3 Must Know Steps before Eyelid Surgery - Step 1

Continuation of the lecture of "3 Must Know Steps before Eyelid Surgery"

The slide summarizes the first step before embarking on eyelid

surgery.

Some patients bring their favourite film stars and wanting to look

 exactly like them. While it may be possible to achieve some

resemblance of eye shapes, an exact copy is not always 

possible. Beware of doctors who over promise as

they often under deliver.

Pictures of film stars and celebrities before and after eyelid surgery

may mislead patients to believe eyelid surgery can make them appear

 glamorous and may be disappointed when the operations only

enhance their appearance.

Western magazine featuring glamourous female Caucasians make some

Malaysian readers wanting to achieve the same deep-set looking

eyes. Unfortunately, the results can be a facial mismatch because

of ethnic differences in the facial features (bone structures,mouth

and nose). 

This girl wanted to appear like her idol. I promises to give her good

looking double eyelids but advise against having deep set eyes as

she would appear odd and may lose her ethnic identity which

she may regret.

After eyelid surgery, there would be a period of recovery and patients

have to be aware of these and avoid being over anxious. Although

eyelid surgery can drastically appear the appearance of some

patients, most would be enhancement.

Some patients are insistent of achieving a certain look and after careful

counselling to ascertain they don't have any psychological problems,

it is safe to produce the desired results. However, it is important

 to warn the patients the resutls may be difficult to reverse.

Will continue the lecture in my next blog.

3 Must Known Steps before Eyelid Surgery - Introduction

I gave this presentation last Sunday in Jalan Yap Kuan Seng, Kuala Lumpur. For the benefit of those who could not attend the lecture, I have chosen the main points of the presentation for this and the next 3 blogs. This is the introduction bit to the presentation.

 

 The above are some of the patients I had operated on. As can be seen, 

not all eyelid operations are cosmetic surgery, some conditions can 

interferes with the vision and some may be life-threatening.

 If you show these photos to the public and ask them to rate

the persons according to intelligence, friendliness, health, 

trustworthiness,  attractiveness and whom you would are 

more llikely to employ.

The majority of the public, based on the appearance alone, 

will give positive attributes to the above photos as 

shown (tips) and more likely to employ these people.

However, what the public was unaware of were that some 

of the pictures belong to the same persons before and

post eyelid surgery. Although we want to believe that look 

or beauty is only skin deep, but most people based

their perceptions based solely on the person's appearance. 

Those who have ageing changes or abnormal eyelid

shapes are being disadvantaged in their social life.

The lecture will continue tomorrow.

3 Must Know Steps before Eyelid Surgery

I shall be giving a talk on the 13th March (Sunday) at 11:00am entitled "3 Must Know Steps before Eyelid Surgery". Everybody welcomed.

Optimax
No:33, Lot 2,Ground Floor,
Jalan Yap Kwan Seng,
50450 Kuala Lumpur.
Tel: 03-2164 2846 Fax: 03-2164 2849

Reconstruction of a Poorly Repaired Upper Eyelid Trauma

The patient discussed in the previous blog underwent eyelid reconstruction yesterday. There are several ways that the eyelid could be repaired, the one used here was my own choice and other oculoplastic surgeon might well do it differently. The main reason I chose this technique was because the scars will be confined to the upper eyelid. The other techniques that can be used in this case include pentagon excision of the peaked eyelids followed by reconstruction using reversedTenzel's flap or McGregor's flap, however, these techniques will create additional scarring outside the upper eyelid.

 

The upper eyelids were marked to create two sliding flaps.

Creation of the sliding flaps. Note the retraction is partially 

released due to the release of the contracted skin.

The scarred and poorly apposed eyelid was removed 

through pentagon excision.

 

 Following the pentagon excision.

 

The two ends of the eyelids were apposed accurately.

At the conclusion of the repair.

The two sliding flaps were sutured in a Z fashion to lighten 

the wound.

The eye 24 hours after the surgery. The eye is closed with 

4/0 silk to prevent excessive eyelid movement 

which may affect the viability of the flaps.

The postoperative result will be shown in future blog.

A Poorly Repaired Eyelid Trauma

This man fell off his motorbike in January this year resulting in laceration to the right upper eyelid. He was seen by a junior causualty doctor in another town who did not have experience with eyelid repair. The result is a poorly reconstructed eyelid with upper eyelid retraction. The left eye is constantly irritated because it was not completely covered by the lid when the eye is closed. He was referred to the oculoplastic clinic for reconstruction. The pictures show the eyelid margins are not apposed appropriately and there are scarrings with skin shortage centrally. The eye will be reconstructed later this week and I shall post the procedure in the next blog.

 

 

Tumour of the Lacrimal Gland

Tumours of the lacrimal gland are uncommon orbital tumours, each year my clinic sees about 8 new cases. Half of them are caused by lymphoma and the rest are true tumours of the lacrimal gland. 

This patient was referred by a private ophthalmologist for treatment. She had progressively swelling of the right upper eyelid for about 6 months. The swelling was painless. The CT scan performed in the private centre revealed lacrimal gland swelling.

 Right upper eyelid swelling.

 CT scan shows lacrimal gland swelling.

The CT scan and the history suggested this was most likely to be pleomorphic adenoma which is a benign lacrimal tumour. Although benign, this tumour can grow to a big size causing disfigurement and problem with eye movement and sometimes visioin. It is important to remove the tumour completely, as any residual lesion can cause recurrence and worse transform into cancerous lesion. The tumour was approached through incision through the double eyelid (skin crease) and removed in whole.

 Preparing the operation. Local anaesthetic with adrenaline 

was given to reduce bleeding during the operation. The

skin marking was at the skin crease (double eyelid).

 Tumour identified.

 Tumour isolated.

 The tumour was freed from the surrounding tissue.

The whole tumour excised and sent for histology.

 

Appearance of the eye 24 hours post-operation.

Result of the Child who Could not Close her Eyelid as a Result of Scarring from Shingles.

This child was followed up in another town nearer to her remote village 9 days after the reconstruction. She is now able to shut her eye and the eye is not constantly red anymore. She needs regular follow-up in case the wound contracts taking her back to the beginning. Her mother is advised to applied antibiotic and steroid cream regularly to prevent excessive scarring. I will continue to post her progress in future blog.

 Severe scarring from shingle resulting in failure

to close the left eye.

One day post-operation.

9 days after the surgery. The wound still appears raw 

but the contracture has been released. The corneal

scarring has also very much improved.

Lid closure is now normal but it is important to keep a close 

eye on the wound in case severe contracture recurs.