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. 

Good turn-out for the Aesthetic and Cosmetic Surgery updates. Here are our lucky winners!

On 16 October 2014, ISEC Penang organized a talk on "Advances of Aesthetic & Cosmetic Surgery from Korea & USA".

I presented 3 talks :

1. New Concept on Facial Ageing
2. Advances of Aesthetic & Cosmetic Surgery from Korea & USA
3. DOs and DON'Ts in Aesthetics

It was a fun-filled day. The turn-out was very encouraging despite being a weekday and during office hours. I am glad to meet all the attendees and had a good interactive sessions with them. I also managed to do a live demo for dermal filler injection of the eyebag. It was the first time for many of them to watch a live injection.

There were 3 lucky draw winners, each received free aesthetic treatments. The grand prize winner walked away with a free eyelid and medial epicanthoplasty surgery.

Yummy and healthy food for the participants.

 I will be visiting ISEC Penang 20 & 21 November 2014. For appointments kindly call 04 228 8802. Address 229, Jalan Burma, Penang.

美学与美容手术的公共讲座

When : Thursday 16 October 2014  10am

              Where : International Specialist Eye Center (ISEC)

   229, Jalan Burma, Penang

Advances in Aesthetics & Cosmetic Eyelid Surgery from Korea and USA

Hi friends from the Northern region esp Penang, International Specialist Eye Center (ISEC) Penang is organizing an update on 'Advances in Aesthetics & Cosmetic Eyelid Surgery from Korea & USA' featuring Dr Alice Goh, a board certified Oculoplastic Surgeon trained in Samsung Medical Center, Seoul, Korea & UCLA, Los Angeles, USA.

Come and join us for a fun-filled day and learn from the professionals on new advances, what you should know about aesthetic treatments, DOs & DONTs, door gifts, Live Demo and Lucky Draws.

You could win yourself a FREE double eyelid + epicanthoplasty correction and other beauty treatments to be won!

Lunch will be served.

Agenda
1000H Registration & Door Gifts
1030H New concepts in Facial Aging
1045H New Advances in Aesthetics & Cosmetic Eyelid Surgery
1130H DOs & DONTs
1145H Lucky Draw
1200H Lunch
1230H Q & A Ask the experts
1300H Live Demo on aesthetic treatments and delivery of treatments for lucky draw winners

Date:    Thursday 16 October 2014
Time :  1000H - 1400H
Venue: 229, Jalan Burma, Penang
www.isecpenang.my

Please call/ email for free registration

Call 04 228 8802
 jocelynchong@isec.my

Doctor, I want a double eyelid but do I need an epicanthoplasty? 医生，我想有双眼皮，但我需要开眼头吗？

In my previous blog, I discussed about the difference between having double eyelid surgery alone vs double eyelid & epicanthoplasty. This blog talks about the different types of epicanthal fold and how to determine if epicanthoplasty is needed.

It is important to first identify if you have an epicanthal fold. If you do, what is the type of epicanthal fold because this will determine the amount of correction needed. You can see for yourself in the mirror if your caruncle is covered by a fold of skin.

There are 4 main types of epicanthal fold whereby only 3 types require correction. 

Type I is when the lacrimal lake or caruncle is fully exposed and no correction is needed.

Type II-III are the most common ones that I come across in Malaysia, with varying degrees of severity.

Type IV is relatively rarer.

The description of various epicanthal fold is illustrated below.

I routinely recommend epicanthoplasty for most (but not all) of my patients now because I really do think that creating double eyelid combined with epicanthoplasty has a more superior and accentuated effect. In selected individuals, correcting epicanthal fold will allow full exposure of the inner eye corner and lacrimal caruncle. This will further increase the horizontal eye aperture and overall widen the eyes that makes it brighter, more attractive and easier to apply eyeliner. With epicanthoplasty, I can also decide to create a tapered or parallel eyelid crease, depending on patient's desire. 

Epicanthoplasty surgery needs precision and skill to achieve favorable outcome. The most common complication associated with this surgery is scarring. The inner eye corner is multi contoured and the skin is really thin. Incision made here has to be so precise that it is hidden so that no visible scar is noticeable after healing. 

This patient had a low eyelid crease and a mild Type II epicanthal fold especially in the left eye.
She wanted a natural crease and correction of epicanthal fold.
She underwent suture double eyelid and epicanthoplasty correction.
Picture here is before and 3 days after. 

This patient had thicker and puffy eyelid and an unusual Type IV epicanthal fold.
You can observe that the fold originated from below and curved upwards.
She also wanted a natural crease and reduce the eyelid puffiness.
She underwent incisional double eyelid and epicanthoplasty correction.
This is before and 1 week after.