Epicanthoplasty to make the eyes bigger

Just done 6 eyelid operations for the day. In addition to removing the epicanthus (the excess skin that cover the nasal side of the eye), epicanthoplasty also lengthens the eyes and make the eyes appear bigger. There are several ways to perform epicanthoplasty and some methods create more scars than others, the one I prefer is skin redraping procedure which leave inconspicuous scars along the lid margins. This young woman under such technique, the first picture was taken before the procedure, the middle one immediately after the operation and the bottom 10 days later. #epicanthoplasty #双眼皮 #开眼角 #蔡鐘能眼科医生 #眼角 #epicanthus #blepharoplasty #eyelengthening #skinredraping #doubleeyelidsurgery #drchuachungnen #isecsibu #kuchingoptimax #ttdiopyimax #kliptimax #penangoptimax #miricolumbiaasia #sarawakeye #malaysiaeyelids #malaysiaeyelidsurgery #kuchingeyespecialist #sibueyespecialist #mirieyespecialist #oculoplastic #eyespecialist

Double Eyelids for a 5-year-old Boy

Not all double eyelid surgery (Asian blepharoplasty) are done for aesthetic purposes. This 5-year-old boy had a long history of eye irritation and blurred vision. Examination showed ingrowing eyelashes exacerbated by his puffy eyelids and lack of skin creases (double eyelids). I created low skin creases (for boys double eyelids should be made low and girls higher) and everted the eyelashes. The creation of skin creases (double eyelids) not only made the eyes appear bigger but also prevent the upper eyelid skin from coming over the eyes and push the eyelashes inwards. The operation was done under general anaesthesia and the lower pictures were taken 6 months later.

An elderly man with droopy eyelids

This 75-year-old had ptosis (droopy eyelids due to weak levator muscles) since since young. He did not seek help as he was able to see by lifting his head slightly. However, over the last 5 years, he was unable to see well even by lifting his chin by 45 degrees. This was because the ptosis has been compounded by dermatochalasis (droopy eyelids due to excess upper eyelid skin). To improve his vision, bilateral upper blepharoplasty was combined with frontalis suspension. The bottom picture was taken at 4 weeks follow-up. 

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.

Advantages of Posterior Approach Ptosis Operation for Mild to Moderate Ptosis

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I 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.

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. 

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).

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.

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

Droopy Eyelid (Ptosis) after Double Eyelid Surgery

This young woman had double eyelid surgery performed in a beauty saloon by a visiting China “doctor” . Postoperatively she noted the right eye to be droopy in the medial two third of the upper lid. She returned to the “doctor” and was reassured that it will correct itself in a few months. But the droopiness persisted. When she returned to the beauty saloon, the owner of the centre told her the “doctor” would not return and asked her to see the new visiting “doctor”. The later told the patient that she was unable to correct the droopy eyelid and asked her to seek help in “proper” medical centre. On examination, she appeared to have damage to the medial 2/3 of her levator aponeurosis. Posterior conjunctivomullerextomy was performed with good outcome (bottom picture taken at one month postoperative).