Droopy lower eyelid from facial paralysis

This old man developed a left facial palsy about one year ago. Despite investigations including brain scan, no cause was found. Bell's palsy is the name given to facial palsy of unknown cause. In the majority of cases, the palsy resolves with time but this patient unfortunately failed to do so. The facial palsy caused problem with his eyelid closure and the left eye was always uncomfortable because of exposure (Figure 1). In severe cases, such exposure can cause problem with vision. To alleviate the discomfort, the lower eyelid needs to be repair to avoid better eyelid closure. In this case, the best procedure was to shorten the lower eyelid using lateral tarsal strip procedure (See Figure 2).



Figure 1. Left facial palsy causing droopy eyelid

and ocular exposure.

Figure 2. Lateral tarsal strip. In this procedure,

the lower eyelid was shortened and tightened to

treat the droopy eyelid.

After the procedure, the appearance of the lower eyelid improved and the exposure and discomfort were reduced (Figure 2).

Figure 3. Immediately after the operation.

A Phoney Surgeon on the Loose

With the approaching Chinese New Year, many women like to look their best on the festive season. Unfortunately, it is also the best time for unscrupulous people to make a quick buck by posing as doctors. Many of these phoney doctors collude with beauty centres to get unsuspecting customers for various operations under unsterilized conditions. Worse yet, many of these operations were badly performed and when the victims try to have the complications rectified these phoney doctors have disappeared into thin air.

This month I came across two such cases performed by a phoney doctor. The victims had thread lift performed in the same beauty centre by the same person who claimed to be a doctor. However, he refused to give away any name card or his surgery address. I thought this should have raised the alarm bell but the patients were persuaded by the beauty owner to part with over 4000 ringgits each for the procedures.

In a thread lift (see figure below), barbed threads are used to lift sagging eyebrows and deep nasolabial folds (the furrows between the nose and the corners of the mouth) or aging neck tissues. Although thread lifts have decreased in popularity becuase their effects are not lasting, in proper hands they can still be a useful tool.

Case 1

This woman had double eyelids and thread lift performed to lift her right eyebrows. The doubel eyelids were badly formed and there was an abscess in the right upper eyelid. She had pain each time she open her right eyes. The phoney surgeon could not be contacted. On examination, there was a hard mass. Surgical exploration showed the thread lifts had been badly placed resulting in constant irritation to the eyelid with each opening and shutting of the eyes and hence the abscess formation. The thread lifts were removed in total. 

Poorly formed double eyelid and a right

upper eyelid abscess.

Poorly formed double eyelid and a right

upper eyelid abscess.

The thread lifts removed from under the abscess.

Case 2

A woman underwent thread lifts to lift her sagging jaws. The sites where the thread lifts were passed were poorly sutured and the thread lifts were protruding (see arrows in the pictures below). There was pus oozing from the wound as well as bleeding. Again she tried in vain to contact the phoney surgeon. However, the owner of the beauty saloon, seeing the serious nature of her complications asked her to see a proper doctor immediately. The wounds were cleaned and mutiple pieces of thread lifts and sutures were removed. Recontruction was needed to close the wounds after draining off the pus.

Severe inflammation with abscess formation after

poorly performed thread lifts. The left pictures

show the extent of the wounds after

removing the thread lifts and sutures.

Some of the sutures and thread lifts

removed from the wounds.

A Woman with a Left Droopy Eyelid and Foreign Body Sensation

This woman underwent a suture technique for double eyelid surgery a year ago in a beauty centre.  For the past three months, she has been experiencing pain in the left eye with foreign body sensation. Unfortunately, the person who did her operation could not be contacted as she had since left the country.On examination, her left eyelid was slightly droopy and the eye was red. Everting the eyelid revealed a raw area with poorly placed suture which had eroded through the inside of the eyelid. The suture was removed with a pair of forcep and the symptom disappeared. Most of the suture technique performed by qualified surgeon rarely erode through the skin. However, most of the beauty centres  bring in unqualified personnels from oversea to perform the procedures. Worst still, these personnels could not be contacted when complication arises. 

Left droopy eyelid and foreign body sensation.

Raw area under the eyelid with protruding

stitch (arrowed).

Stitch removed.

Doc, why do I get these yellowish lumps on my eyelids?

Yellowish lumps on the eyelids of this man are caused by cholesterol deposits (xanthelasma). Blood test is important to find out if the patient has high blood cholesterol level. Although lowering the blood cholesterol will not make the deposits fade away, it is important to reduce the risk of heart diseases. There are several ways to remove the deposits including laser and direct chemical application. However, in Asian patients neither method is advisable as it can lead to skin depigmentation and make the resulting appearance worse. The best treatment is excision as shown here.

