Many Korean patients come to consult at my Los Angeles plastic surgery practice due to an unsuccessful double eyelid surgery operation from the past. This has become a serious issue among Asian patients; many undergo surgery anticipating the best possible results, only to be dissatisfied with the way they look afterwards. Some of the most common cases for an eyelid revision are described below.
A high fold is a fold that has been set too high above the eye. The eye elevating muscle, which supports the burden of skin on the eyelid, is crucial to the successful formation of a relatively high crease (i.e. outfold). As such, a weak eye elevating muscle cannot support the burden created by such a high crease. Another reason that the eye cannot support a high fold is a condition called borderline ptosis. Borderline ptosis is a condition that some patients are born with, and transitions into a full-scale ptosis with age. Often times, this condition should be taken into account during consultation before the patient undergoes surgery. However, after surgery operations where this is not taken into account, the patient suffers the repercussions of a permanently swollen, puffy eyelid (also referred to as a “sausage” eyelid in South Korea). This overly heavy eyelid compresses down onto the eye, making the patient appear sleepy.
A remedy to this case is to release the high fold and recreate the fold at a lower height. This is done by the creation of two planes around the formed scar tissue as a means to produce a buffer between the virgin skin (unscarred tissue) and the scarred tissue. This buffer prevents contact between the scar tissue from re-adhering to the virgin skin. Upon creating this buffer, the upper eyelid skin can be excised depending on how much it droops. Typically for younger patients, there is no need for this excision; however for older patients, who skin is less elastic, this upper eyelid skin excision is performed.
Upon releasing the previous fold, either the suture or open technique can be applied to create the lower, more suitable fold. Depending on how deep into the skin the prior crease was, a specific technique is used. For a crease that was very deep, the open technique is used; whereas for a crease that was weak, the suture technique is used. After a high fold has been remedied, the patient appears more natural with lower creases that are proportional to the shape and size of the eye.
A decreasing fold often results from two causes. The first cause is the patient’s fatty eyelid skin. A patient who has undergone a suture technique may notice a loosening fold due to the sutures’ inability to support the crease. The second cause may be that the sutures were not placed tightly enough to support the crease. Whichever the case, the way to solve this problem is to reapply the suture technique to the eyes. This can be done with or without the removal of the previous sutures. Upon revision of a loosening fold, the patient is able to experience a long-lasting fold that does not loosen over time.
Ptosis after surgery
As mentioned, patients with a borderline ptosis condition experience issues after an operation that did not account for this matter. Those who underwent surgery in this condition eventually witness a full-scale ptosis, or a drooping upper eyelid. The drooping upper eyelid skin covers the crease, thereby making the eyes appear smaller and more crowded. The solution to this situation is to perform a ptosis repair (tighten the eye elevating muscles), and excise the excess skin such that it no longer droops over the crease. After this procedure, older patients instantly regain youth in their eyes, appearing larger and brighter.
There are various double eyelid revision techniques to correct different conditions. The duration of the surgery will depend on the condition of each patient. The surgery takes place under local anesthesia, with or without oral sedatives. The skin stitches will be removed 4-6 days after the surgery at our office. The critical swelling will subside in 1 week, and the remaining swelling will subside gradually within 8-12 weeks.