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Difference between the effect of double plastic surgery and downtime, postoperative course and bu...

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Difference between the effect of double plastic surgery and downtime, postoperative course and burial method

Incision, which is a double eyelid plasty, is an operation that uses a scalpel to make an incision in the skin of the eyelid and adjusts the amount of fat and muscle under the skin to reproduce the double line . The double line created by the incision method can be expected to last semi-permanently, and it is said that it is easy to reproduce the ideal double design such as wide double or parallel double .

There are two main types of incision, each with different types of doubles suitable for formation and the length of downtime. Therefore, when considering open surgery, it is important to understand the characteristics of each surgical procedure and the content of the surgery in advance, and to understand the mechanism for reproducing double lines and the surgical procedure that is suitable for you. is.

In addition, if the ideal double is not achieved by the incision method alone, surgery may be performed in combination with other eye shaping, so be aware of the characteristics of these surgeries and the effects that can be expected by using them together. Keeping it will lead to better surgery choices.

An incision method in which the skin of the eyelids is incised to form a double

An incision is a surgical procedure in which the skin of the upper eyelid is incised with a scalpel to form a double layer. By removing excess skin sagging and inner fat from the eyelids and adjusting the eyelid muscles needed to form the double eyelids, the thickness, double width and shape of the eyelids are balanced. ..

Although there is downtime such as swelling due to the incision in the skin, it is said to be suitable for all shapes of eyelids as a method of forming a double layer.

IMPORTANCE Incision and buried suture are 2 primary techniques for creating double eyelids. The incision method is suitable for all kinds of eyelids, but operational trauma and prolonged recovery time limit its application.

Source : Creating natural double eyelids with continuous buried suture and mini-incision technique using subcutaneous absorbable suture for patients with puffy eyelids

The double incision method is roughly divided into two methods, full incision and partial incision, and the method is selected according to the ideal double finish and the structure of the eyelid that is different for each person. Before explaining the procedure of total and partial incision, I will explain each part and role around the eyelid related to the incision method, and the difference between single eyelid and double eyelid.

Area around the eyelid related to the incision method

Areas around the eyelids related to the incision method

Orbicularis oculi muscle It covers the area around the eyes and regulates the amount of muscle tears that move the eyelids.
Levator palpebra (Gankenkyokin) Muscles that lift the eyelids by contracting
Tarsus (Kenban) A fibrous connective tissue consisting of a mass of collagen that has hardness and elasticity. The contraction of the levator palpebra muscle lifts the tarsal plate and opens the eyelids.
Levator aponeurosis Tissue that connects the levator palpebra and tarsal plate
Orbital fat (cancer) It has the role of cushioning the impact from the outside of the fat around the eyeball.
ROOF (roof) Eyelid thickness can be reduced by removing the adipose tissue inside the orbicularis oculi muscle

In the incision method, the skin is incised along the ideal double line, and the structure in which the double line appears is artificially reproduced by one of the following methods.

  • Suture the skin of the eyelids with the subcutaneous tissue such as the tarsal plate and levator aponeurosis
  • Suture the orbicularis oculi muscle and tarsal plate, or the orbicularis oculi muscle and levator aponeurosis, or the orbicularis oculi muscle and tarsal plate and levator aponeurosis

The difference between single, deep double, and double is the connection between the levator palpebra and the skin.

There are single, double, and back double eyelid shapes, and these have different eyelid structures. In the double eyelid, the branched levator palpebra muscle is connected to the upper eyelid, and when the eyes are opened, the entire skin is pulled up, so the skin is folded at the connection point with the levator palpebra muscle, and a double line appears. To do.

On the other hand, the single eyelid does not fold the eyelid even when the eyes are opened because the levator palpebra muscle is not connected to the skin, the connection is weak, or the skin does not lift due to the large amount of fat in the eyelid. Double lines do not appear in .

In the back double eyelid, the levator palpebra muscle is connected to the upper eyelid like the double eyelid, but the double width is narrow due to the influence of excess skin and subcutaneous fat, and the eyelid is thick and double. There is a difference in appearance such as the line being partially hidden.