Some interesting excuses for having plastic surgery.

There are many excuses to have plastic surgeon, this beauty queen did it to appear prettier than the girl her ex-boy friend dumped her for. How dumb is that!

Proud to be plastic

Ex-beauty queen Leng Yein has had multiple cosmetic procedures and is undeterred by haters. -TNP
Pearly Tan

Thu, Dec 29, 2011
The New Paper

AT 18, she was deemed beautiful enough to be crowned Miss Malaysia World in 2003.

Today, at only 26, Ms Leng Yein has undergone almost 10 cosmetic procedures - including a nose job, adding dimples and enhancing her breasts - to improve her looks.

And she has caused a stir on both sides of the Causeway by raving about her procedures and posting pre- and post-surgery pictures on her Facebook page, which has 110,000-plus fans.

Her posts have been polarising, with young women looking to her as their go-to cosmetic surgery agony aunt.

But some parents worry that she is the wrong role model for young, impressionable females.

A 21-year-old undergrad here, who wanted to be known only as Wendy, said: "I've been thinking of making my nose narrower and sharper since I was teased in secondary school.

"She not only posts pictures of her face just after surgery for us to see, but also says that it's painful but she can tolerate it.

"I admire her. I want to be like her - dare to change what I'm not satisfied with myself, regardless of the pain."

Though her parents are against the idea, Wendy is considering a trip to South Korea to have her nose done.

She said: "I want to do what I feel will make me happy, like her (Ms Leng)."

But Madam Lorna Neo, 44, a secretary and mother of two daughters aged 18 and 19, felt that it was "terrible" that young women are looking up to Ms Leng.

"She has gone through so many surgical procedures that she no longer looks like the person she was born as. I definitely don't want my daughters to think what she's doing is okay," she added.

Mrs Julianne Lee, a 50-year-old housewife, said: "She may say she's happy and confident, but what's the use of being happy with something that is not natural, that didn't originally belong on her?"

The mother of two - her son, 25, is a model and daughter, 19, a student - was also concerned about botched procedures, asking: "What happens when the surgery goes wrong?"

Ms Leng, who now owns a boutique, a fashion accessories shop, a nail and beauty salon, a tattoo parlour and a restaurant in Kuala Lumpur, Malaysia, was 21 when she first had cosmetic surgery - a nose job - in 2006.

But she had been thinking of going under the knife since 2003. That year was notable for two things - she won the Miss Pahang and Miss Malaysia World titles, and her boyfriend dumped her for another woman.

Proud to be plastic Click on thumbnail to view (Photos: The Straits Times)

 Left her for prettier girl

Ms Leng, who got married in October last year, told The New Paper in Singapore recently: "When my first love left me for a prettier girl, I thought... just because she's hot, you left me. One day, I want to be hotter than her."

But her first procedure, done in Beijing, China, which saw an implant inserted up the length of her nose, was botched.

She noticed that the implant was shiny in photographs as it overstretched the skin on her nose, but she did not correct it until much later. (See report on facing page.)

Since then, Ms Leng has had five other procedures and a few more corrective ones done.

With each procedure, she gets a shot of self-confidence, she said.

But she sparked controversy when she came out about her plastic beauty earlier this year.

It was reported in the media, and her supporters thanked her on her blog and her Facebook page for leading the way in making plastic surgery less taboo.

On her blog, reader Li Lin wrote: "Leng Yein jie jie (Mandarin for sister), I am proud of you! You dare to show what's in you, what's with you and what's about you.

"You taught me on how to love myself, too. I really admire you, your courage, the way you live and almost everything."

But one of Ms Leng's detractors criticised her for her openness.

He wrote: "She is shameless... bold and is probably the only celebrity (in) Malaysia (who has gone) public (about her) multiple plastic surgeries."

Others rubbished her blog posts and called her "disgusting" and "plastic".

Ms Leng told TNP that she is proud of herself and has no regrets.

She described how her friends had insisted their features were "original" even after she noticed their sharper jawline and other facial changes.

She said she did not want to deny her plastic surgery journey as she did not want to be like her friends.

She feels that if they had been open about their surgery and advised her on which clinics and doctors to go to and what risks she would be facing, she would not have made the mistake of having her first procedure done in Beijing.

She said this is the reason she advises young women now - so they can make informed choices on where to get plastic surgery done.

And she will not let the opinions of others bring her down, saying: "Haters will hate everything they can find about me."

As for her extensive plastic surgery, she said: "I don't care whether it's natural beauty or not. "When you curl your hair and perm your hair, (it's) also not natural. Like push-up bras, that's not natural. Instead of putting silicone inside, you just put it outside."

Asked whether she felt plastic surgery was for everyone, Ms Leng said: "Big, small eyes, square face, sharp face, thick lips, thin lips, it is all beautiful...

