Revision surgery does not always require an incisional technique. If your previous eyelid surgery was performed using a non-incisional method, such as a buried-suture or natural adhesion technique, non-incisional revision surgery may still be an option. However, an incisional approach may be more suitable when there is excess tissue covering the eyelids that creates a heavy appearance, when the upper eyelids are noticeably puffy, when you wish to raise the crease significantly, or when you want to lower the existing crease substantially. Even in cases where the previous surgery was performed using an incisional technique, revision with a natural adhesion method may be possible depending on the individual condition of the eyelids. A thorough consultation and careful assessment are therefore essential in determining the most appropriate surgical plan.

The puffy, “sausage-like” appearance that is commonly described in double eyelid surgery is often caused by setting the double eyelid crease too high for the individual’s eye structure. When the distance from the eyelashes to the crease is too high with the eyes closed, it is difficult to avoid an overly prominent or unnatural-looking crease. Through revision incisional double eyelid surgery, the crease can be appropriately lowered while also removing excess skin that covers the crease. This can significantly improve the “sausage-like” appearance without necessarily reducing the visible height of the double eyelid crease when the eyes are open.