Friday, July 13, 2012

A Recent Interview Appearing in Sinchew Daily 上瞼下垂危及視力‧病情惡化將帶來併發症

A recent interview in Penang.

上瞼下垂危及視力‧病情惡化將帶來併發症

  • 眼科與眼部整形醫生蔡鐘能為病人驗眼。(圖:星洲日報)
  • 上瞼提肌陟前術。
  • 額肌瓣轉移懸吊術。
  • 上瞼下垂(大小眼)女性重拾美麗容顏。
  • 上瞼下垂老人家挽回視野。
眼睛是靈魂之窗,只要擁有一雙靈活的眼睛,無論男女,都會叫人眼前一亮,覺得此人容貌出眾。一旦眼睛出狀況,如眼瞼下垂,整張臉將不再亮麗,那該怎辦?
要如何辨別上瞼下垂(或俗稱大小眼Ptosis)?

我們的雙眼向前平視時,上瞼緣的正常位置,應該在眼角膜上緣與瞳孔之間,低於這個水平便是上瞼下垂。
上瞼下垂不只讓雙眼失去神采,它也可能危及視力,並帶來其他併發症,這才是最關鍵的事。

患上瞼下垂者,輕則下垂的上瞼遮蓋部份瞳孔,重則整個瞳孔被遮蓋,故不但妨礙容顏的美觀,也影響視力,先天性者可造成重度弱視,而強力睜眼會導致頭疼。

蔡鐘能:根據病情選擇手術
OPTIMAX眼科專科醫院眼科與眼部整形醫生蔡鐘能教授建議,一旦發現本身屬上瞼下垂者,應該向醫生尋求診治,避免病情惡化。
他說,一般上,醫生會根據病情和病人討論,以便選擇上瞼下垂手術。以下是3種常見的手術:
1.上瞼提肌陟前術(Levator Advancement);
2.上瞼提肌切除術(Levator Resection);
3.額肌瓣轉移懸吊術(Frontalis Suspension)

上瞼提肌陟前術。
(Levator advancement)

額肌瓣轉移懸吊術。(Frontalis suspension)

上瞼下垂(大小眼)女性重拾美麗容顏。

上瞼下垂老人家挽回視野。


瞼下垂症的主要症狀
●眼睛疲憊︰患者需要借助抬起額頭的肌肉,才能睜大眼楮。
●下巴抬高︰由於往下看時眼皮垂得更厲害,所以會傾向於抬高下巴來看水平線上的物體,讓他人誤以為“高傲”。
●視力模糊︰眼皮下垂後壓迫到眼角膜,產生散光,患者視力模糊,看到的影像有時會彎曲不直。

應選擇正規整形美容醫生
蔡鐘能說,除了上瞼下垂,眼皮鬆垂(Dermatochalasis),或有意進行雙眼皮手術(Asian Blepharoplasty/Double Eyelid Surgery),或眼袋手術(Eyebag Surgery),也應該向相關的醫生尋求診治。
他說,整形美容畢竟是外科手術,特別是針對靈魂之窗的外科手術,更是無可避免的存在一定的風險,因此一定要選擇正規的整形美容機構和相關的醫生,以免弄巧成拙。

眼皮鬆垂
切除多餘皮膚
改善上瞼外形

人的上眼皮會隨年齡增加而逐漸鬆垂,以致眼睛呈三角形,有損容貌。
下垂的眼皮也會壓迫眼睫毛,引致眼瞼不適。更甚的是,鬆垂的上瞼遮蔽視野,帶來生活上的不便。
上眼皮鬆垂不是病,可是它降低生活素質。解決的辦法是切除上瞼多餘的皮膚,改善上瞼外形,使雙眼皮線條更加流暢。

雙眼皮手術
分為埋線和切開法
割雙眼皮增加立體感

雙眼皮手術,又稱重瞼手術,可以增加眼部的立體感,使眼睛看起來大而有神,很多愛美的單眼皮一族都願意嘗試這項手術,割雙眼皮蔚然成風。
割雙眼皮是否能夠達到預期的效果,取決於幾個因素,醫生的經驗是最重要的因素。
雙眼皮手術主要有兩種,即埋線法,和切開法。
埋線法是指在眼瞼上埋3個線口,其優點是手術後腫脹不明顯、沒有手術痕跡,過後很快便能夠恢復,缺點是有雙眼皮消失的可能。它適合於眼皮薄、皮膚無鬆弛的單瞼年輕女性。
眼皮較厚的中年女性適合切開法。它的優點是形成的雙眼皮穩固不容易消失,大多數人皆適合這項手術。
接受雙眼皮切開法者,可同時進行眼瞼除皺術。

