Doctor, what to prepare before and after eyelid surgery?

After you have decided to undergo an eyelid surgery, it would be helpful to know what preparation you can do to facilitate the procedure/ surgery. Also, what you can do after the procedure/ surgery to enhance the recovery.

The following is a list of before (pre) and after (post) procedure/ surgery instructions. Please note these instructions may vary between doctors.

PRE-OPERATIVE INSTRUCTIONS:

A. Medications:

The following medications, oil and herbs have blood thinning properties and should be stopped prior to surgery to reduce bleeding during surgery and thus will also reduce swelling and bruising after surgery .

Please STOP the following 2 weeks before and 1 week after procedure/ surgery:

1. Anticoagulants :- 1. Aspirin
                                 2. Clopidrogel (Plavix)
                                 3. Warfarin (need physician clearance)

2. Fish & Liver oil :- Omega-3, Cod Liver Oil, Salmon fish oil, Krill Oil
3. Flax Seed Oil
4. Vitamin E
5. Pain Killer :- Non Steroidal Anti Inflammatory Drugs (NSAIDs)
                          1. Ibuprofen (Brufen)
                          2. Mefenamic Acid (Ponstan)
                          3. Indometacin (Indocin)
                          4. Naproxen (Naprosyn)

6. Herbs / Traditional Medicine :- 1. Ginseng
                                                       2. Gingko Biloba
                                                       3. Dong Quai
                                                       4. Jamu etc
7. Smoking
8. Reduce Ginger and Garlic intake

If you have high blood pressure, diabetes and high cholesterol, please CONTINUE the medications like normal.


B. Preparation from home:

1. The day before surgery, shampoo your hair. Before heading to your surgery, wash you face with cleanser and water. Do not apply any moisturizers, lotion or make-up.

2. Do not wear jewelries, including rings, bracelet, earrings.

3. If you wear contact lens, be prepared to remove them. Preferably, wear your glasses.

4. Bring a hat/ cap/ scarf and sunglasses to be worn after surgery to cover your eyes.

5. No need to fast as most eyelid procedures are performed under local anesthesia with or without sedation. You may take light meal on surgery day and resume normal meal or as tolerated after surgery.

6. Prepare ice or eye pack for compression after surgery.

7. If you have opted for sedation, please have someone accompany you after surgery.

8. Start supplement Vitamin C 2000-3000mg (Brand Ester C by Kordel available in pharmacy or Ester C by American Health in GNC)

POST-OPERATIVE INSTRUCTIONS:

1. Rest with your head elevated about 30 degrees.

2. Use ice packs immediately after surgery and for the first 2 days on the operated area as frequent as possible. You may alternate cold and warm compress after 2 days when the bruise begin to appear. Ice compression helps with swelling while warm compression helps to disperse the bruising.

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3. Please take pain medicine if in pain. If there's sharp, pricking pain, please contact your doctor.

4. Do not exercise or lift any heavy objects or bend down for the first week. You may walk around without exertion as mobility will improve blood circulation and helps with wound healing.

5. Apply the ointment prescribed as instructed.

6. Take high dose vitamin C (2-3gm/day) to enhance wound healing.

7. You may take shower and wash your face but be very gentle with the incision site. You may dap dry the incision area but please do not rub.



THINGS TO KNOW ABOUT POST-OPERATIVE RECOVERY:

1. The swelling will worsen for the first 48 hours before it gradually resolves.

2. Occasional discharge including blood, tears and mild oozing is normal. However, if there's continuous fresh blood discharge, please contact your doctor.

3. Sutures are removed 1 week after surgery

4. Avoid direct sunlight to your eyelids esp if incision was made on the skin. Cover the incision site with the ointment prescribed.

5. 70-80% of swelling and bruising is usually gone at 2 weeks, it may take several months for the remaining swelling to completely dissipate. Final results usually take upto 6 months. This is normally applied to incision on the eyelids. Suture method for double eyelid usually take shorter downtime.

6. Numbness, swelling, tingling sensation, itching, discoloration, bumpiness, crusting, tightness and redness around the incisions are normal and should resolve with healing.


If you have further questions, kindly call 03-22846090 or email alicegoh@isec.my

What is BB Double Eyelid?

BB Eyes （BB眼睛）

“BB eyes” stands for Bigger and Brighter eyes. This is a series of customized cosmetic eyelid surgeries created by oculoplastic surgeon Dr Alice Goh. As she believes that no two eyes are the same, each eyelid design is customized to cater for each individual’s need.

BB Double Eyelid Suture Method (BB 双眼皮)

This is a safe and lasting double eyelid procedure invented by Dr Alice Goh to create a natural eyelid crease. This method is safe and uses high quality suture material to create the double eyelid.  It is performed in a hygienic procedure room and sterilized instruments. The double eyelid procedure alone takes approximately 15 mins each eye. However, additional time required if more procedures are done at the same time.