Features of each incision method and mechanism to create a double thread ・ Suture material

There are two main types of incision, full incision and partial incision, each with a different length of incision line (width of incision in the skin) . There is no definition such as "○ mm or more" for the length of the incision line for each surgical procedure, small incisions with an incision width of about 1.0 cm, medium incisions with an incision width of about 1.5 cm to 2.0 cm, and total incisions beyond that. There are also medical institutions that classify as such.

Since there are differences in the double types of total and partial incisions that are suitable for formation, which technique is suitable depends on the ideal finish that is different for each person and the structure of his or her own eyelids, depending on the doctor. It is necessary to receive diagnosis and advice before making a decision.

"Full incision", a technique that makes an incision from one end of the eyelid to the other

A total incision is made by making a long incision in the skin from the inner corner of the eyelid to the outer corner of the eye, removing excess fat, and then sewing the orbicularis oculi muscle on the eyelash side to the anterior tarsal plate or levator aponeurosis. This is a method to reproduce the structure in which double lines appear . Since the incision line becomes a double line as it is, scars are less noticeable, and although the upper eyelid may hang down with aging, it is said that the double line can be maintained semi-permanently.

In addition, since the incision site is wide, the amount of subcutaneous fat in the eyelids that can be removed is large, and it is possible to remove the orbital fat that covers the eyeball and the fat layer called ROOF. It is suitable for single cases where the eyelids look heavy due to the large amount of excess fat, and for forming wide parallel doubles.

"Partial incision", a technique for incising a part of the eyelid

Partial incision is a procedure in which only the center of the eyelid is incised by about 6 mm to 10 mm, or only both ends are incised by about 3 mm to 4 mm . After removing the orbicularis oculi muscle to expose the tarsal plate, suture and fix it to the skin on the eyelash side to reproduce the structure in which double lines appear . Since ROOF cannot be removed, the amount of fat that can be removed is smaller than that of a total incision, but the advantage is that the downtime is short due to the narrow incision range. This technique is selected when the skin of the eyelids is originally thin or when you want a narrow double eyelid.

However, it is rare that if the incision line is too short, the sutured tissue will not adhere sufficiently and the double line will disappear after surgery. In addition, when the eyes are closed or the eyes are turned down, the treatment site may be dented, which may make the appearance unnatural.

Compare the characteristics of full and partial incisions

Technique Total incision Partial incision
Feature An incision in the eyelid from the inner corner to the outer corner of the eye tends to be selected when the eyelid is thick or when a parallel double is formed. A surgical procedure in which only a part of the eyelid is incised.
merit A large amount of fat can be removed and a clear double line can be formed. Small degree of postoperative swelling
Demerit Postoperative swelling is greater than partial incision If the incision line is too short, the double line may disappear or it may look strange. Not suitable for thick eyelids.

The material of the suture used in the incision method and the timing of thread removal

Regardless of the surgical method, most of the threads used to suture (outer stitch) the skin surface of the eyelids that have been incised by incision surgery are ultra-fine nylon threads for medical use inside the body. It is said that foreign body reaction is unlikely to occur, and it has been used for many years not only in cosmetic medicine but also in surgical operations. The thread used to suture the incision site will be returned to the hospital about one week after the surgery to be removed .

Incision surgery may also involve a procedure called "middle stitching," in which the skin tissue of the eyelids is sutured to the tarsal plate or part of the levator aponeurosis. It is said that the risk of double lines disappearing after surgery is reduced because the thread supports the sutured tissues until they adhere firmly to each other by performing the middle stitch, but it is medical care whether or not to perform the middle stitch. It depends on the institution.

There are two types of thread used for middle stitching, one that is gradually absorbed into the body over the years and one that is non-absorbent. Which type of thread is handled depends on the medical institution, so foreign matter in the body. If you are uncomfortable with the (thread) remaining, check the type of thread used for middle stitching from the homepage of each medical institution or contact information, and undergo surgery at a medical institution that uses absorbent thread. Please give me.

Main designs and features of double eyelids that can be reproduced by the incision method

There are various types of double eyelids that can be reproduced by the incision method, and the design is decided by looking at the ideal finish and the balance with the entire face. However, since the incision method involves removing excess subcutaneous fat from the eyelid and part of the orbicularis oculi muscle, it is difficult to return to the original state of the eyelid after surgery, so consult with the doctor about the design. Then, receive objective advice and decide carefully.
In incision surgery, the following double eyelids can be reproduced.

