgery?

The biggest cause of failure is when the patient themselves thinks of double eyelid revision surgery too lightly.

After a failed double eyelid surgery, the idea of "just fixing it again" to correct the shape leads to failed revision surgery.

To undergo double eyelid revision surgery, more than anyone else, you must first understand the cause of the failed surgery yourself so that failure does not happen again.

The content below is an analysis of the causes of failure in cases where patients had double eyelid revision surgery at another hospital, then requested revision at our clinic, and we examined them through various tests.

First, when double eyelid revision surgery is performed together with epicanthoplasty

There are clinics that perform revision surgery to reduce the double eyelid line together with epicanthoplasty.

Epicanthoplasty thickens the line on the inner side (medial canthus).

When doing revision surgery to reduce the line, performing a surgery that, on the contrary, makes the inner line larger is not a logical procedure.

Unnecessary epicanthoplasty can cause various problems.

Epicanthoplasty should only be applied when needed for eyes with an epicanthal fold, and unnecessary epicanthoplasty can cause side effects such as excessive exposure of the inner mucosa, a severe out-fold line, eyes that look too close together, or a sharper appearance.

Unnecessary epicanthoplasty often ends up ruining the impression, so caution is needed.

Second, when the scar tissue is not fully dissected during double eyelid revision surgery

During double eyelid revision surgery, the existing scar tissue must be removed or thoroughly dissected to release adhesions between tissues that have become stuck together.

Otherwise, tissue repositioning cannot be achieved.

If the muscle layer and fat layer are not clearly dissected while releasing adhesions, tissue repositioning becomes impossible, making it difficult to narrow the double eyelid line.

If you suture without proper dissection, not only will the double eyelid line not narrow at all, but the skin below the incision line will be pulled upward, causing eyelash eversion.

Third, when orbital fat repositioning is not performed

If fat needs to be repositioned but this is neglected, the dissected tissue can stick together again, making it hard to open the eyes widely, and in some cases even creating triple eyelids.

Along with dissection of scar tissue, repositioning the orbital fat is one of the important steps in surgery because it acts like a lubricant to prevent tissues from sticking together again.

Fourth, when fat is not repositioned in the inner canthus (the inner corner of the eye)

If orbital fat is not repositioned to the inner canthus, scar tissue develops on the inner side of the eye, interfering with opening the eyes widely.

Scar tissue should not form on the inner side of the eye.

The inner side of the eye plays an important role in helping the eyes open widely, and if excessive scar tissue forms in this area, the eyes may not open widely or a natural line may not be created.

Fifth, when ptosis correction (eye correction) is not performed

In cases of sleepy-looking eyes, eye correction must be performed to help the eyes open wider.

Usually, levator palpebrae superioris shortening is performed. The levator palpebrae superioris (the muscle that lifts the eyelid) is an important structure that opens the eyes, and most patients undergoing double eyelid revision surgery have weakened eyelid-lifting muscles.

It is important to perform levator palpebrae superioris shortening (step 6) to help the eyes open widely.

If this is not done, the existing sleepy-looking eyes will not be corrected, reducing the effect of the double eyelid revision surgery.

Sixth, when the sutures are removed too early

The reason sutures are removed late during double eyelid revision surgery is that most revision patients do not have much excess skin, and because the tissue has been repositioned, the tissues need to be held firmly in place by the strength of the sutures.

The repositioned tissues tend to spring back to their original position like a spring, so they must be held by the sutures. If the sutures are removed before the tissues stabilize in their new positions, the tissues may return to their original places, leading to a poor surgical outcome.

Seventh, when fat grafting and double eyelid revision surgery are performed at the same time for sunken eyelids

There are clinics that perform fat grafting and double eyelid revision surgery at the same time when the eyelids are sunken, but this should not be done.

Fat grafting should be performed first, and double eyelid revision surgery is possible after 3 to 6 months.

When performing double eyelid revision surgery, tissue must be dissected, but fat grafting cannot be done into the dissected tissue.

If fat grafting and double eyelid revision surgery are done at the same time, it is like scattering fat into the dissected empty space, so the fat does not properly take, and only the double eyelid line is damaged.

Therefore, performing the two surgeries at the same time is not appropriate.