"If you think that your beauty can win you a prize (at a beauty pageant), don't do anything."

But she added that those who choose not to go under the knife should not be jealous of others who opt for cosmetic enhancement.



Ego issue rather than self-confidence

Cosmetic surgery can boost self-esteem, but the result could be a desire for more procedures to strive for perfection, says psychologist Daniel Koh of Insights Mind Centre.

He said: "Plastic surgery is based on helping medical cases with defects after disfigurement. But for (Ms Leng Yein), it sounds more like an ego issue than for self-confidence.

"As long as she stays in an industry built on looks, she is likely to continue going after perfection."

He said that beauty queens may feel anxious to keep up with the expectations of having the title.

Clinical psychologist Danny Ng of Raffles Hospital agreed that the beautiful have their own problems.

He said a former Miss Singapore once consulted him as she had problems holding down a relationship due to her good looks.

Self-esteem

"She felt she had to flaunt her beauty to prop (up) her self-esteem," he said. "Self-esteem has nothing to do with success or ability. It is mostly affected by expectations."

He feels the younger generation is becoming increasingly obsessed with the idea of having the perfect body.

He said: "Why do beautiful people feel so lousy about themselves? Because someone out there is always better and they don't know how to be content."

Dr Jun Jin Chua of Mount Elizabeth Medical Centre said that about 5 per cent of his patients are very pretty.

He said: "It is common for very pretty girls to come in for cosmetic surgery (because) they want to look prettier.

"When they are not satisfied with themselves, they will not be happy no matter how many surgeries they get."

Dr Chua advises those keen on cosmetic surgery to select doctors who can offer expert advice.

He added that the most common risks of plastic surgery are infection, scarring and bleeding, but if done properly, it should last a lifetime without problems.

She had to fix botched nose job twice

She had mulled over having cosmetic surgery for three years, but when she finally did it, it was on the spur of the moment.

In 2006, Ms Leng Yein travelled to Beijing, China, to take part in the Miss Tourism International 2006 contest.

There, she met other beauty queens, many of whom she said had plastic surgery done to enhance their looks.

"But because of their different ethnicities, I couldn't tell what was real and what was fake," she said.

The day before she was supposed to travel home, she met and became friends with an 18-year-old masseuse who had had plastic surgery done on her nose earlier that day.

Ms Leng said she was surprised to see that the girl had nothing more than a runny nose.

"I thought you must wrap your nose, stay at home. Then you would bleed and you would see stitches," she said.

The next day, they went shopping, and when the girl decided to thank her doctor at his clinic, Ms Leng found out that a nose job took about an hour and cost about RM2,000 (S$820).

She decided to do it and told her family only some time after she had returned to Malaysia.

She recounted with a laugh how her mother said she had sensed something different about her nose, but thought she had simply lost weight.

A few months later, Ms Leng had her breasts enhanced while she was visiting friends in Bangkok.

She also decided to get dimples, which she said can last for about three years.

In 2008, she had surgery done on her lips as well as corrective surgery on her nose to correct the botched job done in Beijing.

Corrective surgery

But the corrective surgery also went wrong. She realised that her entire nose could move from side to side, and knew she would have to correct that, too.

In September last year, she made her lips fuller.

And in July this year, she went to South Korea for a series of procedures on her eyes, eyelids, nose, lips and dimples.

These procedures were sponsored, as she is the Korea-Malaysia endorsed ambassador for LaFa Plastic Surgery & Cosmetic Solutions.

Ms Leng said she has spent almost $100,000 of her own money on cosmetic surgery.

pearlyt@sph.com.sg

双眼皮手术的并发症 / Complications of Double Eyelid Surgery.

This article appears in this month Chinese version of Cosmetic Surgery & Beauty. The English version was published earlier in the year.

Doc, I can't shut my right eye since the car accident!

The skin on the eyelid is the thinnest in the body and distensible allowing the eyes to open and close at ease. If the skin is lost or poorly repaired as a result of trauma, the eyes may have difficulty in closing. This man was involved in a car accident in a rural area 6 weeks earlier. The laceration was repaired by an inexperienced medical officer who failed to appose the wound properly. This resulted in poor cosmesis and the patient was unable to shut his eye at night. The picture shows that the skin was sutured poorly to the lateral side of the upper lid resulting in shortage of skin in the middle part of the eyelid and the lateral side was bulky due to the excess skin.

To improve the appearance of the patient's eyelid and allow the eye to shut properly, reconstruction was undertaken as shown in the photographs below. The area of scarring was released and covered with skin flap taken from the lateral side of the upper lid.

The picture below was taken 2 months after the reconstruction showing much improved cosmesis and normal eyelid closure.