Main designs and features of double eyelids that can be reproduced by the incision method

Oku double

Feature The double line is hidden inside the eyelids. The width of the back double can be adjusted.
Those who are facing Those who do not want to change the impression of the face as much as possible, those who want to make the eyes look a little bigger

Suehiro type double

Feature The double line starts near the inner corner of the eye and the double width expands toward the outer corner of the eye.
Those who are facing Those who like a natural look, those who have natural makeup

Narrow parallel double

Feature It is said that it goes well with those who are modest in the double-faced parts that can naturally emphasize their eyesight while being clean.
Those who are facing Those who want to improve the impression of their eyes without any discomfort

Wide parallel double

Feature Please note that if you make the double width too wide, which has a clear presence and is easy to make up, it will give the impression of sleepiness.
Those who are facing Those with thin eyelids, those with clear facial irregularities, those who like gorgeous makeup

Incision downtime and post-surgery course / correction

The incision method is said to take about half a year to complete a natural double , including all steps such as post-surgery downtime and thread removal. After surgery, it is important to understand the downtime and the progress after surgery, to be in good physical condition, and to stay calm so as not to give excessive stimulation to the surgical site.

[About 1 week later] Swelling, swelling, and redness are noticeable

In most cases, about one week after the surgery is completed, the patient will return to the medical institution to remove the suture used for external sewing. At this time, the swelling, swelling and redness of the treated area are still continuing.

[1 to 3 months] The redness of the affected area subsides

About one month after the surgery, we will visit the medical institution again to have a medical examination and check the finish of the double design. From this period, swelling, swelling, and redness are said to subside over time.

[6 months] Almost completed

The swelling, swelling, and redness have all subsided, and the double line is almost complete. Depending on the medical institution, you may be instructed to have regular medical examinations for a doctor's diagnosis even after 6 months.

Be careful during downtime

How to deal with swelling

The swelling peaks one week after surgery , during which time you should cool and be careful not to over-improve blood circulation. When cooling, place an ice pack wrapped in clean gauze or towel on your eyelids. Be careful not to put the ice pack directly on your eyelids as it may cause frostbite.

In addition, it is recommended to stay calm and refrain from alcohol after surgery because the eyelids tend to swell when blood circulation improves due to exercise, bathing, drinking, etc.

How to hide scars

Basically, the eyes will swell for about 3 days to 1 week, and the change in appearance will be easy to see. If you do not want to be noticed by the surroundings, cover your eyes with sunglasses. Eye makeup is possible from the day after the thread is removed, and the makeup can make scars less noticeable.

How to correct double surgery by incision

In the incision method, the tissue of the eyelid is directly excised by incising the skin to adjust the position of the muscle and suture, so it is difficult to make corrections such as returning to the original state or narrowing the double width like the burial method. However, depending on the procedure, you may be able to undergo reoperation.

If the incision line does not adhere well to tissues such as the levator aponeurosis, the double line may narrow or return to its original single. Especially in partial incision, the cause of backtracking is that the weight of the eyelids cannot be supported and the eyelids return to a single layer. The remedy is to re-operate and re-adhere the tissue that was poorly adhered to in the previous surgery to form a double .

Pain, risks and side effects of incision surgery

Pain from incision surgery

Since incision surgery is performed by local anesthesia, it is said that there is almost no pain during surgery, but when local anesthesia is injected around the eyelids, there is a tingling sensation . Intravenous anesthesia may be used depending on the medical institution, so if you are worried about pain, it is safe to check in advance what kind of anesthesia the medical institution considering surgery handles.

As for post-surgery pain, you may feel pain near the incision site, but in most cases it will subside in a few days. In addition, some medical institutions prescribe pain-relieving medications as aftercare.

Risks and side effects of incision method

  • Pain in the surgical site for 2 to 3 days
  • Swelling, swelling, and redness of the surgical site for about 1 week to 3 months
  • Left-right difference and scars on the eyelids after surgery
  • Very rarely, it is difficult to open the eyelids, discomfort at the surgical site, double line disappearance (backtracking), dry eye, etc.

