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Severe out-fold lines revised into in-fold lines

An out-fold refers to a line in which 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 makes the surgery obvious and creates an awkward eye shape, so it needs to be changed into an in-fold line.

The highlight and core of double eyelid revision surgery, and the peak of the technique, is changing an out-fold into an in-fold.

If the inner line is not properly arranged the way you want, the overall line becomes awkward and it is difficult to achieve the desired line.

Changing an out-fold into an in-fold when there is no excess skin or when scarring is severe can be considered one of the most difficult revision surgeries.

■ Causes of out-folds

① When the double eyelid line is designed too high overall

② When the inner design line is set too high

③ When unnecessary or excessive epicanthoplasty has been performed

④ Excessive skin removal

■ Surgical method

In most cases, it is only possible with full incision. In some cases, buried suture or partial incision methods may also be possible, but this is only when adhesion is weak and the line has partially loosened. When adhesion is strong or the scar line is dark, correction is almost impossible with buried suture or partial incision methods.

The method involves full incision, precise dissection between the orbital fat and the levator palpebrae superioris, repositioning the inner orbital fat, and also dissecting and smoothing the inner scar line.

This requires highly advanced technique and accumulated experience.

Thick sausage-like swelling below the incision line

This refers to a swollen-looking condition where the area below the double eyelid line bulges like a pouch, making it look as if the surgery was done only a few days ago.

■ Causes

① When the line was made too high

② When the skin and orbicularis oculi muscle are thick

③ When the buried suture for the double eyelid line is stitched below the height of the incision line

④ When the suture area loosens and the double eyelid line gets pushed downward

■ Surgical method

Sausage-like effect after full incision surgeryIn most cases, correction is only possible with full incision. Some of the orbicularis oculi muscle below the incision line should be removed to reduce the thickness of the muscle, and the sagging skin is pulled upward, tightened, and fixed.
Sausage-like effect after buried suture methodIf sausage-like swelling occurs after buried suture surgery, it is caused by the line being designed too high and the line partially sagging after surgery. In that case, the partially loosened line is pulled upward and firmly tightened again to secure the line. Partial incision or full incision surgery is performed.

Triple double eyelid line

This refers to a case where the line appears in three layers, and it needs to be organized into a single line.

Usually, the upper line among the two lines is removed and the line is aligned with the lower single line.

■ Causes

① As the line loosens, it loses its center of tension and another line forms above the incision line

② Excessive fat removal causes another line to form above the incision line due to scar adhesion

③ Skin slides downward below the scar line, creating a new line

④ Excessive scarring at the suture site causes a line to form above the scar

■ Surgical method

When scar adhesion is not severeIn cases of a triple line caused by the line loosening, the existing line is firmly fixed with a partial incision method so that the line above the incision line naturally loosens.
When scar adhesion is severeThe surgery is performed with a full incision method. The scar tissue is removed through full incision, and correction is made by dissecting and repositioning the orbicularis oculi muscle and orbital fat.

Triple double eyelid with sunken eyelid

When the eyelid becomes sunken, the skin may be pulled upward, making the line larger or creating a triple double eyelid.

Sometimes multiple layers of wrinkles appear.

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

■ Causes

① As the eyelid becomes sunken, the line loses its center of tension and another line forms above the incision line

② It can also occur when the eyelid becomes sunken due to excessive fat removal

③ It can also occur when the eyelid fat naturally decreases over time

■ Surgical method

It is corrected with micro fat grafting.

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

The advantage is that it can be corrected simply without incision.

However, this applies only when the eyelid is sunken.

If correction cannot be achieved with fat grafting, full incision correction is necessary.

Eyelash eversion

This refers to a case where the skin below the incision line is pulled upward tightly and the mucosa under the eyelashes becomes visible.

Excessive exposure of the mucosa gives a poor impression.

■ Causes

① Excessive skin removal

② Suturing while pulling too tightly upward during closure

③ Lack of excess skin, causing the skin below the incision line to be pulled upward

④ Severe adhesion of the scar line

■ Surgical method

Correction is possible only through full incision, and if surgery is delayed, the appearance of eyelash eversion may become fixed, making correction impossible.

In the case of eyelash eversion, surgery should be performed as soon as possible to see correction effects, but if correction is done months or years later, it often cannot be properly corrected.

In other words, surgery must be performed before the appearance becomes fixed for correction to be possible to some extent.

The scar line is incised, the skin below the incision line is lifted, and then dissected downward to release the tension of the skin that had been pulled tightly upward.

Usually, the dissection is carried out to near the eyelashes, and in some cases, part of the orbicularis oculi muscle is removed.

After adjusting the loosened skin to an appropriate height, it is fixed with sutures so it does not move, and then the skin is closed.

When the scar line is dark

In the case of surgery performed with the incision method, scars will inevitably form at the surgical site.

If the scar line is faint and light, there is no major problem, but if the scar line is dark and deeply indented, it creates discomfort when the eyes are closed.

In such cases, it is necessary to make the scar line less noticeable so that it is not easily visible even when the eyes are closed.

■ Causes

① When the scar becomes wider due to excessive skin removal

② When the remaining skin is not removed and the skin covers the incision line, causing it to darken

③ When a sunken scar occurs due to excessive removal of the orbicularis oculi muscle under the skin

④ When there is no excess skin and the scar line gradually widens or becomes deformed

⑤ The habit of rubbing the eyes frequently after surgery

⑥ When a person is constitutionally prone to scarring

■ Surgical method

The edges of the scar line are designed precisely, only the scar tissue is removed, and then the normal skin is meticulously sutured together along with the orbicularis oculi muscle under the skin.

If there is no excess skin, it may be necessary to delay the time for removing stitches, so it is also important to remove the stitches only after confirming that the wound has healed sufficiently and the scar will not widen.

If there is a so-called sausage-like effect, where the area below the incision line is thick, some of the orbicularis oculi muscle layer under the skin is removed and the skin is pulled upward and smoothed to correct it.

■ Cautions

After stitch removal, continue disinfecting for a few more days until the holes in the suture line are filled in.
Wipe the scar line well with antiseptic so that foreign substances or dead skin do not collect there.
Do not rub your eyes with your hands just because your eyes are tired or there is eye discharge. It is better to wipe it with a cotton swab.
Rubbing your eyes can deform the double eyelid line or make the scar messy, so do not rub them at all.

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