Eighth, problems that occur when fat grafting and double eyelid revision surgery are done together

▷ With fat grafting, swelling makes it almost impossible to accurately judge or adjust the double eyelid line.

As a result, the desired double eyelid line is not created, leading to dissatisfaction with the surgery.

▷ If the incision is made immediately after fat grafting for double eyelid surgery, the transplanted fat will spill out through the incision site.

During double eyelid revision surgery, dissection must enter between the orbital fat layer and the levator palpebrae superioris layer, but fat is grafted into that area.

▷ Conversely, if fat is directly grafted into the orbital fat layer after incision, the grafting will not be accurate or precise, so later engraftment may not take properly, or unsatisfactory issues such as a bumpy appearance may occur.

What is the double eyelid revision process when the eyelid is sunken?

A sunken eyelid causes the double eyelid line to be pulled upward and become distorted.

As people age, wrinkle lines often appear.

In this condition, the first step is to correct the sunken eyelid with fat grafting.

When the eyelid is sunken, even if revision surgery is performed, the double eyelid line usually does not come out beautifully.

After micro fat grafting using a micro needle, the sunken eyelid is corrected.

The width of the double eyelid line has also been reduced from before, but fine wrinkles remain in the line, and the inner part of the line is thick, making it look unnatural.

The line should be corrected naturally through double eyelid revision surgery, which is planned after 3 months, once the fat has fully taken.

Three months after fat grafting, double eyelid revision surgery is performed to restore a natural line.

A natural double eyelid is one that is narrow on the inner side and gradually becomes wider toward the outer side.

◇ As in the example above, the sunken eyelid should first be corrected with fat grafting, and after 3 months, once the final settled appearance is confirmed,

surgery must be planned according to that shape and revision surgery must be performed in order to achieve accurate surgery and good results. ◇

Director Shin Duhan, board-certified plastic surgeon ~ more than tens of thousands of successful cases over 20 years ~

What is extreme revision surgery to correct a damaged double eyelid line?!

It refers to revision surgery performed in a very severe condition or in an extreme state where further surgery is said to be difficult, in order to restore a normal eye shape.

This is surgery that restores an eye shape that is in very poor condition, or almost impossible to restore to a normal eye shape, as close to normal as possible.

The goal of extreme revision surgery is to restore eyes with multiple double eyelid revision surgeries, foreign substances such as fillers injected into the eyelids, thick chunks of fat grafted with severe unevenness and adhesions, or severe ptosis, to a normal eye shape.

Examples of severely damaged double eyelids?

What is the difference between extreme revision surgery and general revision surgery?

In general double eyelid revision surgery, some surgical steps may be simple or omitted depending on the condition, but in extreme eye (double eyelid) revision surgery, if there is not enough excess skin or the existing scar line is too high and dark, making revision almost impossible, the scar is not excised; instead, subcutaneous dissection is performed to create a new line underneath it.

This means fully mobilizing all available techniques for natural and beautiful double eyelid restoration through multiple dissection and repositioning of tissue to release scar adhesions, insertion of micro fat tissue, levator palpebrae superioris shortening, and dissection and partial resection of the orbicularis oculi muscle below the incision line.

What is the plan for extreme revision surgery?

1. If there is insufficient tissue or skin, the limit of how much can be expanded is measured and then expanded.

2. If the levator palpebrae superioris has almost no function, the limit to which it can be lifted is calculated.

3. If the skin is very thick, a plan is made to resect the orbicularis oculi muscle to make the tissue thinner.

4. If scar adhesions are very severe and cannot be released, a plan is made for micro fat insertion after scar dissection.

5. If the sausage-eye phenomenon is severe, a plan is made to remove it through dissection of the incision line and partial resection of the orbicularis oculi muscle.

6. If the scar line is very high, a plan is made to flatten it rather than excise it.

7. If the scar line is very dark and sunken and cannot be excised, a plan is made to fill the sunken area.

8. If eyelash eversion is severe, a plan is made to correct the eversion by dissecting beneath the eyelash roots.

Examples of extreme revision surgery applied at our clinic

Double eyelid revision surgery can achieve good results even in very difficult and challenging cases if performed according to principles with sufficient planning.

However, surgery is not possible in every case.

If there is too little excess skin or the scar adhesions are very severe, there are limits to surgery, and sometimes surgery is not possible at all.

