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)