Thursday, December 29, 2011

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.

 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.


"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.

Saturday, December 3, 2011

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.

Monday, November 21, 2011

The Peril of Medical Tourism

Medical tourism is big business in South East Asia. It allows patients to combine medical treatment with holiday at very affordable rates. Several countries have emerged as major medical tourist destinations such as Thailand and Singapore. Provided the treatments are performed by well-qualified doctors in established hospitals or clinics, patients usually receive good and uncomplicated cares. Occasionally, the language barrier and cultural difference can spring surprises for patients especially when the patients were seeking aesthetic treatments.

Beauty can come in many forms but most people do not
want aesthetic procedures that make them drastically
different from members of their communities.

Even people from East Asia show differences in their
eyelid appearances. The native Thais (left and middle pictures)
tend to have higher skin creases than the Chinese.

This woman went to a neighboring country for upper eyelid surgery. Post-operatively, she was very upset that the skin creases were made too high and the eye appeared sunken. She complained to the surgeon and was told by him her looks were what the women in his country desired. If he were to make the skin creases too low or did not remove the fat his patients would be upset !. It is important to discuss with the surgeon beforehand the looks you desired and do not trust the doctors to make the judgement for you especially if you have the operation done in a different country. Remember that  beauty comes in many forms and different cultures have different ideas of beauty.

The unhappy patient. High skin creases measuring 8mm
and sunken sulcus from fat removal.

Tuesday, October 11, 2011

Doc, Can You Remove the Excess Skin from the Sides of My Upper Lids?

In patients who have excess upper eyelid skin (dermatochalasis), the amount of excess skin tends to be more on the lateral side. This can be caused by several factors but two of the main ones are loss of the lateral fat pad with age (leading to loss of support for the skin) and drooping of the eyebrows. During surgery, it is important to remove this lateral skin; otherwise these excess skin (known as lateral hooding) can make the patients appear old and sad. Patients who had had surgery performed in beauty centres or by less experienced surgeons often fail to have these problems addressed because the operators were concerned about leaving behind scars beyond the double eyelids. However, when done properly, these extended lines beyond the double eyelids usually resolve within a few weeks.

This middle-aged woman underwent upper eyelid surgery in another centre seven months ago. She was unhappy with the result because of lateral hooding. On examination, her eyebrows were at the normal position and therefore lifting the eyebrows is not appropriate in this case. She was offered two options: a. excision of the skin below the eyebrows to lift the excess skin; or b. remove the excess skin directly. She opted for the later option because the heights of the double eyelids are also asymmetrical. 

Excess upper eyelid skin drooping over the lateral sides of
the eyelids (lateral hooding).

Patient also has unequal double eyelid heights.

Excision of the skin below the eyebrows can lift
the excess skin.

The excess skin can be removed by directly removing
the excess skin.

Extended upper eyelid blepharoplasty was performed together
with recreations of the upper eyelids .
The appearance of the eyes at one weeks, the scars beyond
the double eyelids have begun to fade.

The following pictures show another patient who underwent dermatochalasis (excess upper eyelid skin) operation using the extended upper blepharoplasty technique. The scars faded after 14 days.

A patient with excess upper eyelid skin and significant
lateral hooding.
Extended upper blepharoplasty was performed.
The wounds beyond the double eyelids were sutured with
nylon for better results.

Appearance of the eyes at 14 days, the scars have faded.

Tuesday, September 27, 2011

Are Oculoplastic Patients Vain?

Most people assume oculoplastic surgeons deal mainly with patients who are vain as shown by this humourous poem below (from Survey of Ophthalmology).

A Resident's Lament (Akshay Gopinathan Nair MBBS, Michael F. Marmor MD)

As I study now to be an eye MD,

I ask what kind of doc I want to be.
It is a rather daunting question
That raises fear and apprehension,

As each eye part has its own specialty!
Should retina be the field in which I train
To find a tear or subtle new membrane?
But I seem to give my patients aches
When I indent to find their breaks
And that just makes for too much mental strain.

Perhaps it should be neuro-ophthalmology:
The optic nerve, its path, and its pathology.
But when there’s pallor, one asks Why?
With CT, PET, and MRI …
So why not just go into radiology?

My surgery could be limited to refractive.
I’d soon build up a practice, very active.
Though YAGs and excimers do magic
The odd myopic surprise is tragic:
On balance this may not be so attractive.

Then how about procedures oculoplastic
On skin that is no longer so elastic?
But operative hours are long (a pain),
And patients they are, oh, so vain.
It’s hard not to say something too sarcastic.

Perhaps glaucoma is the field to choose,
Though pressures, fields, and angles do confuse:
Does pressure cause the nerves to die,
Or sick nerves yield when pressure’s high?
I’d like a field where fewer patients lose.

Strabismus is another possibility,
To repair defects in the eye’s motility.
But waiting rooms with children crying
Would, in time, become quite trying
(From residency right through to my senility).

With so much then to learn, is it reality
To limit oneself to only one modality?
The eye is wondrous and diverse!
I think I’ll embrace, for better or worse,

The field of ophthalmology in totality.

Although most of my private patients are concerned with double eyelids and eyebags; a large proportion of my patients seen in the Sarawak General Hospital are concerned with non-cosmetic eyelid conditions such as eyelid tumours and eyelid malpositions referred from all over Sarawak. A recent example is this patient who developed a right cicatricial ectropion (retraction of the eyelid as a result of scarring) after facial infection.