Conspicuous swelling and pain after surgery are generally said to subside within a few days to a week, but if the swelling does not subside or the pain continues, there is a possibility of infection, so self-treatment is necessary. Avoid and consult a medical institution that has undergone surgery.

As a result of double eyelid surgery by incision in 352 people in China, there was a slight laterality in 8.2%, and although the double width was narrowed in 2.0%, it was symmetrical, parallel and natural. It has been reported.

Results: A total of 352 patients with 704 eyes were operated on and followed up in our study. There were 29 patients (8.2%) that showed slight asymmetry, and 7 eyes (2.0%) showed shallow creases. Besides that, all the creases There symmetry, parallel and natural. Just as congenital double eyelids, when opening eyes there was no sausagelike appearance, and when closing eyes there were no depressed scars. Conclusions: By reconstructing the physiological structure of upper eyelids, our double eyelid operation creates dynamic double eyelids, which are accordant with the congenital ones both in appearance and movement.

Source : A Modified Procedure for Blepharoplasty: Physiological Structure Reconstruction of Upper Eyelids

Difference from the burial method (double technique without incision)

The burial method is a method of forming a double layer using a medical needle and suture without making an incision in the eyelid . It is a method to reproduce the structure where the double line appears by threading several places from the back side of the eyelid along the desired double line and connecting the skin and muscle, and the treatment is performed in a shorter time than the incision method. Is completed.

As for the burial method, the method of passing the suture through the back of the eyelid and the part to be fixed differ depending on the surgical method, and medical institutions and doctors may arrange the treatment on their own. In addition, it can be restored by removing the suture that connects the skin and muscles of the eyelids. It is a double procedure suitable for those who are resistant to surgical operations or who do not want to prolong downtime.

Features of the burial method compared to the incision method

Double art Burial method Incision method
Surgical procedure None Yes
Treatment method Pass the suture through the back of the eyelid and fix it at the site where you want to form a double line. Make an incision in the eyelid with a scalpel to form a double line
downtime About a week It takes about 1 to 2 weeks until the big swelling subsides, and about half a year until the swelling completely subsides and is completed.
merit・ The treatment time is as short as 10 to 15 minutes ・ Swelling is small and downtime is short ・ It can be restored ・ Makeup is possible after surgery ・ The fee is cheaper than the incision method・ Basically, there is no need to worry about returning to a single layer. ・ Excess fat on the eyelids and sagging skin can be removed. ・ It is easy to reproduce the ideal double layer.
Demerit・ If the desired double width is too wide, the double may not be fixed. ・ Not suitable for people with thick eyelids or a lot of fat.・ Long downtime such as swelling and redness ・ Basically impossible to restore ・ Scars may remain ・ High cost ・ Easy to reproduce ideal double

Surgery that can be combined with incision

If the incision method alone does not achieve the ideal double, surgery may be performed in combination with other eye shaping as follows.

Incision in the inner corner of the eye

Many Japanese have skin that covers the inner corners of the eyes called Mongolian folds, which tends to make the eyes look smaller. An incision in the inner corner of the eye is an operation to widen the width of the eye by removing the Mongolian folds .

When forming a wide parallel type double, it is necessary to set the start position of the double line higher than the Mongolian folds, so if the Mongolian folds are developed, the incision method alone will give an unnatural finish. It may be.

By performing an incision method in combination with an incision in the inner corner of the eye, it is possible to aim for a well-balanced double eye, and it also leads to improvement of problems such as small eyes and eyes that look apart .

Incision at the corner of the eye

An incision in the outer corner of the eye is one of the eye shaping that makes the eye look larger on the outside by widening the width of the eye toward the outer corner of the eye . By adjusting the angle of the line from the outer corner of the eye to the lower eyelid, it is possible to make the sagging eyes sharp and long, and to make the slanted eyes look round and soft.

In addition, it is said that the incision of the inner and outer corners of the eye is performed at the same time as the incision method or after double formation to achieve a well-balanced finish .

Orbital fat resection (lower eyelid degreasing)

If you have a tendency for ptosis, such as heavy eyelids that do not open sufficiently or narrow vision, the orbital fat in the upper eyelids may have moved to the back of your eyes. The orbital fat that covers the entire eyeball is pushed forward by the weight of the eyeball if the muscles and membranes that support the eyeball are weak, so the fat in the lower eyelid protrudes forward, causing slack under the eye. Although it appears, the operation to remove this slack is orbital fat resection .

