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Double eyelid reconstruction

Double eyelid reconstruction after failed surgery


The double eyelid reconstruction surgeries account for a large proportion of double eyelid blepharoplasty. Since the tissue adhesions during the operation procedures, it is a rather difficult surgery, and it is best for patients to carefully choose an experienced plastic surgeon to do the job, so as to avoid another possible failure.

What cause double eyelid surgery failures? The reasons of double eyelid surgery failures include:

一、Preoperative evaluation errors

  1. Whether the two eyes are symmetrical
  2. Whether the heights of eyebrows are symmetrical
  3. The tightness of eyelids
  4. Whether there is hyperplasia for orbicularis oculi
  5. The amount of orbital fat
  6. Whether this are nasolacrimal ducts (epiblepharon)
  7. The amount of fat under the eyelids
  8. Whether there is blepharoptosis
  9. The height of double eyelid creases are wrongly designed

二、Evaluation errors during surgery

Whether the left and right eyelids, fat and muscles are properly removed in the surgery, as well as the adjustment of levator palpebrae superioriss, are the main factors of whether the surgery will be successful. (Fig.)

What are double eyelid surgery failures and how can they be repaired?

1. The double eyelid ceases (lid folds) disappear or become unobvious: The patient should re-select the surgery method. For those who have no or slight inner epiblepharon, they can choose the buried suture method. For patients with thick eyelids or serious inner epiblepharon, they should choose incision method for reparation. For patients whose lid folds have disappeared, they can re-implement partial eyelid surgery. The newly formed lid fold should be consistent with the original double eyelid lines and look natural.

The patient in this case study had undergone suture method of double eyelid surgery previously, but the double eyelid line of her left eye disappeared in less than a year. The patient was bothered by the asymmetrical eyelids of the two eyes, and after communicating with our surgeon, she decided to adopt the mini incision double eyelid surgery to reposition the double eyelid of her left eye. Our surgeon applied the epitaxial incision on her excessive inner canthus to repair her double eyelid, so the two eyes became symmetrical after the surgery. The patient was very satisfied with the results of the surgery.

2. Double eyelid creases are too high (double eyelid is too wide): The incision should be redesigned to within 6 to 8 mm for the double eyelid reparation, and shift the orbital fat to fix it onto the new incision. In severe cases, autologous fat transplantation is required.

The patient of this case study underwent incision method of double eyelid surgery more than a year ago, and the post-operative results almost crushed her. The overly large-size eyelids were so unnatural that she could not go out without applying makeup. After communicating with our surgeon, she decided to adopt double eyelid fine-tuning and lowering surgery to redesign the incision, while moving the orbital fat so that the distance between double eyelids and eyebrows was no longer 1:1, thereby re-creating natural-looking double eyelids. After the surgery, the patient could finally meet people with her bare face.

3. Triple eyelids after surgery: The reason for such issue is the adhesion of levator palpebrae superioris onto the upper eyelid. The surgeon must shift the orbital fat to fill the adhesion location and use the suspension suture on it.

The patient of this case study had multiple eyelids after her double eyelid surgery, which troubled her when she applied her daily makeups. She must spend more time on her eye makeup every time, and it was in contrary of her original intention of doing the double eyelid surgery. After discussing with the patient, our surgeon conducted a double eyelid repositioning surgery for her. During the operation, our surgeon separated the adhered levator palpebrae superioriss and planned neat new double eyelid lines. The patient was very satisfied with the result of the operation.

4. The failed surgery created inner double-folded eyelids: There are two reasons for this issue – the first is that the double eyelid was designed for too low, and the second is that the eyebrows are not high enough and require brow lift surgery.

The patient of this case study underwent the stitching double eyelid surgery, but the postoperative effect of inner double-folded eyelids was not what she wanted. After discussing with the patient, our surgeon performed a mini incision double eyelid repositioning surgery for her, re-placing the incision at the 8mm position and fixed the double eyelid lines onto the new incision.

The patient in this case mainly wanted to improve his tired-looking issue, and as a civil servant, he did not want obvious double eyelids. After lots of communication with the patient, our surgeon advised the patient to do an endoscopic micro-trace forehead facelift surgery. The main purpose of surgery was to reposition the overly-low eyebrows onto the browbone, so the distance between and eyes and eyebrows would go back to the standard height rather than having the eyebrows pressing down on his eyes. The change after the surgery was in line with his expectation, and he was very satisfied with his new double-fold eyelids, which made him look energetic and looked very natural.

5. The asymmetry of two eyes after the surgery: There are three possibilities. One is that the double eyelid design is asymmetrical, which can be solved by re-incising the less-than-ideal side of double eyelid and making the same as that of the ideal side. The other possibility is that the surgery did not remove the pretarsal orbicularis muscle and pretarsal tissue, and the third possibility is that a ptosis problem was not discovered before the surgery, so that a levator palpebrae superioris shortening surgery is required.

This patient of this case study underwent two double eyelid surgeries and the results were asymmetric double eyelids, which became even more obvious after makeups, so that greatly bothered her. After communicating with the patient, our surgeon helped her to take out the orbital fat inside her overly-high right double eyelid to fill into the adhered location. The surgeon repaired the overly-high eyelid line, caused by lack of fat, from the previous surgery and used the suspension suture on it. After the surgery, the double eyelids of both eyes became symmetrical and it completely solved her problem.

The patient of this case study underwent stitching double eyelid surgery, thinking that it would improve the shape of her eyes. However, it was never the case, and the surgery did not improve the uneven eyes issue that she cared most about. After consulting with our surgeon, she realized that it was the ptosis issue caused by weak levator palpebrae superioriss, and the surgeon must re-incise her double eyelids to perform a levator palpebrae superioriss shortening surgery.

When communicating with our surgeon, the patient of this case study made it clear that she liked smaller double eyelid for her right eye so both sides would look the same. After the communication, our surgeon fine-tuned her orbicularis oculi muscle of her left eye and added a small amount of fat therein all while reposition the double eyelid line. After the surgery, the double eyelid lines of both eyes are similar and she was very happy about it.

The patient of this case study made it clear that she had consulted with many other physicians before coming to us, and she wanted to solve the uneven eyes and tired-looking issues of hers through the double eyelid surgery. However, those physicians told her that the uneven eyes issue could not be completed solve, so she was hesitant. After communicating with the patient, our surgeon did a pretarsal orbicularis muscle adjustment to solve her eyelid drooping issue, as well as performing an eyelid muscle repositioning surgery.

Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic

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