Wednesday, February 29, 2012

Modified Technique for Double Eyelid Surgery - Partial Incision Technique

The two main techniques for creating double eyelids  are incisional technique and suture technique. Several modified techniques have been developed for the incisional technique in order to achieve the desirable results with faster recovery. These techniques include partial incision technique and mini-incision technique.  While these techniques sound exciting they are not suitable for all patients.  Those who have excess skin or very full upper eyelids (meaning fat removals are needed), the conventional incisional technique is still preferrable.

In the case of partial incisional technique, only the middle third of the lid is incised. This has the advantages of faster recovery and less scarring.

Comparing the incision for conventional
and partial incision.

During the operation, the tarsal plate or the levator muscle (the muscle that opens the eye)  is exposed. The muscle under the skin nearest to the eyelashes is then sutured to either the tarsal plate or the levator musclefter,  the skin is then closed.

Muscle sutured to the tarsal plate.

Muscle sutured to the levator.

A patient before and after partial incision.
The scar only scans 1/3 of the upper eyelid.

Tuesday, February 21, 2012

17 years of low self-esteem gone in 20 minutes.

Right droopy eyelid before and after surgery.
Ptosis refers to droopy eyelids and it is usually caused by weak muscle that open the eyelid. Most cases occur in older patients but it can also occur at birth in which case it is known as congenital ptosis. Ptosis needs special attention as it can cause lazy eye and further more children with significant ptosis often suffer from emotional stresses as they are soft targets for bullying. This girl had significant ptosis since birth but her parents did not seek help believing this was only a small blemish. However, the significant ptosis had produced poor vision in the right eye and she had low self-esteem and was socially withdrawn. On examination, she had very poor muscle function and so the best option to treat her ptosis was with frontalis suspension in which the forehead muscle was recruited to lift the eyelid. The technique is as shown in the series of picture below and took between 15 to 20 minutes to complete.

Sunday, February 5, 2012

Oculoplastic Surgeons Must be Experts in Jigsaw Puzzles

One of the common referrals to oculoplastic surgeons is severe eyelid trauma needing meticulous repair. The defect may be partial or full thickness and careful inspection usually reveals that slowly piecing the remnants together like a jigsaw puzzle will correct the repair. Failure to put the pieces together can lead not only to poor cosmesis but affect the proper functions of the eyes such as causing watering eyes and pain from eye exposure.

The pictures below show eyelids that had been badly repaired by doctors who were definitely not good jigsaw puzzle players.

Poorly repaired lower eyelid trauma referred
for reconstruction.

Another poorly repaired eyelid trauma. The left eye
was removed because the globe was badly
ruptured during an explosion accident.

The following cases show how traumatic eyelids should be pieced together like jigsaw puzzles to give reasonable to good cosmetic and functional results.

Severe eyelid trauma from fall.

The left upper eyelid was avulsed.

Immediately after repair.

Facial appearance at one month.

Repair of eyelid trauma from
road traffic accident.