Understanding the Causes of Failed Double Eyelid Lowering (Dujulttagi) in Busan and Key Insights for Sausage Eye Correction

Many people researching revision surgery to lower a double eyelid line that was set too high often come across a specialized technique known as 'Dujulttagi' (line-lowering revision without skin excision). While reviews show that some achieve a much more natural crease than before, others share experiences of lingering multiple folds or noticeable scars after surgery. Why do recovery processes and final aesthetic outcomes differ so significantly from person to person, even when undergoing the same Dujulttagi procedure?

The surgical approach and clinical trajectory vary depending on how the initial surgery was performed, the depth of internal adhesions from the original crease, and the remaining amount of skin and adipose tissue. In particular, revision surgery aimed at lowering an overly high crease—often considered a failed initial surgery—must address tissues that have already undergone structural alterations. This inherently makes the revision approach far more delicate and complex. Revision eyelid surgery cannot simply focus on etching a new crease; it requires a comprehensive assessment of the initial scar, internal adhesions, and available skin laxity.

If you are considering Dujulttagi in Busan to correct a puffy, sausage-like eyelid crease, it is vital to look beyond before-and-after photos in reviews. You should first understand the physiological principles of this technique, the appropriate indications for it, and why secondary folds or scars might appear post-operatively.

Does Dujulttagi mean creating two double eyelid folds?

The name 'Dujulttagi' (literally "double-line incision") often leads people to misunderstand it as creating two separate eyelid folds. In reality, it involves releasing the adhesions of the previously high crease and anchoring a new, lower crease below it. However, if the dynamic folding force of the high scar from the primary surgery remains active, the original line may persist or fold together with the newly formed crease. Therefore, revision surgery necessitates meticulous evaluation of the exact position of the prior crease and the severity of deep tissue adhesions.

The foundational principle relies on systematically releasing existing adhesions to the required extent and allowing the new crease to establish itself securely. However, not all procedures designed to lower high double eyelids follow the identical Dujulttagi method. Depending on skin elasticity, thickness, previous scar line placement, and the degree of descent required, surgeons may select between skin excision or adhesion release techniques. In other words, even if the primary goal is lowering a high fold, the surgical method must be individually tailored based on a direct evaluation of your eyelid anatomy.

What is the difference between skin excision and Dujulttagi?

In revision eyelid surgery aimed at lowering a fold, remaining eyelid skin elasticity and volume are critical factors. When sufficient skin remains and only a modest downward shift is needed, an excision method that removes excess skin along with the old incision scar can be considered. Conversely, when the line must be lowered substantially or when prior procedures and lift surgeries have left minimal skin excess, further skin excision becomes hazardous. Under these circumstances, the Dujulttagi technique—releasing the high adhesions and creating a new line underneath—is the indicated approach.

Typical indications include cases requiring a significant downward shift of the crease, eyelids with depleted skin reserves due to repeated surgeries, or transitioning from a wide out-fold (parallel crease) to a softer in-fold or in-out fold.

In particular, when adjusting the medial inner corner from an out-fold to an in-fold, the anchor depth and adhesion at the start of the original crease must be carefully examined. Depending on how deeply tissues were anchored during the first surgery, the process required to completely neutralize the former line can vary substantially.

Why might a released high crease reappear?

A frequent question among patients inquiring about Dujulttagi in Busan is why the previous fold sometimes reappears. Because real-world reviews feature both successful and unsatisfactory outcomes, understanding the mechanisms behind potential failure is essential.

If the primary surgery utilized an incisional method, internal scar tissue and dense fibrosis are often present within the incision track. When the former fold was anchored deeply, adhesions extend beyond the superficial dermis into the deeper eyelid lamellae. Even if existing adhesions are meticulously dissected during surgery, tissues may readhere during the natural healing cascade, causing traces of the previous line to partially show through. When both the new and old lines exert competing folding vectors, the eyelid may exhibit a dual line or irregular multiple folds upon opening.

However, an irregular appearance in the immediate post-operative phase should not instantly be diagnosed as permanent re-adhesion. Early on, post-surgical edema, localized tissue induration, and temporary creasing during wound remodeling frequently cause overlapping folds that soften over time.

Why scars may appear as two lines after Dujulttagi

Dujulttagi should not be mistaken for simply excising the old scar alongside excess skin to form a new crease. Instead, it entails delicately releasing the deep adhesions of the elevated line and placing a new incision lower down to anchor a natural fold. Consequently, while only the newly designed lower crease defines the fold when eyes are open, both the previous scar and the new incision line may remain visible when the eyes are closed.

Furthermore, what patients commonly refer to as 'scar tissue' (fibrotic hypertrophic tissue) is not a single uniform condition. Post-operative swelling combined with tissue induration, chronic fibrosis in the previous scar track, internal re-adhesion, or normal inflammatory healing responses around the new crease all represent distinct biological phenomena. An eyelid that feels thick or firm should not be hastily categorized under one label; it requires a comprehensive assessment of the healing timeline, surgical scope, and baseline scar condition. When considering revision options like Dujulttagi in Busan, evaluate not only the dynamic fold when your eyes are open, but also the cosmetic acceptance of closed-eye scarring.