Friday, April 29, 2011

Life Transforming Facial Plastic Surgery

Some of the people are fervently anti-plastic surgery considering it to be an affront to nature. However, I believe the facial feature is as important as the voice in daily social commincation. If a person had a hoarse voice, he or she would have no hesitation in seeking help to correct it. Similarly, a person with a less than pleasant facial feature should have the same right to look his or her best. The following are some Japanese women who had undergone amazing transformation and nobody of the right mind would deny these people are much nicer to look after the operations and likely to make more friends.

Sunday, April 24, 2011

Unequal Double Eyelids (skin creases) due to Unrecognized Droopy Eyelid (ptosis)

A common complication of double eyelid surgery is unequal heights of the double eyelids. Because the eyes are prominent parts of the face a different of 1mm can be obvious and cause distress to the patients. There are several reaons which may account for these complications and one of the commonnest causes is due to unrecognized droopy eyelid (ptosis) on the part of the surgeon before the surgery.

This young woman (above) went to a beautician one year ago because of xanthelasma (cholesterol deposits; arrowed). The beautician told her that the lesions could only be removed if she were to undergo double eyelid surgery by a "doctor" from China who happened to be in the saloon that week. Unfortunately, the double eyelids were unequal with the left one being too faint and high. In addition, the left droopy eyelid that she had since young became more obvious. In addition, the xanthelasma was not removed using the cream as prescribed by the beautician. 

In patients who have double eyelids, droopy eyelid is more obvious because the affectd eye has a higher double eyelid (skin crease). In patients who have single eyelid, the mild droopy eyelid may not be obvious until the patients have had double eyelid surgery. Very often the patients blame the surgeons for the asymmetry, therefore it is important for any surgeons who carry out double eyelid surgery to thoroughly examine the patients before the operation paying particular attention to any eyelid asymmetry. In patients who have droopy eyelid, additional surgery to strengthen the eyelid muscle should be performed simulatneouly to avoid patient's disatisfaction.

The middle-aged woman (above) had a left ptosis as shown by a higher left eyebrow (an attempt to open the eye wider with the forehead muscle). However, the surgeon missed the sign beause of excess eyelid skin in both upper eyelids. Post-operatively, the patient complains bitterly about the asymmetrical double eyelids.

Another patient (above) with a weak left eyelid muscle partially masked by the excess skin. After removal of the excess upper eyelid skin and double eyelid surgery, the left droopy eyelid became very obvious even though the skin creases were marked at the same height before surgery.

Another patient (above) who had a mild left droopy eyelid made obvious by double eyelid surgery because the double eyelid failed to form in the left eye due to the weak muscle. Again the left eyebrow was higher on the affected side in an attempt to open the eye wider by recruiting the forehead muscle.

Lifting the eyelids, reveal right droopy eyelid.

Another patient with right droopy eyelid.

To avoid patients' dissatifactions, the eyelids should be examined carefully for any asymmetries. These two patients (pictured above) came for eyelid urgery, examinations of the eyelids reveal droopy eyelid on the right eyes. In order to achieve good results, the procedure should include strengtening the eyelid muscles (ptosis operation).

This young woman wanted to have double eyelid to the right eye only. However, eyelid examination showed that she also had a left droopy eyelid. To avoid postoperative asymmetry, the right double eyelid surgery was combined with a left ptosis operation.

Wednesday, April 6, 2011

Doctor, could you lift my eyelids by cutting the skin just below the eyebrows?

Recently, I receive an increase in demand for infrabrow excision to treat excess upper eyelid skin. The requests appear to stem from an increase of infrabrow excision performed by unlicensed doctors from China who perform these procedures in some beauty centres. The procedure involves removing the skin just below the eyebrows to lift the excess upper eyelid skin.

Infrabrow excision for excess upper eyelid skin.

A patient undergoing infrabrow excision.
The scars are prominent without make-up.

This procedure is easier to performed than the traditional upper eyelid blepharoplasty; has less postoperative swellings and does not significantly change the facial appearance. However, it  has several disadvantages:

a. the recurrence rate of excess skin drooping over the eyes is higher because there was no barrier from the skin crease (double eyelid) which stop the skin from the lid margin.

b. the scar can be prominent because the cut is through the part of eyelid which has thicker skin. Consequently, the procedure is indicated mainly for female patients as any scarring can be covered with an eyebrow pencil or eyebrow embroidery.

Pictures of before (above) and after (below) infrabrow excision.
The scars have been covered with drawing of the new eyebrows.

Before and after infrabrow excision. The scars are prominent
without make-up.

Monday, April 4, 2011

Doctor, how can my excess upper eyelid skin be removed?

Excess upper eyelid skin or medically known as dermatochalasis is a common ageing process seen in most patients over 40 years of age. The condition can give the patients a tired look and if severe can interfere with one's vision. There are 4 ways to address this problem as shown below:

 The arrows point to the excess upper eyelid skin that droop over 
the eyes and cover the double eyelids making the patient 
appears tired.

The above pictures show the 4 ways of treating this problem. Method a and b do not remove the excess skin but instead lift up the eyebrows which in turn lift up the excess skin. Method c and d. work by removing the excess skin. Method a is known as the coronal forehead lift which has the advantage of not leaving scar in the forehead as it is hidden by the hairline. Method b is direct brow lift in which the skin above the eyebrow is excised which would leave a scar but concealable by the upper border of the eyebrow if done well. Method c is infrobrow excision in which excess skin below the eyebrow is excised which would leave a scar but concealable by the lower border of the eyebrow. Method d is the most commonly performed procedure in which the excess skin above the double eyelid is excised and the resulting scar forms the double eyelid.