眼袋手術
皮下組織水腫
根據眼袋類型确定療法

眼袋是下眼瞼浮腫現象。眼瞼的皮膚很薄,皮下組織薄而鬆弛,很容易發生水腫,以致產生眼袋。
眼袋影響容貌,使人看起來疲憊衰老。它的形成涉及多種因素,主要因素有:
●衰老退化─多數發生在40歲以上的人身上。
●遺傳─部份年輕人有眼袋多數和遺傳有關。
醫生會根據眼袋形成的類型,斟酌適當的治療法,常用的手術有以下兩種:
●外切口法(Subciliary Lower Blepharoplasty)─在下瞼睫毛根部下1毫米處切開皮膚,拉出眼袋脂肪並切除。可同時切除多餘皮膚消除皺紋。
●內切口法(Transconjunctival Lower Blepharoplasty)─通過結膜面的小切口,將膨脹形成眼袋的脂肪部份切除,具有創傷較小,手術後外觀沒有痕跡的優點。可是,它有局限性,肌肉皮膚組織鬆弛者接受這種手術,可能加重下瞼衰老的外觀。

Tuesday, July 10, 2012

2800 Year-old Technique that Stands the Test of Time

As an oculoplastic surgeon, I use various techniques to reconstruct the eyelids and surrounding areas. It is interesting to know that many of these techniques have been in use for centuries and some milllineum. A recent article in the news is a case in point.

This unfortunate woman had her nose hacked off  by a violent spouse 32 years ago. With the help of an organization that helped aboused woman, her nose reconstructed using skin from the forehead. Nose cutting used to be a common punishment for women who committed adultery. In the 21st century, most of the cases of nose lost in civilized countries occur in accidents but mutilation is still common in some less developed countries as a form of revenge by a jealous lover or husband.

Pre- and post nose reconstruction.


This technique of using forehead skin (paramedian forehead flap) had been in use in India since 800BC and was attribuated by Sushruta, an ancient Indian doctor widely regarded as "father of surgery". The mannique below was from 19th century Europe for teaching this technqiue. This procedure is also popular known as Indian flap.


Mannique for teaching nose reconstruction
and the steps involved.

"The love of life is next to the love of our   
own face, thus the mutilated cry out for help."
-Sushruta-

Monday, June 25, 2012

Cautionary Tale: Correcting other Surgeons' Unsatisfacotry Results

The following news reminded me of a case in my clinic recently: a 26-year old patient who wanted to look like a Chinese film star underwent 4 eyelid operations by the same plastic surgeon: 2X double eyelid surgery, 1X epicanthoplasty and 1X brow lift. She showed me the picture of the film star and said she was unhappy because the surgeon did not achieve the results she wanted. She wanted me to widen her double eyelids further. While the surgery involved only removal of some loose skin I was reluctant to comply because of her demanding and pedantic behaviour. I was of the opinion that if the result were not 100% perfect, she would blame me for all the imperfections from the pervious operations. I politely asked her to see her plastic surgeon for correction. There is a saying in medical profession: "It takes 10 years to learn how to operate and another 10 years to learn when not to operate."
.
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Woman spends $16k on botched double eyelid surgery


SINGAPORE - A Singaporean permanent resident is demanding that her double eyelid surgeon refund her the $16,000 she spent on double eyelid surgery that she claims resulted in uneven eyelids.
According to Shin Min Daily, Miss Sun, 37, who is originally from China, said that because her natural eyelids are not beautiful, she went for four double eyelid surgeries from 1992 to 2010.
After having been operated on, she felt that there was an improvement, but still believed there were certain flaws that she was dissatisfied with. Hence, on April last year, she forked out $16,000 for a prominent plastic surgeon here to do her fifth surgery.
However, before the doctor removed the stitches, she discovered that the surgery appeared to have gone wrong. Her eyes looked uneven and the widths of the double eyelids were different.
The doctor then assured her that it takes time for the wound to recover, and told her to do physical therapy. In the end, the surgery still ended up a failure, she lamented.
Miss Sun is now demanding a full refund, but the doctor is only willing to return $6,400 to her.
"I am not satisfied. I had an appointment with the doctor to meet at 8am to discuss the situation. I arrived 10 minutes late, and the doctor's assistant said the doctor is at a surgery and has no time to see me. This is not sincerity," she told Wanbao.
Miss Sun said she then opted to wait at the clinic, but was driven away by security called in by the clinic.
After explaining to the security officers the reason why she was waiting at the clinic, she said they eventually allowed her to stay.
However, the clinic resorted to calling the police instead, she claimed.
The police have confirmed that they have received complaints regarding this dispute, and have explained to the relevant parties on what legal action is available to them.
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不满前4次手术 找狮城名医操刀 女郎割双眼皮变“大小眼”

