How Should Double Eyelid Surgery Be Performed for Sunken Eyes?

 

How Should Double Eyelid Surgery Be Performed for Sunken Eyes?

 

Hello, I am Dr. Lee Sang Kyun of TS Plastic Surgery.

 

There are many factors in determining a patient's eye condition before eyelid surgery. While it is important to understand the patient's desire for the eyelid line or the area they want to improve, it is essential to understand the characteristics of the patient's eyes.

So we look at various factors during the consultation, including orbicularis oculi muscle force, skin thickness, overlying tissues such as muscle and fat, brow bone and cheekbone structure, and asymmetry, and then after diagnosing these factors, we develop a surgical plan.

One of the features that we will talk about today is sunken eyes, which are often categorized as complex cases to treat, so let's look at why that is and how to treat them.

Protruding vs. Sunken Eyes

Protruding eyes are those that project forward from the cheekbones and the most forward point of the eyeball, and sunken eyes are those that recede inward. Protruding eyes have the disadvantage that the eyelids are easy to loosen due to the tension of the skin covering the protruding eyeball. The lines can deepen if the eyelids are held tightly to prevent loosening, but with the right solution, it is possible to reduce the protrusion of the eyes and create a cool and beautiful eye look. I've written a previous post on protruding eye surgery, which you can check out for more information.

 

https://blog.naver.com/tsprs/222262856277

 

Characteristics of Sunken Eyes

Because the eyeball is recessed, as opposed to protruding, several characteristics of a sunken eye make it different from a protruding look.

1. Bulging Above the Eyes

There is often a narrow space between the brow bone (eyebrow) and the eye, and skin, muscle, and fat are packed into the narrow space, so many people look puffy above the eye. Most patients think that fat is the cause of puffy eyes and believe that they only need to remove the fat, but it is often caused by protruding orbital bone and other soft tissues. In this case, it is difficult to improve the puffy appearance even if the fat is removed.

 

2. Hidden Eyes

Due to the large amount of soft tissues between the brow and the eye, the bulging volume can cause the pupil to be shaded. When the upper part of the pupil is shaded and darkened, it can make the eyes appear smaller. The pupil may appear to have less exposure than it does, which is not the same as having less exposure due to a lack of strength to open the eyes, and in severe cases, the eyelid may be pressing on the eyelashes.

 

3. Small eyes - Stuffy Look

The vertical height of your eyes may be short, resulting in less pupil exposure. Still, if your eyeballs are set inward, the horizontal length of your eyes may also be relatively short. The proper horizontal length of the eye is about 1/5 of the width of the face, but because the eyeball is recessed inward, a lot of skin is covered, making the eyes look small and cramped.

 

 

Sunken Eyelid Surgery

1.     Natural In-Outline Rather than Inline or Outline

In the case of sunken eyes, even if the line is placed high, the result will often not be the same as the height of the line. Tissues such as skin and eyebrows can often cause the line to be 30-40% less than planned, so it's best to set the line somewhat higher.

However, if you set the line too high, there is a risk of creating sausage eyes, which often have a short distance between the brow and the eye, which could be better for an outline.

Conversely, if you hold the inline too low, it can turn into an inline, so I usually recommend a natural in-outline.

 

2.     Incisional Method is Favorable than Non-Incisional Method

The characteristics of sunken eyes are such that if you try to make a double eyelid line at the time of consultation, it will be made poorly or released slowly. Because the tissue above the eye is thick, it is more likely to be loosened if operated with a non-incisional method. Therefore, working with an incisional rather than a non-incisional method to remove unnecessary fat and skin during surgery is much more helpful.

However, suppose too much skin or soft tissue is removed. In that case, the eye may not close, or the eyelid line may be elevated and become unnatural, so the surgeon's know-how to pull it moderately without overdoing it is necessary.

 

3.     Processing both canthoplasty and ptosis correction if needed

If the vertical height of the eye is short because the pupil is obscured, it can be corrected with a ptosis correction, and if the horizontal length of the eye is short, it can be fixed with a canthoplasty. To perform canthoplasty together, you need to ensure there is enough space for canthoplasty and that you receive an accurate diagnosis before surgery to prevent side effects such as overcorrection.

 

Although sunken eyes are more difficult to create than protruding eyes, it is still possible to achieve the desired look if the characteristics of the eye are well understood and the surgery is performed correctly.

Also, the protrusion of the eye is not the same in both eyes, and there may be differences between the eyes of the same person. Even these tiny differences can change the outcome of the surgery, so it's important to have your surgery performed by an experienced surgeon who can accurately diagnose your eyes before surgery and systematically plan it.