It is said that the amount of orbital fat removed can be minimized by moving the orbital fat by incision and returning the fat in the upper eyelid to the normal position.

Fat dissolving injection

Fat dissolving injection is one of the slimming treatments in which a drug that reduces the number of fat cells is injected subcutaneously . Since the subcutaneous fat in the eyelid is the adipose tissue outside the orbicularis oculi muscle and cannot be removed by incision, the eyelid thickened by the subcutaneous fat may be combined with a lipolytic injection. It is possible to perform the treatment after waiting for about half a year after receiving the double formation by the incision method.

Advantages and disadvantages of the incision method ・ Points to judge orientation and unsuitability

While double surgery by law is said to be able to maintain double lines semi-permanently, it also has the disadvantage of requiring long downtime because it is a surgical procedure. The specific advantages and disadvantages of the incision method are as follows.

Benefits of double surgery with incision

Easy to reproduce the ideal double design

Unlike the burial method, which creates a double by implanting sutures along the double line, the incision method is ideal for wide doubles and parallel doubles because the structure of the eyelids can be adjusted by surgical procedures. It is said that it is easy to reproduce the double design .

Less worry about returning to the original eyelids

Since the incision method treats the fat and muscles of the eyelids, the formed double can be maintained semi-permanently . It is said to be a double technique that is suitable for those who have experience that double lines did not settle with thick eyelids and burial methods.

Can also improve excess skin and fat around the eyelids

If the skin of the eyelids is thick or the amount of fat is high, the upper eyelids may cover the eyes and make the eyes look smaller or heavier. The incision method is also suitable for such cases, and it is possible to lead to a refreshing eye area by removing excess skin tissue and fat .

Upside down eyelashes can be expected to improve at the same time as double formation

Upside-down eyelashes are symptoms that touch the surface of the eyeball when the eyelashes that should originally grow outward of the eyelid grow inward, and are also called varus. Leaving the lashes upside down can damage the surface of the eye (cornea and conjunctiva).

The incision method removes the skin and fat from the eyelids, adjusts the muscles so that the eyelashes grow in the correct direction, and then sutures the tissues together. You can also expect improvement of upside down eyelashes by fixing the edges of the eyelids with the edges bent forward and encouraging the eyelashes to face outward .

Disadvantages of double surgery by incision

Scars are easily noticeable immediately after surgery

Since the skin of the eyelids is incised and sutured , scars remain around the eyes immediately after surgery . It is said that the thread is removed after about one week, and the scars settle down to the extent that they are not noticeable even without makeup after a few months.

Long downtime such as swelling and redness

Compared to the burial method, the incision method makes an incision in the skin, resulting in longer downtime . Cuts in the skin tissue and capillaries cause internal bleeding and swelling of the eyelids, causing pain and redness that lasts for a week or two. It is said that it will take about half a year to complete the natural appearance of the double layer. During downtime, avoid blood flow-promoting behaviors such as strenuous exercise and heavy drinking. If the swelling persists and you are concerned, it is also recommended to use ice or an ice pack to cool the treatment area.

The thin skin of the eyelids makes it especially prone to swelling, and internal bleeding is also a noticeable delicate area. Swelling can often be dealt with by icing to cool the inflamed area, but some people may be concerned about swelling or redness in the affected area for about 3 months after surgery.

The finish may be unnatural depending on the surgical procedure

Part of the eyelid may be dented or a line may appear in an unnatural place when the eyes are closed , such as when the subcutaneous tissue is partially removed by a partial incision or when the fat is removed more than necessary. .. Since it can be caused by the practitioner's lack of skill or inappropriate counseling, a doctor who has abundant and proven results of double formation by bringing a photo of the desired double image and telling it firmly. It is important to have surgery under the condition.