If preoperative examination determines that revision surgery will be difficult, the rule is not to make a surgical plan at all.

http://www.doublefold.co.kr

Carefully checked more than 100 times, stitch by stitch, during double eyelid revision surgery

What are the requirements for successful double eyelid revision surgery?!

For a successful revision surgery,

there are things the patient themselves must be prepared to do and work on.

① For double eyelid revision surgery, more than anyone else, the patient must first figure out the cause of the failed double eyelid surgery. It is not easy to undergo double eyelid revision surgery without understanding the cause of the mistake.
② Only when the patient understands the cause of the mistake and the doctor in charge also understands it can the patient and doctor proceed with surgery based on trust.
③ In order to understand the cause of the failed double eyelid surgery, it is essential to seek a detailed consultation from a board-certified plastic surgeon with as much experience as possible.

Requirement for successful double eyelid revision surgery NO. 01: Surgery must be performed by a board-certified plastic surgeon.

Even revision double eyelid surgery should not result in an unwanted outcome.

At the very least, you should know whether the surgeon performing the operation holds a board certification in plastic surgery, is a board-certified specialist in another field, or is a general physician with only a medical license.

Among plastic surgery clinics, there are many that only have a plastic surgery signboard but are actually run by non-specialists.

It is important to distinguish this well and, as much as possible, avoid surgery by a non-specialist.

Requirement for successful double eyelid revision surgery NO. 02: There must be a lot of surgical experience in double eyelid revision surgery.

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

If you are considering double eyelid revision surgery, it is better to consult a specialist who focuses on double eyelid revision surgery for better results.

Double eyelid revision surgery is one of the more difficult, high-level plastic surgeries.

That is why even among board-certified plastic surgeons, some say they are not confident enough to do it.

Having surgery from a specialist with solid know-how and accumulated experience in double eyelid revision surgery can restore a more beautiful and natural eye shape.

Requirement for successful double eyelid revision surgery NO. 03: You should not think of double eyelid revision surgery as easy.

If you think of double eyelid revision surgery too lightly, the probability of failure again is very high.

Double eyelid revision surgery is several times more demanding and difficult than the first surgery, and it is one of the most advanced plastic surgeries.

Therefore, it is better to think more carefully about revision surgery and decide on surgery.

Having surgery with vague expectations alone can lead to bad results again.

Requirement for successful double eyelid revision surgery NO. 04: You must know the exact cause of the failed double eyelid surgery.

For double eyelid revision surgery to succeed, the first thing is for the patient themselves to understand why the eye shape became unattractive after the first surgery.

To avoid experiencing failed double eyelid surgery again, through consultation, either the patient or the plastic surgeon performing the surgery must accurately understand why the first surgery went wrong, based on the correct mechanism, so that proper revision surgery can be performed.

Therefore, through consultation, the patient must be able to clearly understand why the first surgery went wrong and what process the revision surgery will follow, so they can proceed with trust and achieve good results.

Requirement for successful double eyelid revision surgery NO. 05: The double eyelid revision surgery should not be too short.

A typical double eyelid surgery takes about 30 minutes to 1 hour.

However, a full-incision double eyelid revision surgery cannot be completed in a short time.

If double eyelid revision surgery is finished in less than 1 hour, there is a high chance that some part of it was done inadequately.

Unlike the first double eyelid surgery, revision surgery involves undoing the original double eyelid, dissecting scar tissue, repositioning tissue, and performing precise layered suturing, so the operation inevitably takes longer, and good results can only be obtained when every step is carried out according to principle.

Saying that double eyelid revision surgery ends too quickly is like a runner crossing the finish line fast by taking a shortcut instead of running the proper course.

The same applies to double eyelid revision surgery.

Only when every step is carried out without omission and according to principle can good results be obtained.

Requirement for successful double eyelid revision surgery NO. 06: The eyes should open well and widely immediately after revision surgery.

A double eyelid line that is too large and eyes that look sleepy are called pseudoptosis, and most double eyelid revision patients fall into this category.

The goal of surgery is to make the double eyelid line thinner and to help sleepy-looking eyes open more clearly.

If the surgery is successful, in most cases the eyes should open comfortably as soon as the surgery is over.

If the appearance immediately after double eyelid revision surgery is not much different from before surgery, it is highly likely to have been a failed surgery.