The conventional double eyelid formation rely almost solely on the suture to create the eyelid crease. Over time, the tensile strength of the suture reduces and therefore the force of keeping the eyelid crease is also compromised. She believes that BB Double Eyelid technique will last longer because of an additional step which create tissue adhesion to reinforce the lid crease formation. Therefore, as time passes when the tensile strength of the suture reduces, the tissue adhesion will continue to hold the lid crease formation.

The double eyelid procedure can be combined with other procedures to enhance the results of the double eyelid. In patients with puffy eyelids, fat removal can be performed together with the double eyelid procedure without any additional incision on the eyelids. Droopy eyelid can also be corrected without addition skin incision. Other enhancement and lengthening procedures such as Magic Epicanthoplasty (开眼角) and Lateral Canthotomy （开眼尾）can also be done together. 

The 10 advantages of BB Double Eyelid Suture Technique:

1.      Safe

2.      Scarless

3.      Natural

4.      Lasting

5.      Quick procedure

6.      Quick recovery

7.      No suture removal

8.      Fat removal possible without additional incision

9.      Droopy eyelid can be corrected together without additional incision

10.  Lengthening eyelid procedure such magic epicanthoplasty and lateral canthoplasty can be done together.

Call us at 603 22846090 for an appointment to consult Dr Alice Goh.

Follow us at Facebook: Dr Alice Goh
Instagram @dralicegoh

                Cases 1: BB Double Eyelid (Suture Method) with Magic Epicanthoplasty

Case 2: BB Double Eyelid (Suture Method) with Scarless Droopy Eyelid Correction

                    Case 3:BB Double Eyelid (Incision Method) with droopy eyelid correction
                                                          and Magic Epicanthoplasty

                           Case 4: BB Double Eyelid (Suture) with Droopy Eyelid correction

                                            Case 5: BB Double Eyelid (Suture method)
                                               with Scarless Droopy Eyelid Correction

Case 6: BB Double Eyelid (Suture Method) with Scarless Droopy Eyelid Correction

and Magic Epicanthoplasty 

Doctor, Can you make my eyelids longer?

In order to make the eyelid bigger, there are 2 factors to look at :

1. Vertical aperture

2. Horizontal aperture.

The horizontal aperture can be increased by lengthening the inner eyelid corner or outer eyelid corner. This blog will discuss about how to increase the horizontal aperture of the eyelid by increasing the length of the outer eyelid. You may read about the inner eyelid corner lengthening through Magic Epicanthoplasty via link below.

Magic Epicanthoplasty

The outer corner fo the eye where the upper and lower eyelid joins is called the lateral canthus (figure 1). The tendon that holds the lateral canthus to the bone is called the lateral canthal tendon (figure 2). 

The vertical and horizontal aperture is shown here. The inner corner of the eye
is medial canthus and the outer corner of the eye is called lateral canthus.

Figure 2. The lateral canthus is supported by lateral canthal tendon 
attached to the bone.

Over time, the lateral canthal tendon become weak and sags as seen in older patients which may give rise to eyelid malposition. To correct this, the lateral canthal tendon is tightened through surgery to support the aging eyelids.

To widen the eyelids for cosmetic purpose, the lateral canthus can be modified surgically. Cosmetic lateral canthotomy is a simple procedure whereby the lateral canthus is split to widen the horizontal aperture of the eyelid. In this procedure, it is imperative that the lateral canthal tendon is not disrupted so as to maintain the anatomic relationship of the lateral canthus to the bony structure. Therefore, an additional of only 2-4 mm can be achieved with this procedure.  This can be performed along with double eyelid procedure (whether suture or incision technique) and magic epicanthoplasty to achieve longer and wider eye that makes the eye appear larger, wider and more attractive. 

The lateral canthus is split to increase approximately
2-4 mm of the horizontal width of the eyelid.

This patient underwent double eyelid procedure with 

suture method together with lateral canthotomy 

which added an additional 3mm to her eyelid aperture.

As this is a delicate surgery, please make sure that you go to a qualified surgeon if you want to get this procedure done. The surgeon has to understand the anatomy of the eyelid and not compromise the inter-relationship of the lateral canthus and lateral canthal tendon.

What can happen if double eyelid procedure is not done right? 如果双眼皮手术过程没有对的话会发生什么事情呢？

Of late, I have seen quite a number of complications following double eyelid procedure which prompted me to write about this issue.

I am extremely burdened and wish to educate the public of the possible complications, some of which may be sight threatening. A seemingly simple procedure such as double eyelid, if done by the wrong hands can prove futile. Worse, one may potentially become blind.

The common and less dangerous problems with double eyelid procedure using suture method are uneven lid crease and lid crease may be short-lived. The more serious complications such as eyelid infection, bleeding and even corneal abrasion may lead to infection and eventually, blindness. 

