"The key requirement in complex Asian revision surgery is
augmenting or repositioning the upper orbital fat. Unfortunately,
only a handful of doctors know anything more about managing fat
than how to take it out."
Although Asian cosmetic eye surgery, or double eyelid surgery, is the most common cosmetic operation performed worldwide, the incidence of aesthetic and functional complications is surprisingly high. Not counting insufficient patient education leading to unrealistic expectations, the most frequent reasons for dissatisfaction in an approximate order of frequency are
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Less severe problems: (more common)
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• more than mild asymmetry of the creases
• overly low creases
• incomplete or shortened creases
• loss of creases over time, especially after non-incisional suture methods
• overly noticeable scarring
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More severe problems: (less common)
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• overly high, deep, or arched creases
• formation of highly irregular or multiple creases
• ptosis (inability to open fully)
• upper eyelid hollowness
• skin shortage or internal tissue damage preventng adequate lid closure
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Double eyelid surgery is sometimes described as "simple" and yet in the hands of the occasional eyelid surgeon who may lack a thorough understanding of Asian eyelid anatomy and the experience to properly plan and meticulously execute the most appropriate procedure, the rate of aesthetically disappointing asymmetry is reported to vary between 13 and 35 percent.
The most common causes of such problems following double eyelid surgery include:
• insufficient preoperative evaluation
• poor choice of surgical procedure
• unpredictable tissue healing
• poor execution of the surgical procedure, including:
- incorrect placement of skin incisions
- incorrect amount of skin removal
- excessive fat resection
- failure to treat the orbicularis muscle and orbital septum optimally
Because double eyelid surgery is performed commonly, many patients seem surprised that revision of surgical results is so difficult. Once tissue has been removed or damaged, efforts to restore the eyelid are both challenging and not fully predictable. For this reason, undergoing revisional surgery simply to refine an acceptable result into "perfect" is not recommended.
I don't think I could ever express my gratitude to you for drastically altering my life in such a positive way. I never dared to think it was remotely possible to have the result I have now, as it has exceeded all my expectations. Most of all, thank you, Dr. Meronk, for being a consummate professional, a compassionate doctor, and a brilliant surgeon. I will never forget what you've done for me.
With deep gratitude,
Won Kyong Kim
New York, New York
(following revision of unsatisfactory eyelid surgery performed elsewhere)
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The subject of revisional Asian eyelid surgery is quite technical and demands a professional understanding of operative technique and eyelid anatomy. While a full description of surgical options is too complex for this discussion, a good deal of understanding can be gleaned from studying the example case studies presented below.
Each revisional surgery must be custom-tailored to the problem at hand. Although a variety of techniques have been described for treating the less severe group of problems noted above, most previously published approaches provide suboptimal results in more advanced cases due to shortcomings in reestablishing more normal orbital and periorbital fat relationships (video).
The key requirement in complex Asian revision surgery (as shown in the cases below) is augmenting or repositioning the upper orbital fat. Unfortunately, only a handful of doctors know anything more about managing fat than how to take it out.
Several revisions by Dr. Meronk photographed below demonstrate examples of more innovative approaches used in complicated and/or previously untreatable cases. Such techniques are of limited availability since most doctors have little familiarlity with orbital hollowness surgery designed to restore fat volume, anatomic compartments, and tissue relationships.
Caution: Actual surgery photos
Unless the eyelids have been severely compromised by the initial surgery, revisional surgery will generally yield at least partially improved function and a more aesthetically-pleasing shape to the lid and crease. Perfection or near-perfection, however, is never a realistic goal in either primary or secondary surgery and is seldom attained.
Revisional double eyelid surgery may require six to twelve months to reach a final result. It is not rare to need more than one operation.
Some conditions (especially those that persist after multiple previous operations) are not treatable using even the most advanced techniques.
Costs for revision of unsatisfactory results following Asian double eyelid surgery (incisional or suture technique) generally range from between $ 4,500 to $ 9,500 depending upon the nature and magnitude of the problem.
Unusually complex problems or treatment after previous failed revision surgery performed elsewhere may cost more.
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