The immediate post-surgery appearance should not look unnatural; in most cases, this leads to a natural appearance after the swelling goes down later.

Requirement for successful double eyelid revision surgery NO. 07: The thick front line should become thinner immediately after revision surgery.

The highlight of double eyelid revision surgery is naturally converting a severe out-fold line into an in-fold line.

If the inner line does not become narrower and natural, the overall line is not corrected.

From immediately after surgery, the inner line, which is the first button, must be properly formed so that the outer line continues naturally and a good prognosis is achieved.

If the line is still thick right after surgery and the inner line is not narrowed properly, that cannot be considered a good prognosis.

Requirement for successful double eyelid revision surgery NO. 08: There should be a slight degree of lagophthalmos for a certain period after double eyelid revision surgery.

If the eyes close too well immediately after surgery, the surgery is incorrect.

In most double eyelid revision cases, there is not enough excess skin.

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

If that happens, the double eyelid line becomes large again, making the surgery essentially pointless.

Therefore, a successful double eyelid revision surgery should be one in which the eyes temporarily do not close well after surgery.

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

The duration of lagophthalmos varies slightly depending on the degree of ptosis correction and the amount of excess skin.

If there was not enough excess skin, recovery from lagophthalmos is slower; conversely, if there is excess skin, recovery is faster.

Requirement for successful double eyelid revision surgery NO. 09: Sutures should be removed a little later.

Sutures should be removed later.

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

Unlike the first double eyelid surgery, in which all sutures are removed around 3 to 4 days after surgery, in double eyelid revision surgery the last suture is removed around day 7.

If sutures are removed early after double eyelid revision surgery, the scar will widen and the tissues above the incision line may be pulled upward again, leading to results that are essentially no different from not having surgery.

Because the suturing is done when there is a shortage of tissue, the sutures must hold the tissues in place until they settle into their new positions.

If the sutures are removed before the tissues have settled, the tissues that have not yet settled may be pulled upward again, resulting in a failed surgery.

Choosing when surgery is very complicated or difficult during consultation

When you visit for consultation and are examined, there are times when, from the surgeon’s perspective, the eye shape is very complicated or there is no confidence that a satisfactory result can be created.

In such cases, the surgeon cannot simply say with confidence that it will definitely work, but if they say it is a bit difficult, trust in the clinic may decrease or they may be mistaken for an unskilled doctor.

From the surgeon’s perspective, if they try to provide honest and principled care and accurately judge the patient’s condition and explain what is difficult and that the result may not be good, some patients will accept it, but more often they do not.

They misunderstand the doctor as lacking skill and being of lower caliber.

Eventually, the surgeon is pushed into a situation where, to avoid being called unskilled even for a very difficult surgery, they must give an exaggerated consultation saying it will definitely go well, and if the patient is swayed by that exaggerated consultation and undergoes surgery, it can lead to an even more hopeless situation.

From the patient’s perspective, it is very important to distinguish a surgeon who gives no exaggeration in consultation and who practices with conviction.

There are various possible prognoses after revision surgery.

Some people think that if they meet a highly skilled doctor for revision surgery, they will definitely get a good result.

This is a very dangerous idea.

Even for a skilled doctor, there are cases that improve through surgery, cases that cannot improve, and sometimes cases where the result turns out unsatisfactory.

Before surgery, you should keep these three possibilities in mind during consultation and make a realistic judgment by checking whether surgery is possible, and if so, how much improvement can be expected,

or whether it is impossible.

When revision surgery is difficult or impossible

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

These include cases with insufficient excess skin, cases where the scar line is too dark and adhesions are difficult to release, cases where the skin and muscle are excessively thick, cases where multiple revisions have made the tissue hard and thick, cases with severe sausage-eye phenomenon but a high likelihood of recurrence because the tissue will be pushed back down even after surgery, and cases with severe ptosis.

Just as some patients can be saved and some cannot, no matter how skilled and capable the doctor is, the same applies to double eyelid revision surgery.

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

If you go into surgery with only a vague hope that some clinic somewhere will be able to do it perfectly, you are setting yourself up to fall into a deeper pit.

Therefore, you must judge the limitations and prognosis of your current condition well before deciding on surgery.

​http://www.duhans.com​