Another Double Eyelid Disaster from Beauty Salon

Insanity has been defined as doing the same thing over and over again and expecting different results. In the following case, the insane one is the patient and the beautician the unscrupulous one.

This 15 year-old girl presented with multiple swellings of both upper eyelids along the skin creases. She underwent four double eyelid surgeries over the past 12 months. The procedures were performed by the same beautician in a bauty/hair salon over a two year period. However, each time the double eyelids failed to form and after the last surgery which was 9 months ago, she was left with unsightly lumps in her upper eyelids. The beautician was unable to offer any remedial treatment for the swellings and as expected told her that she got "special" eyelids which were not suitable for double eyelid surgery.

The arrows in the top picture show the lumpy lesions. The bottom

picture show the prolene sutures excise (arrows).

She became depressed and afraid to go out for fear people would see the lumps. To get rid of the lumps and at the same time create stable double eyelids, I perform the incision technique . The lumpy lesions were found to be caused by prolene sutures wich were placed repeatedly by the beautician in the hopeless attempt to create double eyelids. These sutures were excised and skin creases were created with a height of 7 mm. She made an uneventful recovery.

The eyelids before and after revision with the lumpy

lesions removed.

The Hollywood Double Eyelids (blepharoplasty)

In my previous blog, I discussed the type of double eyelids (high skin creases with hollow upper eyelids) that some young Hollywood actresses used to aspire to but is not longer in fashion. However, when the new generation of Hollywood celebrities grow old and develop excess upper eyelid skin (dermatochalasis), they invariably go to Hollywood cosmetic surgeons who all seem to be taught by the same teacher. They without fail create hollow upper eyelid with exceedingly high double eyelids and elevate eyebrows (through brow lifts). Consequently, these ageing celebrities seem to have come out from the same factory. Unfortunately, these make them appear old as the loss of fat in the orbit (as evidenced by hollow orbit) is one of the sign of ageing.

Some victims of Hollywood blepharoplasty.

Do Caucasians Need Double Eyelid Surgery?

Almost all Caucasians are born with double eyelids so one may assume that they don't need double eyelids to make their eyes bigger. However, you may be surprised that some Caucasians undergo eyelid surgery to make their double eyelids even higher as these are thought to make them more glamorous. These so-called "Hollywood blepharoplasty" used to be popular amongst leading Hollywood actresses in th 50s and 60s and the most famous of which is Marilyn Monroe. To achieve these Hollywood double eyelids, the surgeons would remove orbital fat to make the eye sunken and suture the skin creases excessively high so that the patient would have some degrees of droopy eyelids. That may be why Marilyn Monroe always has a sleepy look.

Nowaday these looks are thankfully out of fashion, all the Hollywood movies would be full of sleepy beauties. Nonetheless, the height of the skin creases used to confer audience and director impression of the actress and got them tyecasted. A high skin creases gives the impression of a larger eye opening and accentuates the expression of the upper lid and much favored by leading actresses playing seductress. A low skin crease, in contrast, gives the eye a narrow and rather expressionless look. However, this can give mystery and intrigue to some actresses making them prime choice for mystery movies.

Marlene Dietrich (right) with her high double eyelids always played

seductress whereas Laura Bacall with her low double eyelids always 

casted as the woman of mystery.



Botched Dobble Eyelid Surgery by Phony Surgeon and How to Check the Validity of Your Doctor

This unfortunate woman came to see me a few months ago after a botched double eyelid surgery performed by a "doctor". Examination showed that she had unequal double eyelid heights and the double eyelids were too deep with unsightly scars. In addition, she had sunken orbit as a result of too much orbital fat being removed. She returned to the doctor but was told he did what she wanted and he could not see any problems.

When I asked her about the doctor, she produced a name card which showed the doctor had an oversea qualification. I began to smell a rat when she told me that he performed the procedure in his wife's beauty salon. I searched for the doctor name in the Malaysian Medical Council Register and could not locate his name. It is bad enough for ignorant people to have double eyelid surgery performed in beauty salon without proper sterilization and worse still for some crooks pretending to be doctors and peform invasive procedures.

If you want to find out if your doctor is genuine, you may visit the Malaysian Medical Council and enter his/her name to verify his qualification.

Botched Double Eyelid Surgery in Beauty Salon

This 50 year-old woman presented with bilateral droopy eyelids and unequal double eyelids. She underwent double eyelid surgery in a beauty salon two years ago. Suture technique was employed. She noticed the two eyelid were not right the next day and returned to the beautician for advice. However, she was told that her eyes were normal. Since the operation, she has been reluctant to go out for fear of being ridiculed.

In order to correct the problems, the double eyelids need to be re-operated using the incision technique to lower and balance the double eyelids. It is illegal for non-trained personnel to perform medical procedure in Malaysia, unfortunately, the law is not well enforced. Consequently, there are many botched surgery being performed in beauty salons for quick profit. I shall show more of such cases in future blogs.

Case 2: Excision of Basal Cell Carcinoma with Reconstruction

This patient has a lesion on the nasal side of her right eyelid which bled easily on contact. A biopsy confirmed basal cell carcinoma. Fortunately, the lesion was a distance away from the punctum (the holes that drain the tear) otherwise there was a risk of the tumour spreading into the deep structure. The resulting defect was covered using rotation flap.

A lesion on the nasal side of the right eye.

The tumour was marked with 3mm margin to ensure sufficient

excision of the tumour without leaving behind any tumour cells.

The defect was covered with a rotation flap.

 

The rotation flap was created to cover the defect.

The defect was partially covered by the flap. The remaining

defect was closed directly.

At the conclusion of reconstruction.

Diagrams showing the principle of rotation flap.

Don't Worry its Just a Small Black Head - An Unwanted Side-effect of Suture Technique for Double Eyelid

This 46 year-old woman underwent double eyelid procedure in a beauty saloon 2 year ago. The procedure was performed by a so-called "beauty surgeon" employed by the saloon. Although, she got her double eyelids but she was unhappy with the excess skin hanging over her skin creases (double eyelids) which the beauty surgeon was unable to do anything. Recently, she had been bothered by constant irritation in the left upper eyelid and a black spot. She returned to the beauty saloon but was told by the owner that it was just a small black head and there was nothing to worry about. When the patient asked to see the beauty surgeon, the saloon owner says she had no idea where she was as she only employed those surgeons on one-off basis.

Poor double eyelid formation because the excess upper

eyelid skin was not addressed.

A black spot causing recurrent irritation in the left

upper eyelid.

When I examined her the black head appears to be the end of the suture used to form the double eyelids. The "black head" was cut and removed it in entirety. 

The suture was pulled and cut.

The whole suture removed and appeared to be 6/0 nylon.

Although suture technique is useful in young patients,  in older people with excess upper eyelid skin (dermatochalasiss), it does not work well. The treatment of choice for this lady would be to combine double eyelid surgery with removal of the excess skin and this could be achieved with incision technique.

The suture technique used in this patient is the two-way continuous buried-suture approach as shown in the diagram above. Picture A 7 to 9 incisions for the creation of a pretarsal crease are made with the tip of a No. 11 scalpel blade, approximately 1 mm long, and are placed approximately 5–7 mm apart in a gentle curving arc. The line begins 5 mm lateral to the medial canthus and ends 10 mm lateral to the lateral canthus. Picture B The first pass of the suture is from lateral to medial, capturing dermis between alternating incisions and superifical tarsal plate between dermal bites. Picture C The suture is then reversed and passed from medial to lateral, capturing dermis and tarsus in the opposite intervening segments.