Retraction of the left lower eyelid as a result
of facial scarring.

Steps used to correct the retraction.

Appearance of the eyelids at second week

Thursday, September 15, 2011

Doctor, Why are My Double Eyelids Unequal? Part III

Another important cause of unequal double eyelid height is due to unequal removal of the eyelid skin. This is especially common in older patients with excess skin, the eye where less skin is removed will result in the eyelid hanging over the double eyelid making the double eyelid appears lower.

The picture on the left shows equal amount of skin to be removed is marked whereas the picture on the left shows that the left upper eyelid has more skin being marked for removal.

This woman underwent a double eyelid surgery in a beauty saloon. Unfortunately, the left double eyelid appeared lower than the right (right picture). She went back to look for the "surgeon" but was told that she had returned to China without forwarding address or telephone. Examination showed that more skin had been removed in the right than the left eye. Revision was carried out by removing the excess left upper eyelid skin.

Thursday, September 8, 2011

Doctor, Why Are My Double Eyelids Unequal? Part II

Case 1. A patient who had double eyelid surgery done
elsewhere. Left skin crease higher than the right.

Case 2. Another patient with a higher left skin crease
performed elsewhere.

As mentioned in the previous blog double eyelid (skin crease) asymmetry is one of the most common complaints from the patients undergoing double eyelid surgery. Unequal skin markings before the operations is an important cause of the asymmetry and to avoid this:

a.  It is important to mark the skin prior to any anaesthetic injections to avoid distortion of the tissue.

b. In addition, double eyelid surgery should be postponed if there is any eyelid swelling which again can distort the tissue for symmetrical markings.

c. During the markings, the measurement should be precise and ideally a caliper (as shown in the picture) should be used rather than a ruler.

d. Another important thing to remember during markings is to ensure that the skin of the eyelids are under equal tension (see pictures below).

The marking is done with a caliper with the eyelid skin
under tension by pulling on the eyebrow.

Marking with a caliper with the eyelid relaxed. Note that the
marking, even though marked at 6mm as the picture above,  
produce a line higher than when the skin is under tension.

Thursday, September 1, 2011

Doctor, why are my new double eyelids unequal?

Several studies looking into the complications and patient dissatisfaction of double eyelid surgery found that unequal double eyelids (asymmetry of the skin creases) is one of the most common complaints (see references below). While unequal double eyelids are common immediately after double eyelid surgery, their persistence beyond 4 weeks should be regarded as permanent. Patients who have significant unequal double eyelids (more than 1 mm different) often seek help to address the imbalance. 

This 38 year-old underwent double eyelid surgery in a beauty saloon using the suture technique. The procedure was performed by a "doctor" from China of dubious qualification. Post-operatively, she noticed significant unequal double eyelids. Despite repeated reassurance from the beauty saloon owner, the asymmetry remained 8-week post-operative. Unfortunately, the surgeon had since gone and could not be contacted.

The three possible causes of this deformity noted were:

a.       The difference in measuring and marking the skin for suturing or incision

b.      Different skin tension while doing supratarsal fixation and

c.        Differing widths of skin excision in upper eyelids.

  1. Strategies for a successful corrective Asian blepharoplasty after previously failed revisions. Chen SH, Mardini S, Chen HC, Chen LM, Cheng MH, Chen YR, Wei FC, Weng CJ. Plast Reconstr Surg. 2004 Oct;114(5):1270-7; discussion 1278-9.
  2. Complications of Oriental blepharoplasty. Weng CJ, Noordhoff MS. Plast Reconstr Surg. 1989 Apr;83(4):622-8.
  3. Unfavorable results in Oriental blepharoplasty. Hin LC. Ann Plast Surg. 1985 Jun;14(6):523-34. No abstract available.

Saturday, August 27, 2011

Asymmetry of skin creases are common amongst attractive faces.

One of the most common cause of dissatisfaction after double eyelid surgery (Asian blepharoplasty) is unequal height of the double eyelids (skin creases). However, even in the best of hands, the lines created are likely to be slightly unequal in height and provided the difference is slight most patients can be persuaded to accept the results. In fact, it is worth noting that amongst models and film stars who are perceived as attractive, asymmetry of skin creases are common (see pictures above).

In the next article, I will discuss the causes for unequal double eyelids after surgery and ways to restore the symmetry.

Tuesday, August 2, 2011

Unequal double eyelids may be mistaken for droopy eyelids.

An eyelid without double eyelid may appear smaller because of the overhanging eyelid. (see why double eyelid makes the eye bigger?) If one eye has double eyelid and the other absent double eyelid, the later may be mistaken for droopy eyelid. I have come across a few patients who were referred to me for droopy eyelid when in fact the problem is absent of double eyelid in the smaller eye and the treatment of choice is to create a double eyelid. There are several ways of doing these either with non-surgical method (glue or tape) or surgery (both suture technique or incision technique).
Right eye appears to have droopy eyelid due to poorly
formed double eyelid. Creation of double eyelid balances
both eyelids.

Right eye appears droopy due to absent double eyelid.
When the double eyelid is created with tape the two
eyes appear the same size.

Below is the article which I recently published in Malaysian Journal of Medicine highlighting this condition: