The Types of Double Eyelids That Unfastens Well and How to Prevent It

 

Hello, I'm Dr. Lee SangKyun of TS Plastic Surgery.

 

One of the most common causes of revision eye surgery is the unfastening of the eyelids.

Many think that non-incision (buried, natural adhesion) unfastens well, and incision doesn't unfasten. Still, if you consider the structure of the eye and perform necessary additional surgery, non-incision may not untie well. Conversely, even if it is an incision, it may unfasten if not correctly operated.

In addition, there are cases where the eyelids are unfastened and reoperated and repeatedly unfastens again, so let's look at why the eyelids are being unfastened and their characteristics.

 

Double Eyelid Surgery?

 

Incisional Double Eyelid Surgery

By creating adhesions in the orbicularis oculi muscle (1), Tarsal Plate (2), and muscle levator palpebrae superioris (3), the skin naturally folds in. It creates a line when the eyes are opened, and this is the double eyelid.

Non-incisional eyelid surgery is a method of tying the skin and orbicularis oculi muscles with threads and creating adhesions to create natural eyelids. In contrast, incisional eyelid surgery is a method of removing some unnecessary fat and muscle, depending on the individual, after making an incision in the skin and then fixing the extension of the eye-opening muscle and the outermost part of the orbicularis oculi muscle to create a double eyelid line.

 

The Reason for Unfastening

1. Failure of Adhesions

Since eyelid surgery involves creating a bond between the tarsal plate, orbicularis oculi muscle, and skin, if this bond fails, the eyelid will not be made, or the created eyelid will unravel and fall off.

Usually, a break or unraveling of the threads before adhesion will cause the eyelids to come undone. Still, in non-incisional surgery, the threads can be secured with double knots to ensure proper strength and reduce the unraveling risk. Double knots can also help prevent the threads from breaking before adhesion.

 

Another thing that can interfere with the adhesion is the habit of rubbing your eyes, which makes the eyelids form the eyelids in the first place. The stitches used in eyelid surgery are thinner than our hair, so they don't have as much force to withstand. Still, if you habitually rub or touch your eyes before the stitches are in place, you're more likely to unravel the stitches and cause your eyelids to loosen.

You'll be given post-operative instructions for your eyelid surgery. While your surgeon needs to do a fine job, it's also essential for you to follow them, as they can affect the outcome of your surgery.

 

1. Thick Skin, Lots of Soft Tissue

If the upper eyelid skin is thick, the distance between the eyelid skin and the eyelid flap that needs to be fixed is more significant, increasing the chance of loosening if not set correctly. In general, when the skin is thick, the oculi muscle or fat is also excessive, and it is important to remove the excess structure with an incisional method to make it less likely to loosen.

Removing excess structure through incisional double eyelids after the first non-incisional double eyelid surgery

 

2. Weak Oculi Muscle Force

If your oculi muscles are weak, you may not have enough strength to lift your eyelids upward, causing your eye lines to look unclear and loose. In this case, you'll need an additional eye correction that adjusts the strength of your oculi muscles.

Combined Double Eyelid Revision and Ptosis Correction to Correct Oculi Muscle Force

3. Protruding Eyes

In the case of protruding eyes, there is a high risk of the eyelids coming undone or becoming sausage eyelids due to the tension of the skin covering the protruding eyeball. When performing the surgery, the lines should be placed at a slightly lower-than-average thickness in-out shape to alleviate the protrusion of the eye, and the fixation points should be placed at a moderate line but with multiple points to prevent the eyelids from coming undone.

In some cases, protruding eyes are accompanied by upper eyelid hollowness, which may require fat repositioning or fat grafting to improve the hollowness if there is too little fat.

 

Incisional double eyelid, ptosis correction, and upper eyelid fat repositioning to reduce multiple creases, hollowness, and protrusion.

Eyelid loosening

is not something an incisional approach can prevent and cannot be controlled by stronger fixation. The features of each individual's eyes are too varied to be monolithic, and even the same eyelid surgery cannot be applied to everyone.

An accurate understanding of anatomy is required to diagnose each individual's unique eye structure and customize the surgery accordingly so that the eyelids can be well maintained rather than loosened. We recommend finding a surgeon to determine your eye structure and customize your surgery.