Revision Eye Surgery

It is not easy to reconsider a surgery you have already had. First, we will go over the basic information.

The criteria for choosing eye surgery are summarized in Causes of Drooping Eyes and Criteria for Choosing Surgery.

There are truly many reasons for considering revision eye surgery, such as for double eyelids, ptosis correction, or medial canthoplasty. People considering revision surgery are bound to be more anxious and more careful than they were for the first surgery. For that reason, we first closely examine why the earlier surgery was not satisfactory and what your eyes are like now, and then decide on a method.

It is considered at least 6 months after the first surgery. Before that, swelling and scars are still changing, so the final appearance cannot be known.

If you look every day in the mirror at eyes you are not happy with, it is only natural to want to fix them as soon as possible.

Even so, please wait a little longer. Eyes right after surgery are swollen and firm. Even if the line looks high and thick or the two sides look different, it changes over several months. Operating again during this period makes the result hard to predict.

Common cases are when the double eyelid has come undone, when the two sides have become different, when the line is too high, and when the eyelid has drooped again.

Read the list below and see whether any of it resembles your own eyes.

• A double eyelid you had done before has come undone or faded
• Your eyes have become uneven
• The line was set too high and looks heavy
• The areas above and below the line are sunken, or the scar stands out
• After medial canthoplasty, the inner corner of the eye looks too exposed
• After ptosis correction, the eye opens too little or too much
• After upper blepharoplasty, drooping remained or has returned
• After lower eyelid surgery, too much of the lower white of the eye shows or the eyelid has drooped
• The eyes do not close fully after surgery

We check when and what kind of surgery was done, what condition the tissue is in now, and what you most want to fix first.

If you know in advance what we look at in the consultation, it is much easier to organize what you want to say.

1. Timing and method of the first surgery — when and by what method it was done
2. Current tissue condition — the amount of remaining skin, the degree of scarring and adhesion (tissues stuck together), and eye-opening strength
3. Priorities for what you want to fix — there are cases where not everything can be solved at once
4. Distinguishing what can be reversed from what is hard to reverse

If you have records of the earlier surgery or before-and-after photos, please bring them.

A Word from the Doctor

"First, it is important to pinpoint exactly what the patient is most unhappy with, and to determine whether it can be corrected through revision surgery or cannot be corrected. Not every complaint can be fixed."

This is because after the first surgery, scars form and tissues stick together, so the original layers are blurred and the remaining tissue is reduced.

Because this is a surgery that opens the same site for a second time, the conditions are different from the first surgery.

A Word from the Doctor

"Revision double eyelid surgery, especially after multiple earlier surgeries, is not a simple adjustment of the line. Removing scar tissue, confirming the muscle position, and correcting symmetry are the key."

Re-fixing a line that has come undone or revising a scar is possible in many cases, but skin and fat that have already been cut away are hard to restore.

This is the first thing you should know before deciding on revision surgery, so we have listed what can and cannot be done separately.

Methods to restore volume in sunken areas (fat grafting, etc.):

For this reason, cutting away the right amount in the first surgery is important. If too little is cut, it has to be done again; if too much is cut, it is hard to do again.

The method depends on the cause. Even for the same 'uneven eyes,' we first separate whether it is a difference in line height or a difference in eye-opening strength.

You may also start with the subheading that most resembles your concern.

When the double eyelid has come undone

A line that has come undone is recreated by tying it again with thread, or by making an incision, organizing the tissue, and fixing it.

A line made with the buried suture method can fade or come undone as the thread loosens over time. When there is a lot of sagging skin or fat, the method may be switched to the incisional method for fixation. The differences between the methods are explained in Double Eyelid Surgery information.

When the line is too high or too thick

Lowering a high line is possible in some cases, but it is harder than raising the line.

To lower a high line, the scar of the existing line is released and wide dissection (separating the tissue layers) is done so that the scar does not reattach in the same place, and then the line is fixed anew at a lower position. If little skin remains, the room for lowering it is reduced^[4].

When the two sides are different

A left-right difference can be a difference in line height or a difference in eye-opening strength, so we first separate the cause.

If the lines are the same but one eye opens less, blepharoptosis (a state in which the eye-opening muscle is weak) may be mixed in. In that case, fixing only the line will not make the two sides match. Surgery to correct eye-opening strength is explained in Ptosis Correction (Blepharoptosis Correction) information.

When the eye opens too little or too much after ptosis correction

If it opens too little, the muscle is pulled further; if it opens too much, the amount of pulling is released and the height is re-set.

Ptosis correction is explained in Ptosis Correction (Blepharoptosis Correction) information.

When drooping remains after upper blepharoplasty

In some cases, revision surgery is done to trim the remaining skin further. However, we first check the amount of skin that remains.

Upper blepharoplasty is explained in Upper Blepharoplasty information.

When you are not satisfied with the result after canthoplasty

For an inner corner of the eye that is too exposed after medial canthoplasty, a method of repositioning the remaining skin to cover it (medial canthoplasty restoration) is considered. A scar may be added^[9][10].

When a lateral canthoplasty has closed up again, or when the lower eyelid has drooped after lower canthoplasty, the decision is also made by looking at the cause^[11]. Canthoplasty is explained in Canthoplasty information.

When too much of the white of the eye shows or the eyelid has drooped after lower eyelid surgery

When the lower eyelid has drooped or turned outward, a method of lifting and supporting the eyelid from the outer corner of the eye is considered.

Lower eyelid surgery is explained in Lower Blepharoplasty information and Lower Eyelid Fat Repositioning information.

Recovery follows a similar sequence to the first surgery, and swelling goes down over several months.

If you have work or an important appointment coming up, this is probably what you most want to know. We have written it by time point.

When you can wash your face, return to work, wear eye makeup, and wear contact lenses, and post-surgery precautions:

The speed of recovery differs from person to person. If you have an important event coming up, please tell us in advance at the consultation.

In addition to the side effects of the first surgery, scars may become thicker or the result may fall short of expectations so that surgery is needed again, and rarely there is bleeding that threatens vision.

This is information you need to know before deciding on surgery, so we have written it out in full without shortening it.

• Asymmetry remains or newly appears
• The line comes undone again, or cannot be lowered to the desired height
• Overcorrection or undercorrection (the eye opens too much or too little)
• The scar becomes thicker or sunken
• The eye does not close fully, or feels dry
• The lower eyelid droops or turns outward (lower eyelid revision surgery)
• Hematoma (a collection of pooled blood), infection
• Rarely, reduced vision caused by bleeding behind the eye

Yes. Typical examples are when 6 months have not passed since the first surgery and when the cause of the problem lies somewhere other than the eyelid. Criteria based on your health condition are checked at the consultation.

Sometimes, having surgery again is not the only answer.

• If 6 months have not passed since the first surgery, we wait and then decide, unless the problem is urgent.
• If the cause lies elsewhere, as when the eyebrow has dropped and presses on the eyelid, fixing only the eyelid again will not solve it.
• If very little skin or tissue remains, the risk may be greater than what revision surgery can achieve. In that case, we will tell you so.
• If you take blood-thinning medication, consult the doctor who prescribed it. Do not stop it on your own.
• If you smoke, a period of quitting before surgery is needed.

Please tell us about all medications you take and any conditions you have at the consultation. Even things that seem minor are fine to mention.