Causes and Solutions for Unraveling Double Eyelids

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This is Gangnam Seoyeon Plastic Surgery, always striving for the highest patient satisfaction :)

Today, we would like to inform you about the causes and treatments for double eyelid unraveling.

*This post is primarily based on the presentation given by Director Choi Dong-il at the April 2022 Korean Society of Aesthetic Plastic Surgery (APS) conference.

The photos below have not been edited in any way, except for brightness adjustments :)

Symptoms and Causes of Double Eyelid Unraveling

Double eyelid unraveling manifests in various forms:

1) The fold is completely unraveled

2) Multiple overlapping folds appear

3) The line looks jagged or irregular.

The primary cause of unraveling is that the skin layer at the front and the conjunctival layer at the back have not properly adhered to each other.

When you open your eyes, the tarsal plate tissue should pull up and cause the tissue to invaginate (fold in).

The back layer and the front part must be well-adhered so they are pulled up together; if adhesion does not occur, only the back part rises.

In this case, the front part does not fold, making the double eyelid appear unraveled.

Looking at this patient, there is only an incision line at the front, but because the double eyelid does not fold, it looks unraveled.

The front part must fold inward for the double eyelid to stay intact.

Cases where the line doesn’t fold well due to insufficient soft tissue removal

Another cause of unraveling is when the double eyelid line does not fold properly because soft tissue was not sufficiently removed.

In this patient, a thick feeling remains because the soft tissue was not adequately cleared, preventing the fold from tucking in properly.

Therefore, soft tissue must be sufficiently removed so that the double eyelid can fold inward more effectively.

Excessive Scar Tissue

In cases like this patient with excessive scar tissue, the double eyelid is forced to form over the scar, which often prevents it from folding cleanly.

This results in a jagged line like the one seen here. A beautiful, curved double eyelid can only be achieved by finding healthy tissue to create the line.

Incorrect Double Eyelid Line Design

Next is the case where the design of the double eyelid line itself is incorrect.

The double eyelid line should follow a smooth curve, but sometimes a distorted line appears at the front.

If the curve fails to form at the front and instead breaks downward, the double eyelid can appear unraveled.

Improper Adhesion of the Double Eyelid Line

There are also cases where the double eyelid line adheres incorrectly, as seen in this patient.

There is a double eyelid at the bottom, but multiple folds exist above it. This patient underwent a ‘scar-preserving line lowering’ technique (often called ‘du-jul-tta-gi’) to lower the double eyelid, but adhesion occurred at the previous high line.

Because the fold forms at the top instead of the new lower incision line, multiple creases appear. To fix this, the old adhesions must be thoroughly dissected, and various techniques are used to prevent re-adhesion.

This ensures the double eyelid folds correctly. This photo shows the result after one month.

Failure of the Levator Muscle to Properly Transmit Force

In this case, multiple folds formed because the levator muscle (the muscle that opens the eye) did not properly transmit force to the double eyelid area.

The lower part is the incision line, and a beautiful line should be created when the muscle’s strength is transmitted there. However, because the force didn’t reach that point, this issue occurred.

This can happen if a previous ptosis correction has loosened or due to various other surgical factors.

Insufficient Skin

This patient had a double eyelid that wouldn’t fold properly due to a significant lack of skin.

In this case, we used the ‘du-jul-tta-gi’ method to lower the line and performed fat grafting to help pull the upper skin down further.

Even with these measures, the front part appears slightly less folded because of the severe skin deficiency.

As the patient ages and the skin naturally sags over time, the line is expected to fold more deeply.

Regarding today’s post, you can find more detailed information in the video below.

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Gangnam Seoyeon Plastic Surgery Clinic complies with medical laws. The photos in this post were taken under identical conditions with the patient’s prior consent. Furthermore, side effects such as bleeding, infection, and inflammation may occur after plastic surgery or procedures depending on the individual, so caution is advised.

Feel free to visit us for a 1:1 consultation with our plastic surgery specialist :)

If you have any questions or would like a consultation, please leave a comment, contact us via KakaoTalk Plus Friend @GangnamSeoyeonPlasticSurgery, or call us at 02-535-8889 :)

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Frequently Asked Questions

What is the most basic reason for double eyelids to loosen?

This is because the front skin layer and the back conjunctival layer did not adhere properly. When you open your eyes, the front part should fold in together, but if adhesion does not occur, only the back part goes up, making the double eyelid appear to loosen.

Do double eyelids tend to loosen easily if the eyelids are thick?

Yes, if the soft tissue is not sufficiently removed, the double eyelid line may not fold well and can loosen. In this case, it is necessary to sufficiently remove the soft tissue so that the double eyelid can fold in properly.

What causes multiple folds to form after double eyelid surgery?

This primarily occurs when incorrect adhesion forms on the existing double eyelid line, or when the power of the muscle that opens the eye (levator palpebrae superioris) is not properly transmitted to the double eyelid line. It is necessary to dissect the adhesion or perform ptosis correction to accurately transmit muscle power.

Is double eyelid revision surgery possible even for eyes with many scars?

Yes, it is possible. If the line has become uneven due to excessive scar tissue, a beautiful curved double eyelid can be created by finding healthy tissue and creating a new double eyelid line, avoiding the scar tissue.

Can the double eyelid line be lowered even if there is insufficient eyelid skin?

Yes, it can be resolved by combining the double-incision method with fat grafting. The surgery is performed by creating a new line below the existing line and lowering the upper skin through fat grafting to reduce the line.