To avoid regret with full-incision sagging-skin double-eyelid surgery: the most common complaints are asymmetry and scarring

Common sources of regret with full-incision sagging-skin double-eyelid surgery are asymmetry between the two eyes, visible scarring, and double eyelids becoming shallower or disappearing. In research involving over 4,000 people, partial disappearance of the double eyelid occurred in 2.1%, and asymmetry in 5.6%. Excessively wide double eyelids and hollowing of the eyelid are also risks that should be addressed through pre-operative design discussion.

What are the most common reasons for regret?

The most common is asymmetry between the two eyes. In a study of 138 complaints regarding eyelid surgery, asymmetry was the most frequent reason, with asymmetry in the height of the double eyelid being particularly noticeable.[1].

Among 60 complaints about first-time double-eyelid surgery, asymmetry accounted for 25 cases (41.7%), and visible scarring for 13 cases (21.7%).[1]Because preferences for the shape of double eyelids vary among individuals, the form envisioned by the surgeon and patient may sometimes diverge.[1]The study concludes that thorough discussion before surgery and having the final result reproduced and shown to you beforehand are important.[1].

In which patients do double eyelids become shallower or disappear?

This is thought to occur more frequently in people with thick skin, younger individuals, and those with weak eyelid elevation. Factors contributing to disappearance include skin thickness, rapid weight gain over a short period, youth, mild ptosis (drooping eyelid), and weak strength in the muscles that elevate the eyelid.[1].

In research examining 4,129 people, partial disappearance of the double eyelid occurred in 2.1%.[2]In recent research over the past 5 years, the rate of double-eyelid disappearance with full incision is reported at 2.1–6.7%.[2].

How noticeable are scars?

Scarring accounted for approximately one-fifth of complaints about first-time double-eyelid surgery.[1]The traditional full-incision technique, in which skin is sutured directly to eyelid cartilage, has been noted to result in a deep double eyelid with limited mobility and visible scarring.[3][2].

In the aforementioned study of 4,129 people, depressed scarring occurred in 0.1%.[2]Because the naturalness of the result varies depending on the technique, asking which layer is secured and how can make comparisons easier.

Why do some people end up with excessively wide eyelids or hollowed eyelids?

Excessive removal of tissue is the primary cause. Removing too much of the eyelid muscle (orbicularis oculi) or fat, or suturing to the muscle that elevates the eyelid, can result in the double eyelid becoming too high.[1]Over-removal or excessive stripping can create multiple double-eyelid lines.[4].

Excessive fat removal can cause hollowing of the upper eyelid, which becomes more noticeable with age.[1]It is recommended to decide carefully how much fat to remove.[1].

In revision surgery for 64 people whose eyelids were pulled too tight, causing the eyes to open too widely, 78% achieved a satisfactory result, but 12% developed eyelid drooping and 10% required further revision.[5]For this reason, the authors recommend revision surgery be performed as early as possible.[5].

Does pre-existing eyelid drooping matter?

Yes, it does. Mild ptosis is one factor that makes double eyelids more likely to disappear.[1].

A case has been reported of a 57-year-old woman in whom one eyelid temporarily drooped after surgery.[6]That report notes that it is important to conduct a thorough examination before surgery to check whether ptosis is present.[6].

What to confirm before having the procedure

There are three key points to consider. First, clarify the image of the double-eyelid width and shape by having it reproduced and shown to you.[1]Second, discuss how much fat and muscle will be removed.[1]Third, check whether you have factors that make double eyelids more likely to disappear, such as skin thickness or eyelid drooping.[1][6].

The appropriate width for your eyelids and how much sagging to remove cannot be determined from an article alone. Have a doctor examine your eyelid elevation and skin thickness during a consultation and confirm these factors.