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   OZ (2016-02-15 17:10:18, Hit : 2437, Vote : 12)
Subject  
   Sausage eyelid ?
Sausage in double fold ?



Have you heard about sausage eyelid ?
Sausage eyelid is a very popular word in Korea, but is not known in most of English speaking countries because it is a peculiar complication in Asian double fold surgery.
Because many Asians have thick eyelid skin, inappropriate double fold surgery can make this complication often.
Sausage phenomenon means swollen looking lower flap beneath double fold crease.
Because it looks like sausage is placed beneath double fold crease, the name was derived.
Young Koean people are very creative and witty in naming.

Immediately after double fold surgery, the double fold crease becomes very deep and fixed and the flap beneath double fold crease becomes swollen, which makes it look like sausage.
But this is not called as sausage.
Sausage phenomenon can be diagnosed if this swollen appearance persists even after 4 months of double fold surgery.




Many people misunderstand that this sausage is caused by remained fat or muscle in lower flap and try to remove that.
But that is total misunderstanding and should not be tried.
Inappropriate attempt to remove remained fat and muscle in lower flap can make double fold crease deeper and lower flap irregular, which aggravate sausage phenomenon.

Let's figure out the causes and solutions for this sausage phenomenon.

1. Too deep and fixed double fold crease
No.1 cause of sausage phenomenon is too deep and fixed crease.
In static fixation, double fold crease is fixed to deep and immobile tarsal plate.
Because the crease is too deep and immobile, lower flap looks loose or swollen.
If the fixation is changed to be shallow by dynamic fixation, sausage is disappeared easily.
You can understand easier by inspecting below diagram.

▲As you can see, the deep fixation can make lower flap more bulging.


▲Changing the fixation from static to dynamic and making doule fold crease shallower can make the sausage disappeared.




2. Too high double fold crease
Because Asians have flat face, too high double fold can make their eyes look more protruded and swollen.
Too much exposed lower flap looks bulged because it follows curved eyeballs.
Making double fold crease smaller(lower) can make crisp crease and natural apperance.
In addition, covering of upper part of lower flap by draped upper flap can hide bulged apperance.




3. ptosis and inappropriate opening of eyes.
Ptosis and inappropriate opening of eyes expose more lower flap and make double fold crease higher.
In addition, these make the lower flap loose and swollen.
Ptosis correction can make double fold crease smaller and lower flap tighter, which makes the sausage disappeared.



4 . Other causes

1) thick skin with loose double fold fixation
This is a very simple cause and can be fixed easily with tightening of double fold fixation.



2) Mongolian fold
Mongolian fold with high double fold makes lower flap flabby and swollen.
It can be easily fixed with medial epicanthoplasty alone.



3) High non-incision double fold crease
Too high non-incision double fold crease makes iatrogenic ptosis and sausage.
By reversing non-incision double fold crease can make it natural.



Even if I listed many causes of sausage, it can be summarized as too deep or high double fold crease.
And solution for this is making double fold crease shallower and lower and thus more natural.

If you have good condition for double eyelid surgery like thin eyelid skin, good eye opening, not fatty eyelids don't have to worry about sausage phenomenon.
But if you have unfavorable conditions like thick eyelid skin, protruded eyeball, weak levator muscle, fatty eyelids, lower eyebrows, you should not be greedy in making eyes bigger and choose small natural shaped double fold crease.



▼Outfold type high fold double fold crease in Caucasians is totally different from that in Asians.



Hyuncheol Park MD
OZ Cosmetic Clinic
Seoul, KOREA




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