Sausage Eyelid Revision - SM Plastic Surgery

Where the crease was set high and thick and the area below it looks full, the line is lowered and the fat and muscle refined, easing an impression that looked heavy. Adhesion and scarring are checked first, and results vary from person to person.

A line set too high, weak eye opening that leaves tissue beneath the line looking bunched, or a lid that is thick in itself can all be causes. In revision the cause is separated and the approach follows from it.

The adhesion of the existing line must be released and the new line refined, and how it is handled varies with the earlier scar. Fine suturing aims to keep scarring down, though how well it heals varies from person to person.

Where weak eye opening leaves the area below the line looking bunched, the levator may be adjusted as well. It is not always combined; whether it is needed is decided after detailed assessment.

With adhesion release and tissue refinement involved, swelling can exceed the first operation, and how long the major swelling takes to subside varies considerably. We advise as the course is followed.

Even when the eyelid itself is thick, the aim is to lower the crease and tidy the fat and muscle beneath it so the puffy impression is eased. Natural thickness cannot be removed entirely, so we explain at the examination how much can realistically be refined.

Soon after surgery, swelling is often what makes the area below the crease look thick. If the fullness remains once time has passed and the tissue has settled, the crease height or the thickness of the eyelid may be the cause, so we distinguish the two by following your progress.

Once the tissue bunched below the crease is refined, the eyelid can look less heavy and the impression clearer. It is not an operation that enlarges the eye itself, however, and the degree of change varies with lid-opening strength and the condition of the eyelid.

Removing too much fat can leave the eyelid looking hollow, so the amount is decided carefully. We first separate whether the fullness comes from fat, from muscle or from the height of the crease, and then refine only as much as is needed.

While swelling remains during recovery the area can still look thick, and it gradually refines as the tissue settles. Changes can still occur over time depending on eyelid thickness and lid-opening strength, so we keep checking at follow-up visits.

When the tissue below the crease bunches up and covers the eye, the look can become sleepy. We approach it by lowering a crease that was set too high and refining the thick areas, and if weak lid-opening strength is behind it we examine that as well.

We first separate whether the crease height, the lid-opening strength or the thickness of the eyelid is the main cause, and set the extent of refinement accordingly. Adjustments are also made during surgery while checking the shape with the eyes open, so there is no fixed amount.

Even after the lid-opening strength has been adjusted, a crease set too high or thick eyelid tissue can keep the area below it looking full. We check the adhesion and scarring left by the earlier surgery and then decide whether to address the crease height or the tissue itself.

When the thick tissue beneath the crease has to be refined directly, the buried-suture method alone is unlikely to produce the change. The suitable approach depends on the earlier method and the state of the tissue, so it is decided after a detailed examination.

Even without any previous surgery, thick eyelids with a lot of fat can make the area below the crease look full. In that case the approach is not a revision but a double eyelid design that takes thickness and lid-opening strength into account, and we explain which applies to you at the consultation.