I recently treated an unfortunate young lady whose wish to have double eyelids ended with a series of tormenting experiences which she described as her worst nightmare. Through the recommendation of some popular bloggers, she had her double eyelid performed by a non-qualified professional.

The patient developed irritation in the left eye few days after the procedure. The irritation then became discomfort and eventually she couldn't open her eyes due to sharp excruciating pain, swollen eyelid and constant tearing. To my horror, she had developed a corneal abrasion caused by an exposed suture underneath the eyelid which rubbed against the cornea. Thankfully she had seen another eye doctor earlier and was given antibiotics eye drops which had helped to keep the bugs at bay. Otherwise she would have developed a nasty corneal infection. The suture underneath the eyelid was not noticeable at first. It took a while to finally locate the suture. A small incision had to be made to remove the suture as it was difficult to pinpoint the exact origin of the exposed suture. 

The left eyelid was later resutured so that the eyelids would not look lopsided. The right eyelid was also resutured as the eyelid crease had become faint two months after the initial procedure. 

I hope this serves as a valuable lesson to all. Please do not take your eyes lightly. You only have a pair of eyes and it's not worth risking them. If any of you wish to have double eyelid procedure, please do your research to identify the correct professional to perform the procedure, one who is not only able to perform the procedure but is also able to manage the complications should they arise. And if you experience any discomfort or irritation after double eyelid procedure, please contact your doctor immediately.

Useful links below ::

To check if a doctor is registered with Malaysian Medical Council (MMC), you may search under medical register using the link below.

Malaysian Medical Council Medical Register

To determine if a doctor is a specialist registered with the National Specialist Register (NSR), click on link below.

Malaysian National Specialist Register

Good Luck! 

Disclaimer: Pictures published with permission. 

She was unable to open her eyes due with eyelid swelling, tearing and sharp pain in the left eye.
 There were visible sutures floating underneath the skin.

The left cornea is stained green with fluorescein which showed a large
corneal defect involving almost the entire lower half of the cornea.
The picture on the right shows a normal healthy cornea just 2 days after treatment.

At a glance, there was no suture seen (upper pic).
After manipulation and a small incision, the suture was identified and removed (lower pic).

The crease in the right eye has become faint approximately 2 months after
the initial procedure (left pic). The eyelid was resutured (right pic).

Before and After
(1 week after right resuturing procedure, right eyelid still slightly swollen)

Aesthetics and Cosmetic Surgery for Men

According to new figures, men are now just as worried about their appearance as women. Aesthetic treatments and cosmetic surgery are traditionally associated with women. However, we see an increasing trend and demand from men for a wide range of procedures tailored specifically for their needs. 

When treating men, I generally have some rules that I follow which is different from treating women. Men, by and large prefer to preserve their natural, youthful good looks and they typically desire to look more "relaxed" and "well-rested". As such my approach when treating men are rather conservative. 

What are the treatments that can help them?

1. Droopy eyelids or Sagging eyelids

With excess skin which hangs over the eyelid margin make one appears tired, less attentive and unattractive. In more severe cases, one tends to use the forehead muscle to raise the eyelid to increase the visual field. In the long run, this will result in unwanted horizontal forehead lines which is commonly seen in men after 40's. 

To correct this, a simple procedure whereby excess skin is removed. Or when the muscle that elevate the eyelid has become weak, muscle tightening may be done together with skin removal. 

This patient under left muscle tightening procedure and 
skin removal in both eyes which yielded
a much more alert and attractive eyes. 

2. Eyebags

Eyebags always make you look tired even when you are not. Eyebags result from weakening of a fibrous membrane called the orbital septum which holds the fat in place. As you age, the septum weakens causing the fat to prolapse forward and cause puffy under eye. 

There are many approaches to correction eyebags. Depending on the severity, one may opt for surgery or non-surgery. Non-surgical eyebag correction involves injection of which may camouflage the puffy eyelids. This is a quick procedure done in the office with minimal or no downtime. 

In more severe cases, eyebags require surgery for complete correction. 

The under eye has been correction using hyaluronic acid gel filler
which camouflaged the puffy lower eyelids.

3. Forehead Lines

Many male patients come to me requesting to get rid of their forehead wrinkles. These forehead wrinkles may develop due to age and can be treated with toxins to relax the muscle. However, forehead lines may be due to excessive contraction of the forehead (frontalis) muscle. The lines formed are due to constant muscle contraction to compensate for the droopy or sagging eyelid. In this instance, correction of droopy or sagging eyelids by means of surgery will automatically relax the frontalis muscle and lessen the forehead wrinkles. 

This gentleman complained of tired eyes and forehead wrinkles and wish to correct them.
This is a typical patient with forehead lines due to constant contraction of his forehead
muscle to lift his eyelids. After a simple procedure where the excess eyelid skin was removed,
his forehead has naturally appear more relaxed and the lines has reduced tremendously. 

Another example of treating forehead lines without BOTOX.