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.

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.

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.

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.

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.