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. 

3D Radiance Part 1 - Nose Contouring 3D的亮采Part 1 - 鼻子轮廓

Facial contouring entails enhancing these facial structures; forehead, nose, cheeks, lips, chin and jawline.

This blog will address nose contouring. 

The nose is the second most prominent feature on the face after the eyes. Besides contouring the cheeks, nose contouring is powerful in restructuring the face. A higher, narrower nasal bridge and tip can make the face appear slimmer and more radiant. East Asians (Orientals) by and large have a different bony structure compared to Caucasians. The nasal bone (nose bone) and zygoma (cheek bone) are less prominent, giving them a rather "flat" facial features. In addition, a prominent mandible bone (jaw bone) give a broad jawline and weak chin further "flattens" the face. 

Traditionally, nose contouring is achieved through surgery using implant such as ear, septal cartilage or synthetic material like silicone. Now with non-surgical techniques, the nose can also be recontoured to achieve a more 3-dimensional (3D) effect which gives definition and illumination to create a sleek, sculpted look. 

This patient's nose was contoured which created a natural 3D effect
with a more well defined nasal bridge, body and tip.

这名患者的鼻子轮廓的创造了一个自然的3D效果 

一个更明确的鼻梁，身体和鼻尖

Google Translate:

面部轮廓限嗣继承增强这些面部结构;额头，鼻子，脸颊，嘴唇 和下巴。 

这个博客将针对鼻子的轮廓。 

鼻子上的眼睛后，面临的第二个最突出的特点。除了轮廓的脸颊，鼻子轮廓是重组面前的强大。更高，更窄的鼻梁和小费可以使脸显得更苗条，更容光焕发。东亚人（东方人）大体上有不同的骨性结构较白种人。鼻骨（鼻梁骨）和颧弓（颧骨）不太突出，给他们一个比较“平”的面部特征。此外，一个突出的下颌骨（下巴骨）给出了广阔的下巴和下巴疲软进一步“变平”的脸。 

传统上，鼻子轮廓是通过手术来实现，其中植入物，如耳朵，鼻中隔软骨或类似硅合成材料。现在，随着非手术技术，鼻子可以的轮廓，以实现更3维（3D），它给出了定义和照明营造一个时尚，雕刻的样子。

Doctor, Please make my eyes smaller! 医生，请让我的眼睛更小！

In most instances, patients come in to see me requesting for larger and longer eyes. However, having big and prominent eyes may not always turn out to be attractive. There are some conditions where you can have prominent, 'bulging' eyes which give a stark or stare appearance and this can be pretty daunting. Thyroid Eye Disease and extreme short sightedness are 2 common conditions. Thyroid Eye Disease causes inflammation and swelling of the soft tissue behind the globe thus pushing the eyeball forward. The axial length of the eyeball is much longer in patients with extreme short sightedness, therefore the eyes appear prominent. Besides cosmetic disfigurement, these patients usually suffer discomfort and dry eye due to constant eye exposure.

What can we do to improve the cosmesis and eye comfort for such patients?

In severe cases, the definitive treatment is orbital decompression surgery whereby orbital bones are removed and sculpted to create more bony space to accommodate the globe. In mild to moderate cases, the eyelids can be sutured together to narrow down the eyelid aperture. Other minimally invasive modalities such as Botulinum Toxin A and hyaluronic acid gel filler can also do the trick.

This patient was very distressed with the prominent and stare look. 

She also suffers extreme eye discomfort due to dry eye.

 After narrowing the eyelid aperture, she not only looks better, her eyes also feel more comfortable.

这名患者是很心疼的突出和星空的样子。

她也遭受极端眼部不适，由于干眼病。

缩小眼睑光圈后，她不仅更好看，她也感觉更舒服。

Google Translate:

在大多数情况下，病人来见我，要求较大和较长的眼睛。然而，有大而突出的眼睛可能并不总会有吸引力。有一些条件，你可以有显着的“胀”眼睛能给出一个鲜明的或凝视的外观，这可以是相当艰巨的。甲状腺眼病和极端短视2个常见的情况。甲状腺眼病引起炎症后面的地球从而将眼球向前的软组织和肿胀。眼球的轴向长度更长患者极度近视，因此眼睛出现突出。除了化妆品毁容，这些患者通常患有不适，干眼是由于眼球不断曝光。

我们可以做些什么来改善外观效果和眼睛舒适为此类患者？

在严重的情况下，彻底治疗是眼眶减压手术，从而眼眶的骨头被移除，雕刻，创造更多的骨性空间来容纳全球。在轻度至中度的情况下，眼睑可以缝合在一起，缩小眼睑光圈。等微创方式，如A型肉毒毒素和透明质酸凝胶填充物也可以做的伎俩。

How do I preserve my natural double eyelid crease when undergoing eyelid surgery?

