"People say I always stare at them and my eyes are uncomfortable"

This woman suffered from hyperthyroidism as a result of Grave's disease a year ago. While she was under treatment, she noticed her eyes became prorgressively more protruding and the upper eyelids began to retract. About 30% of sufferers of Graves' disease will also suffer from Graves' ophthalmopathy that's what this patient had. Her friends and family members were uncomfortable talking to her face to face as she always appears to be staring at them. The retraction of the upper eyelids is giving her a lot of discomfort because of rapid evaporation of the tears. She was forced to use artificial tears hourly.

To improve her appearance and reduce the discomfort, I decided to perform eyelid lowering procedure on her after making sure that her thyroid status and the eyelid retraction were stable. The procedure I used is called müllerectomy which means the removal of Müller's muscle. This is a small muscle of the upper eyelid used to open the eyelid (the other muscle is called levator). Special thanks to Dr. Ting Siew Leng for taking these photos.

Thyroid eye disease with staring eyes due to protrusion

and upper eyelid retractions.

Injection with lignocaine and epinephrine given to

the conjunctiva before operation.

The conjunctiva is cut above the tarsal plate.

The conjunctiva is exposed to reveal the underlying

Muller's muscle.

The Muller's muscle is grasped and dissected from

the conjunctiva and the levator aponeurosis.

More dissection was performed to make sure all Muller's muscle

 was included in the removal.

The Muller's muscle is clamped to reduce bleeding

before it was excised.

After removing the Muller's muscle, the conjunctiva is

closed with buried 6/0 vicryl.

The retracted eyelids were lowered at the end

of the operation.

Doctor, Can You Restore my Double Eyelids?

Revisional Asian blepharoplasty is the term used if a second operation is needed after the initial double eyelid surgery. There are many reasons for revisional Asian blepharoplasty and one of the most common reasons is to restore a double eyelid that disappears. As I mentioned in the previous blog, the disappearance of double eyelid is usually caused by loosening of attachment of the skin to the underlying levator (the muscle that open the eye) so the revision involves restoring this attachment. Depending on the presence of scar tissue, excess skin or puffiness (from inadequate fat removal), the revision can be performed with either a suture technique or incision technique. If there were no excess skin or puffiness of the eyelid, I usually use the suture technique to restore the double eyelid as it has shorter down time. Otherwise, an incision technique is needed to either remove the excess skin to give a more youthful appearance or underlying fatty tissue to allow a better adhesion between the skin and the underlying muscle.

A double eyelid restored with suture technique. There was

no puffiness or excess skin in this eye.

Another double eyelid restored with suture technique. Again,

the eye is suitable for suture technique as there is no excess

skin or puffiness.

This patient had scar tissue, excess skin and multiple folds.

An incision technique was used to restore the double eyelid.

The picutre on the right shows the result second day

 post-operative.

This patient had had suture technique done for double eyelids twice

in a beauty saloon. Examination revealed excess skin and puffiness,

she underwent revisional Asian blepharoplasty using

the incision technique.