Corrects unsatisfactory results from previous double eyelid surgery, including crease loss or distortion, to improve the outcome of the prior procedure and restore the desired eyelid shape.
The ideal first window for revision is within the first two weeks after surgery, allowing the original surgeon to make adjustments before the tissues fully adhere. During this period, minor corrections are relatively simple, and an experienced surgeon can estimate the post-swelling appearance even with mild edema.
The second optimal timing is after six months, once all swelling has completely subsided. Because each eye may deswell at a slightly different rate, revisions performed before full resolution may lead to asymmetry. If the first window has passed, it is better to wait until complete recovery before proceeding with revision to achieve more precise and symmetrical results.
Through an open incision, the surgeon can directly address the problematic areas, fully release adhesions, correct unfavorable tissue positioning, and rearrange the structures to recreate an ideal double eyelid crease.
Using a non-incisional approach, this method subtly adjusts the width or smoothness of the double eyelid crease.
In principle, revision requires releasing the original high or overly deep adhesions and redesigning the crease at a lower and more natural position. However, the crease may easily re-adhere at its previous location. Therefore, in addition to carefully separating the adhesions, the surgeon must understand the anatomical relationships of the eyelid during eye movement, rearrange the tissues appropriately, and perform measures to prevent re-adhesion.
If there is sufficient tissue volume, excess scar tissue can be removed, making the procedure more likely to succeed. However, when there is insufficient skin, a "non–skin excision" revision technique is required. In cases of limited tissue or preexisting incomplete eyelid closure, the remaining tissues must be preserved with great care. During adhesion release, the surgeon must proceed even more slowly and gently to maintain the integrity of the limited remaining tissue.
It is important to first identify the cause of the loosened or faded crease and avoid repeating the same issue during revision surgery. The crease can be widened by re-suturing, or a more stable result can be achieved by switching to the incisional method.
Common causes of multiple eyelid folds include a loosened crease, creating a crease that is too wide for a narrow tarsus, an unstable crease formed by placing sutures too high, sunken upper eyelids, levator muscle weakness, and adhesions.
Frequent causes of perceived asymmetry include one eye having a single eyelid while the other has a double eyelid, differences in crease width, or an inner corner that is outfold on one side but infold on the other.
After understanding the patient's aesthetic preferences, treatment must be tailored to the underlying cause to achieve proper correction.
Levator muscle weakness lowers the height of the eyelid margin at the base of the eyelashes, which may cover too much of the iris and commonly results in complaints of a dull or tired appearance. Conversely, an overly strong levator may create a harsh or startled look. When levator adjustment is required during revision surgery, an incisional approach is usually necessary to clearly visualize the cause of the levator dysfunction.
Aside from levator-related conditions, adhesions or an excessively high crease can also mimic levator weakness. Releasing these adhesions can restore levator function, and this likewise requires the incisional method to fully access and open the adhesions. If the levator was overtightened in a previous surgery, lowering the levator tendon can help soften the gaze. When the levator has been shortened excessively, other tissues may be used to lengthen it; however, because these tissues are not the original levator, the degree of lowering is generally less precise than levator advancement.
Common causes of sunken upper eyelids include insufficient orbital fat and levator muscle weakness. In the latter case, improving levator function can help reduce the hollow appearance. The most effective method for correcting sunken upper eyelids remains autologous fat grafting.
One week before surgery:
• Discontinue the use of double-eyelid tape for at least one week.
• Stop taking anticoagulants (such as aspirin); please confirm with the prescribing physician whether discontinuation is appropriate.
• Stop all nutritional supplements (e.g., fish oil, ginkgo, ginseng, vitamin E).
• Avoid smoking and alcohol from one week before surgery until one month after surgery.
On the day of surgery:
• Arrive with no makeup and remove any eyelash extensions.
• Do not wear accessories or metal items; please remove any piercings in advance.
• If you are nearsighted, you may wear contact lenses to the clinic, but they must be removed before surgery. Please bring a lens case, glasses, or sunglasses for use afterward.
• Local anesthesia does not require fasting; you may eat as usual.
• Please do not drive or ride a motorcycle yourself after the procedure.
• Cold and warm compresses: Apply cold compresses during the first 72 hours to help reduce swelling and bruising. After 72 hours, you may begin warm compresses to promote circulation and healing. For revision surgeries, cold/warm compress timing will be adjusted based on individual needs to avoid re-adhesion.
• Wound care & dressing changes: Keep the incision area dry and change dressings as instructed. If skin sutures are present, they are typically removed around day 6–10 depending on wound healing.
• How to change dressings: Clean the wound twice daily using sterile cotton swabs dipped in normal saline, pat dry, then apply ointment. When applying cold or warm compresses, place a piece of gauze between the compress and the skin to reduce the risk of infection.
• Medication & eyelid hygiene: Use prescribed eye drops or ointment as directed to prevent infection and promote proper healing.
• Eye use & daily habits: Avoid prolonged screen time or long periods of looking downward. Allow your eyes ample rest to support recovery.
• Diet & medications:
- Pain medication prescribed by your surgeon may be taken as needed.
- Avoid irritants such as smoking, alcohol, tea, coffee, spicy foods, and all dietary supplements (e.g., Vitamin E, ginseng, lingzhi, and herbal medicine).
- Maintain a light diet, stay well hydrated, and increase intake of high-protein foods and Vitamin C to support wound healing.
Patients who have experienced an unsatisfactory or failed surgery in the past often carry emotional trauma and a deep fear of being hurt again. By the time they visit us, they have usually done extensive research and consulted multiple doctors. The process before and after a revision double-eyelid surgery can be mentally taxing, so the surgeon must provide extra patience, empathy, and clear explanations of each step of the procedure.
The first surgery always offers the highest chance of achieving a perfect result. After the second surgery and beyond, the eyelid tissue becomes more limited, making it difficult to reach the same ideal outcome—even with a flawless procedure.
Therefore, choosing the right surgeon for the very first operation is crucial, as it can spare patients from the long and difficult journey of revision surgery.
TEL 02-2700-8069
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2F, No. 263, Sec. 1, Dunhua S. Road,Da'an District, Taipei City 106, Taiwan
Our clinic operates by appointment only.