The medical term used to address the excess upper eyelid skin is called Dermatochalasis. This is commonly seen in patients in their 40's onwards when the underlying soft tissue loses volume and the skin loses its elasticity. This causes the skin to hang over the eyelid margin and makes the eyes appear droopy and tired. Blepharoplasty is the surgery performed by most surgeon to remove the excess upper eyelid skin. The traditional blepharoplasty surgery utilizes an incision in the eyelid to remove the excess skin and creating a double eyelid crease. This invariably leaves behind a faint scar on the eyelid after surgery. 

What happens when patients have existing double eyelid crease and wish to preserve their natural crease? In such cases, a surgical approach called infrabrow blepharoplasty can be used to address the excess upper eyelid skin without creating a surgical scar on the eyelid. This way, the natural eyelid crease can be preserved. A faint scar will be seen underneath the eyebrow which can be tattooed over after surgery and the scar will no longer be visible. 

Infrabrow blepharoplasty can be combined with medial epicanthoplasty to increase the vertical and horizontal aperture of the eyes to make it even bigger and brighter!

This patient underwent infrabrow blepharoplasty and medial epicanthoplasty. 

The scar below the eyebrow and inner corner eyelid is almost invisible 

even only 2 weeks after the surgery. 

这名患者接受了提眉和眼角手术。

眉和内眼角眼皮下面的疤痕几乎看不见手术后即使只有2个星期。

Google Translate:

用于解决过剩上睑皮肤医学术语称为Dermatochalasis。这是常见于患者在他们的40年代开始，当底层的软组织损失量和皮肤失去弹性。这会导致皮肤挂在眼睑缘，使眼睛看起来下垂而疲惫。眼袋是由多数外科医生进行，以除去过量的上眼睑皮肤的手术。传统的眼袋手术利用一个切口在眼睑以除去多余的皮肤和创建双眼皮折痕。这往往会留下淡淡的疤痕在手术后的眼睑。 

当患者有现有的双眼皮折痕，并希望保持其自然折痕，会发生什么？在这种情况下，手术方法称为infrabrow blepharoplasty (提眉手术)可以用来解决多余上睑皮肤不会造成上眼睑手术疤痕。这样一来，自然双眼皮得以保存。一丝淡淡的疤痕会被视为可手术后刺过来，疤痕将不再可见眉毛下方。 

Infrabrow blepharoplasty (提眉手术) 可以与内侧epicanthoplasty (眼角手术)被组合以增加眼睛的纵向和横向的孔，使之甚至更大更亮！

Cosmetic lateral canthoplasty and its potential complications

Lateral canthoplasty is a common cosmetic procedure whereby the outer corner of the eye is split to widen the horizontal aperture of the eye. It can be performed together with double eyelid surgery and medial epicanthoplasty to achieve longer and wider eye that makes the eye appear larger, wider and more attractive.


However, if not properly performed can give rise to complications. One of the complications that may arise from lateral canthoplasty is lacrimal ductule fistula, as seen in this patient. She had the lateral canthoplasty surgery done elsewhere a couple of months ago. She was referred to me for uncontrollable tearing. She started tearing a few weeks after the surgery. It has become a nuisance as she needs to wipe her eyes frequently and her eyeliner would not stay and smudge. 


The treatment for the fistula is called fistulectomy surgery whereby the tiny passage connecting to the lacrimal gland is excised and sutured.  

This patient underwent fistulectomy surgery and the tearing subsided immediately after the surgery.

