Tuesday, July 24, 2018

20 Minutes to Correct Triangular-shaped Eyes

This young man was unhappy with the shape of his eyelids which made him look tired and uninterested. To make the eyes appear more animated without making the skin creases too high. Bilateral suture techniques were done and the creases set at 6mm. The lower picture was taken 10 days after the procedure.

Monday, June 25, 2018

Advantages of Posterior Approach Ptosis Operation for Mild to Moderate Ptosis


saw this 70-year-old man yesterday who had had trouble opening his right eye for the past 5 years. The levator function was 10mm in the right eye and 13 Mum in the left eye. The ptosis occluded his right visual axis making driving difficult due to the lack of binocular vision. The eyelid did not open in response to mydfrin (2.5% phenylephrine). A posterior approach levator advancement was performed with good result. The bottom picture was taken this morning. Two of the great advantages of posterior approach ptosis correction is fast recovery and no need for suture removal.

Friday, February 2, 2018

Relationship between skin crease and ptosis surgery

The show of double eyelids (the amount of double eyelids visible when the patient look ahead) after ptosis correction is best illustrated in this patient. This patient had bilateral droopy eyelids and multiple skin creases (top picture). However, she attributed her sleepy appearance to indistjnct double eyelids. When the droopy eyelids was pointed out to her she agreed to have ptosis correction via posterior approach. The double eyelid heights were set at her original skin creases at about 7mm (middle photo, the blue dots indicate the height of the skin crease set). After the operations, she no longer appeared sleepy but was unhappy that her double eyelids were barely visible. The reason for this is because the patient had associated dermatochalasis (excess skin) which covered the skin creases (double eyelids). To make the double eyelids visible, the excess skin above the skin crease need to be excised for this patient. 

Wednesday, January 24, 2018

Ptosis may present as multiple and indistinct double eyelids

Although patients with ptosis usually complain of droopy eyelids or tired looking eyes, some may present with multiple skin creases (double eyelids, red arrow) or sunken upper eyelid (sunken sulcus, blue arrow). It is important for doctors to detect Ptosis in such patients otherwise double eyelid surgery or filler injection may exacerbate the ptosis. This patient who was a contact lens wearer complained her natural double eyelids (skin creases) were faints and multiple (top picture). She asked for double eyelid surgery. However, examination showed she had bilateral ptosis and creation of double eyelids would only make the eyes more droopy and tired (middle photo). Posterior approach ptosis correction was done and the patient was happy that she looked more alert and the multiple skin creases and sunken sulcus were also corrected (bottom picture taken one week after ptosis correction).

Monday, January 22, 2018

Transient eyelid asymmetry after ptosis correction

This patient also had contact lens induced left ptosis (droopy eyelid, top picture). Correction of the left ptosis resulted in droopy of the right ptosis which alarmed the patient (middle picture taken at one week after posterior approach ptosis correction). Two main factors may be responsible for this phenomenon: a. The patient had ptosis in both eyes with one eye being more severely affected. Therefore, successful correction of one eye will bring out the contralateral ptosis. b. The ptotic eye was overcorrected resulting in the opposite eye becoming droopy. However, most oculoplastic surgeons usually overcorrect droopy eyelid slightly so that any drop of the eyelid during recovery will be compensated. 
As this patient did not have right ptosis before the operation, the most likely cause for the imbalance is factor b and she was reassured. At 6 weeks follow-up the two eyes were nearly symmetrical (bottom picture).

Another patient with contact lens induced ptosis

Another patient with contact lens induced ptosis. The left ptosis was also corrected with posterior approach correction which is the preferred method as the down time is minimal. The bottom photo was taken 5 days after the operation.

Wednesday, January 17, 2018

Contact lens induced droopy eyelid (ptosis)

Contact lens wear (both hard and soft) is a known risk factor for Ptosis (droopy eyelid) in people under age of 35. The reasons may be : a. Stretching of the eyelid during contact lens insertion and removal and b. Low grade inflammation from contact lens may weaken the eyelid structure. This 35-year-old woman had been a contact lens wearer for over 20 years in the past 2 years she noticed the left eye had become progressively more droopy. Examination showed no neurological causes and a posterior approach ptosis correction restored the lid to the desirable level (bottom picture taken at two weeks post surgery). For more information, click here for contact lens induced ptosis