2012-06-22 18:01
  • 孙小姐花约3万8000令吉动第五次割双眼皮手术,结果变成“大小眼”。
(新加坡22日讯)女郎4次割双眼皮不满意,花1万6000元(约3万8000令吉)找知名整形医生5度动刀,结果竟变大小眼,要求医生退手术费遭拒。女郎上诊所讨公道,诊所报警处理。
这起纠纷发生在昨天早上8时许,地点是在一家由本地知名整形医生开设的诊所内。
来自中国的孙小姐(37岁)说,由于眼睛不美,她从1992年到2010年,在中国动了4次割双眼皮手术。
动了手术后,她双眼虽然匀称,但仍有瑕疵让她不满意。
2009年成为新加坡永久居民的孙小姐说,她去年4月14日,花了1万6000元5度动手术,由一名新加坡著名整形医生操刀。
不过,在还没有拆线前,她就发现手术似乎不妥,双眼的宽窄变得不一。
医生称需时间康复
“医生当时说,需要时间让伤口慢慢康复,还叫我做物理治疗,但最后我觉得手术是失败的。
仅获部分退款 诊所竟先报警
孙小姐要求医生全数退款,但从去年谈到现在,医生只愿意退回6400元(约1万5360令吉)。
“我不满意,昨天约好医生早上8时见面谈,我迟到10分钟,助理就说医生去做手术了,没时间见我,很没诚意。”
孙小姐欲在诊所等待,岂料诊所却致电保安赶她走。
“我和保安解释后,获准留下,但诊所却竟然报警。”
狮城警方接获投报 
警方受询时证实接获这起纠纷的投诉,并已向双方解释各自能采取的法律行动。
被朋友笑“金鱼眼”
整容失败被朋友取笑“金鱼眼”,女郎出门需戴眼镜遮丑。
孙小姐表示,双眼整容失败后,眼眶大小不一,右眼明显比左眼小,她出门时都需要戴眼镜遮丑。
双眼不时突出
此外,她的双眼也出现“金鱼眼”现象,双眼会不自觉突出,样子有点吓人。
“我朋友看到就取笑我,说我眼珠突出,看起来很凶,这让我深受困扰。”
她透露,心理上大受打击,本来是要整容让自己变得更美,现在却变得更丑。







Sunday, June 10, 2012

Recovery Rate for Incision versus Suture Techniques

The two basic techniques for double eyelid surgery are suture technique and incision technique. The advantages of suture techniques over incision techniques are:
a. faster surgery
b. less swelling
c. shorter down time
Below are the pictures of patients who underwent suture technique versus incision technique.


The pictures were taken before and ten days after double eyelid surgery.
The patient who underwent incision technique still had some swelling
whereas the suture technique patient had little swelling.

Thursday, May 10, 2012

Small Incision for Droopy Eyelid and Double Eyelid

Like most surgeries in other parts of the body, the smaller the incision made to the eyelid the faster the recovery. Small incision is useful in selected patients who want to have double eyelid surgery or correction of droopy eyelids with reduced down time. This patient presented with a left droopy eyelid as a result of contact lens wear. During the consultation, she also desired double eyelids. Small incisions were made to the eyelids (about 1/3 to 1/2 the length of the eyelids) to form double eyelids in both eyes and also to reposition the left levator muscle (which is used to open the eyelid) to correct the droopy eyelid.

Very low double eyelids and left droopy eyelid.

Small incisions about 1/2 the length of the eyelids were created to form
double eyelids and to correct the left droopy eyelid. The left eye has
incomplete closure because the left levator muscle has been pulled
down to lift the lid. Closure usually returns to normal after about
two weeks.

Appearance of the eyes 3 hours after the surgery.

Appearance of the eyes at 6th operative day. Apart from
the bruisings, the eyelids have minimal swellings.

The incision sites occupy only 1/3 to 1/2 the length
of the eyelids.The lid closure of the left eye has
also improved.


Monday, April 9, 2012

Doc, My Child has this Swelling Since Birth !

In the previous blog, the patient presented with an inflammed orbital cyst in adulthood. However, most cases are brought to the attention of ophthalmologists because of parental concern.
Below was a typical case in a 3 year-old boy. The cyst presented as a slow-growing, painless, subcutaneous mass. Intense inflammation may occur if the cyst ruptures spontaneously or because of trauma. Excision resulted in complete resolution.

Swellling of the left upper eyelid below the eyebrow.
Feature typical of an orbital dermoid.

Marking was done below the eyebrow to hide
the scar.

Incision was made below the eyebrow.

The dermoid was exposed via blunt dissection.

The cyst was removed intact to avoid leaving behind
any remnants which may cause inflammation.

The cyst measured 1.5cm in diameter.

Cheesy content inside the cyst.

The wound was closed with 6/0 vicryl.

Appearance at 6 days post-operative, the scar will fade
with time and become inconspicuous as it is hidden
by the eyebrow.