Google Translate:

眼尾手术是一种常见的化妆品程序，使眼睛的外角被分割加宽眼睛的横向孔。它可与双眼皮和内眼角手术实现更长更宽的眼睛，使眼睛显得更大，更广泛，更具吸引力的进行。 

然而，如果没有正确地进行可产生并发症。一个可能产生的横向canthoplasty的并发症是下泪小管瘘，如在本例看出。她有横向内眼角手术别处做了几个月前。她称我为无法控制的撕裂。她开始在手术后撕裂了几个星期。它已成为一个麻烦，因为她需要经常擦拭她的眼睛和她的眼线不会留下污迹。 

为瘘的治疗被称为瘘管切除手术从而微小通道连接到泪腺切除和缝合。

这名患者接受了瘘管切除手术，手术后立即消退撕裂。

Doctor Help! I can't close my eye! 医生帮帮我！我不能闭上我的眼睛！

Lagophthalmos is a condition whereby one is unable to close the eyelid completely. It can be seen in a variety of conditions involving the facial nerve or eyelid itself. The common causes involving facial nerve is trauma, stroke or tumor. However, more commonly lagophthalmos is due trauma to the eyelids which form cicatrix, or after eyelid surgery whereby excessive eyelid skin has been removed. Lagophthalmos can also be seen in certain patients with prominent eyes such as Thyroid Eye Disease or high myopia. This condition may appear inconsequential but can be detrimental in the long run. Constant eye exposure to the air may dry the eye which leads to dryness, discomfort, foreign body sensation and reflex tearing.

Before and 4 days after scar subcision and hyaluronic acid gel filler

 The patient above sustained a full thickness eyelid laceration 2 years ago. She developed a notched eyelid margin and a contraction band that pulled the eyelid upwards causing lagophthalmos. She has been having tremendous discomfort and unable to sleep at night due to chronic exposure.

The definitive treatment for such condition is a reconstructive surgery. The eyelid margin needs to be reconstructed to yield a smooth alignment. The contraction band can be released by means of a Z-plasty. However, she has limited time in Malaysia and wanted a minimally invasive approach.

The contracted scar band was subcised and stented with hyaluronic acid gel filler. A few days later, I injected 5FU into the subcised scar band. She felt much more comfortable now and she told me she managed to sleep through the night, which she couldn't do in a long time.

This is not the definitive treatment but may help her to buy time while she arranges for the next visit to Malaysia for reconstructive surgery.

Combined Double Eyelid and Epi Surgery is more superior than Double Eyelid Surgery alone 联合双眼皮和眼角手术是比单纯做双眼皮手术更出众

In Asians or Orientals, there is a skin fold that covers the inner corner of the eye which makes the eye look small and narrow. This fold of skin is called the epicanthal fold. Inner corner eye surgery or medial epicathoplasty or in short, epi surgery is a surgery to correct the epicanthal fold and widen the width of the eye so that the eyes become larger and brighter. 

The conventional double eyelid surgery may increase the vertical height of the eye but does not address the epicanthal fold. Correcting the epicanthal fold will increase the horizontal width of the eye thus making the eye even larger and more attractive. In addition, it is easier to apply eyeliner and shimmery eye shadow when applied can be seen which brightens the eye further. 

Google Translate:

在亚洲人或东方人，有一个皮肤褶皱，覆盖这使得眼睛看起来小而窄眼睛的内角。皮肤褶皱这种被称为内眦倍。内眼角眼部手术或内侧epicathoplasty或短，外延手术是一种外科手术，以矫正内眦倍和扩大眼睛的宽度，使眼睛变得更大，更明亮。

传统双眼皮手术可能会增加眼睛的垂直高度，但并没有解决内眦倍。校正内眦折将增加的眼从而使眼睛变得更大，更吸引人的水平宽度。此外，它是比较容易申请眼线和当施加可以看出其照亮眼睛还闪闪眼影。

Asians vs Caucasians 亚洲人与白种人

Most people say Asian girls want to have eyelid surgery so they can look like caucasians. This concept of westernization is obsolete. Various eyelid surgeries (e.g double eyelid, epicanthoplasty or lateral canthoplasty) are aimed to create a visible eyelid crease, increase vertical or horizontal eye aperture so that the eyes appear to be larger and brighter, without losing one's ethnicity. In order to achieve that, it's important to study the face carefully and design an eyelid that best suits each individual so that it's harmoniously blended to the rest of the face. ~AG~

Google Translate: 

人们总是说亚洲/东方女孩想拥有双眼皮手术，使他们能够像白种人。西方的这种观念已经过时了。不同的眼皮手术（如双眼皮，内眼角或眼尾手术），旨在创建一个可见的双眼皮，增大垂直或水平眼光圈，使眼睛显得更大，更亮，又不失自己的种族。为了实现这一目标，重要的是要仔细研究的脸，设计出最适合每一个人，这样它和谐地融合到脸部其他处之。