Points to judge the orientation / unsuitability of the incision method

Those who are suitable for the incision method

  • Those who want a wider parallel double
  • Those who did not establish the double line by the burial method
  • Those who have noticeable eyelid thickness and swelling
  • Those with sagging eyelids or excess skin

Those who are not suitable for incision and those who cannot undergo surgery

Those with a narrow space between the eyes and eyebrows

If the incision method is performed on the side where the distance between the eyebrows and the eyes is short, the distance may become even shorter and the appearance may become unnatural. In such cases, it may be appropriate to perform eye surgery to adjust the balance by performing an operation called supraclavicular skin excision (blow lift) that removes the skin on the eyebrows to raise the position of the eyebrows. There is.

Pregnant / lactating

Surgery during pregnancy and lactation is a heavy burden on the body and may affect the foetation, so it is not possible to undergo open surgery. The same is true for burial and other surgeries.

Those taking anticoagulants and antiplatelet drugs

Since the incision method involves a surgical procedure, it cannot be performed if you are taking anticoagulants or antiplatelet drugs that improve blood flow. If you wish to have a treatment, do not stop taking the medicine at your own discretion, and be sure to consult your doctor.

Flow of incision surgery and time required / price

Incision surgery flow

Parental consent is required for minors undergoing surgery. It will lead to a better finish if you attend the counseling and receive explanations to resolve any concerns or doubts about the incision method.

(1) Medical examination and counseling

After filling out the questionnaire, you will receive medical examination and counseling by a doctor. I will tell the doctor about my eyelid problems, ideal double width, shape, etc., so please bring a photo of your ideal finish. Then do a double simulation to determine the design.

(2) Design marking

Once you have decided on the double design you want with the incision method, mark along the double lines you want to form.

(3) Local anesthesia

Local anesthesia the eyelids and leave for a while to relieve the pain. Although there are individual differences, it is possible to minimize the pain when piercing the needle by applying an anesthetic cream in advance.

(4) Incision / excision

After confirming that the anesthesia is sufficiently effective, we will proceed with incision surgery by total or partial incision.

(5) Suture / cooling

After completing the necessary procedures to form the double line, the surgery is completed by suturing the inside of the skin at the incision site and the surface of the skin. Immediately after the surgery, cool for a few minutes to reduce swelling.

Estimated operation time

The standard operation time is 30 to 60 minutes for a full incision and 20 to 50 minutes for a partial incision . Additional time is required to form a wide double layer, to remove excess fat and skin, and to perform another procedure such as an incision in the inner corner of the eye at the same time.

Precautions after surgery

  • You can wash your face and shower from the next day, but please keep the surgical site lightly flushed.
  • You can take a bath about a week after the surgery and after the swelling has subsided to some extent.
  • Makeup is possible about one week after the thread is removed.
  • Please refrain from activities that promote blood flow such as sauna, strenuous exercise, and drinking until the thread is removed.
  • After surgery, the area around the eyelids is damaged and the sutures are on the skin, so please refrain from wearing contact lenses until you finish removing the sutures.
  • Refrain from using false eyelash extensions, false eyelashes, or rubbing your eyes until the downtime has passed and the surgery has completely settled down.

Price of incision surgery

Double surgery by the incision method for the purpose of beauty is treated as self-financed medical treatment that is not covered by insurance, so the fee varies greatly depending on the medical institution, and also depends on the surgical procedure used and whether the target of surgery is both eyes or one eye. there is.

Total incision (both eyes) 250,000 yen to 500,000 yen
Total incision (one eye) 150,000 yen to 350,000 yen
Partial incision (both eyes) 150,000 to 250,000 yen
Partial incision (one eye) 130,000 yen to 180,000 yen

How to choose a medical institution so that the incision method does not fail

In order to prevent mistakes such as left-right difference in finish and backtracking, select a medical institution that has a doctor with abundant experience as an ophthalmic plastic surgeon, or a medical institution that has a large number of cases of double surgery by incision method. Is recommended. In addition, since the appropriate incision method differs depending on the condition of the eyelids and the ideal finish, it can be said that one of the criteria is that it corresponds to full incision and partial incision .

It is also important to choose a medical institution that guarantees aftercare and re-surgery in case you are not satisfied with the finish due to a surgical failure. Since it is difficult to return to the original eyelid after the surgery of the incision method, it is possible to have a surgery without regrets by discussing it carefully with the doctor during counseling and matching the finished image . It is also important to determine the integrity of the response, such as whether there is a thorough explanation of the disadvantages and risks of surgery.

(Updated January 2021)

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