Lower Eyelid Revision Surgery, When Should It Be Done? (Timing and Method)

Lower Eyelid Revision Surgery, When Should It Be Done? (Timing and Method)

Today, I’d like to talk about lower eyelid revision surgery, as explained by Dr. Kang Hyungjoo from Jayjun Plastic Surgery.

Many people undergo lower eyelid surgery to smooth the under-eye area and create a younger appearance. However, as time passes, some may start worrying again. So, when and in what cases is lower eyelid revision surgery needed?

👁 Lower Eyelid Surgery, Starting with the Basics

As we age, the fat pockets under the eyes sag, and the surrounding membrane, muscles, and skin also loosen. This results in shadowing like dark circles and an uneven appearance.

👉The lower eyelid surgery process goes as follows:

The boundary area where the ligaments and muscles attach is released to create a natural flow,

the upper fat is repositioned downward to fill hollow areas,

excess muscle is tightened by securing it to the periosteum,

and in some cases, only a portion of excess skin is removed.

📌 Three Situations Requiring Lower Eyelid Revision Surgery

➤ Aging Changes

Even if you were satisfied with the initial surgery, sagging and hollowness may reappear with time. Usually, after 5 to 10 years, people consider revision because their under-eyes start to bother them again.

➤ Dissatisfaction with Shape or Scars

This includes cases where under-eye unevenness remains, too much fat was removed leading to a hollow look, or visible scars remain. In such cases, fat can be rearranged, scars adjusted, or the skin refined for improvement.

➤ Functional Problems — Ectropion

This is one of the most concerning complications after lower eyelid surgery.

The lower eyelid flips outward, causing dryness and making the eye easily irritated by wind or water, which can lead to dry eye syndrome or conjunctivitis. In such cases, revision is necessary not only for cosmetic reasons but also for functional improvement.

When to Consider Lower Eyelid Revision Surgery

For aging or shape/scar issues → It is generally recommended to wait at least 6 months before making a decision. (Swelling and scars often improve naturally over time.)

For functional problems like ectropion → Discomfort is usually greatest within 1–2 months after surgery. 

If daily life becomes difficult, earlier correction can be considered.

🔎 Methods of Lower Eyelid Revision Surgery

Lower eyelid revision varies depending on the patient’s condition and the method of the initial surgery. Dr. Kang Hyungjoo explained the approaches in three categories: aging-related revision, shape/scar correction, and functional problems (ectropion).

1. Lower Eyelid Revision for Aging

When sagging or volume loss recurs with time, the basic principle is similar to primary lower eyelid surgery.

• Reposition existing fat as much as possible

• Add fat grafting to restore volume in deficient areas

• Remove excess skin if necessary after careful measurement

• Reinforce and secure muscles to maintain support

Additionally, if the eyes appear to lack aegyo-sal (under-eye fullness), volume can be added during suturing to create a natural look.

2. Revision for Shape or Scar Problems

If you are worried about uneven fat or visible scars after previous surgery, the fat condition must first be corrected.

• Smooth out uneven fat

• Remove and secure only the necessary amount of muscle and skin

• If scars have stretched, the incision line can be adjusted to refine the skin and create a cleaner result

If scars have formed as raised keloids, excessive tension during suturing must be avoided. In such cases, a conservative approach is taken to minimize scarring.

3. Functional Problems — Ectropion

One of the most uncomfortable issues after lower eyelid surgery is ectropion (outward turning of the eyelid). This usually occurs if fixation was too tight or too low.

• Release the fixation, or

• Adjust the fixation point within 0.5–1 cm to restore a natural position

If ectropion is caused by skin deficiency, skin from the upper eyelid may be harvested and grafted to the lower eyelid. If an upper eyelid surgery is planned, the skin from that procedure can be used to support the turned-out eyelid.

However, skin grafting is not a common method, as differences in color and texture are inevitable. Therefore, it is reserved only for cases where it is absolutely necessary. Careful evaluation and consultation are essential before deciding.

💡 In summary, lower eyelid revision is not just about “redoing” the surgery. It is crucial to analyze the exact cause and tailor the approach accordingly.

Dr. Kang Hyungjoo emphasizes that the key is to “consider fat, muscle, skin, scars, and fixation points comprehensively to create natural and safe results.”

That concludes today’s post on when lower eyelid revision should be done and the surgical methods involved.