Thursday, August 29, 2013

Full Length Incision Double Eyelid Technique for Puffy Eyelids

Although there are many techniques described for the creation of double eyelids, the full length incision technique is still the gold standard in patients with puffy eyelids for permanent aesthetic results. In this post, the steps for full length incision double eyelid technique is discussed. In patients with puffy eyelids, the excess fat needs to be removed along the full length and failure to do so will create short and/or faint double eyelids and in many cases the double eyelids may disappear completely.
Full length double eyelid surgery. A. Before surgery. B. After marking. C. Excision of skin.
D. Excision of orbicularis muscle. E. Removal of the orbital septum.
F. Removal of the fat. G. Exposing the levator aponeurosis.
F. Double eyelid formed after removal the bulk of the puffy eyelid.

In order to create double eyelids, the skin needs to be sutured to the levator aponeurosis
which opens the eyelid (e). Before this can be achieved in a puffy eyelids,
the following structures need to be removed: skin(a); orbicularis muscle (b);
orbital septum (c) and fat (d).

35 year-old
Because of the amount of tissues that need to be removed in a puffy eyelid,
post-operative swelling tends to be more marked. The picture shows
 the recovery: A (before operation); B (two hours post-operative) and
C (10 days postoperative). The swelling will continue to subside
over the next two months but should be more or less normal
by the fourth week.

22 year-old
Before (top) and 3-week post full length double eyelid surgery.

27 year-old
Before (top) and 3-week post full length double eyelid surgery.

21 year-old
Before (top) and 4-week post full length double eyelid surgery.

48 year-old
Before (top) and 9-month after full length double eyelid surgery.

Tuesday, August 27, 2013

Eyelid Surgery in Malaysia

This is my website for eyelid surgery. The site contains the clinic and hospital addresses where I operate. It also has a new message board where you may post any questions without having to register.

Monday, August 26, 2013

Evolution of the Lower Lid Surgery VI

The picture above shows a patient with eyebags and prominent tear troughs.  
If only the fat is removed, the tear troughs can become accentuated
and give the eyes a hollow look. The patient below had had
transconjunctival (behind the eyelids) fat removal
and has a hollow look and prominent tear troughs.
The previous post mentioned the use of fillers to treat eyebags and tear troughs. However, the procedure is not permanent and would not be suitable for all patients. Some patients are unhappy after the injection because the lower eyelids will appear more swollen than before even though the unevenness is smoothed out.
For patients with eyebags and tear troughs who wish to have more lasting results, fat repositioning over the tear trough can achieve good results. In this procedure, the fat is only minimally removed and the remaining is sutured over the tear troughs.
Diagrams showing how the fat is being repositioned.

A patient undergoing fat respositioning (A). The area over the tear trough
is exposed and the fat is sutured to the area to obliterate
 the tear trough (B and C).
Appearance at one day (D) and at two weeks (E). 


Fat repositioning
Before (picture above )and 4 weeks after the operation (picture below).
Fat repositioning.  
Before (picture above )and 6 weeks after the operation (picture below).

Fat repositioning and double eyelid surgery.
Before (picture above )and 3 weeks after the operation (picture below).

Fat repositioning and upper blepharoplasty.
Before (picture above )and 2 weeks after the operation (picture below).
Fat repositioning and removal of excess upper eyelid skin.
Before (picture above )and 3 weeks after the operation (picture below).

Sunday, August 25, 2013

Evolution of the Lower Lid Surgery V

There are two main ways of addressing the tear troughs. The non-surgical and surgical ways. The non-surgical ways involve the injection of substances (fillers) into the groove to pump up the depression. The substances used may be fat or hyaluronic acid (such as restylane). It is important to seek qualified doctors for such injections as some unscrupulous personnel are known to inject silicone in beauty centres resulting in disfigurement for the patients.
Patient undergoing hyaluronic injection for the tear troughs.
The picture below show the immediate effect of the injection.

This patient complains of swollen lower eyelids one year after silicone injection.
Unlike fat or hyaluronic acid, silicone is not absorbed by the body and
very often causes tissue swelling and hardness due to inflammation.
The inflammation occurs slowly but relentlessly.

Injection of fillers can reduce or smooth out the tear troughs and make the face appear youthful. Unfortunately, the results are not lasting as the body will absorb the fillers and further injections will be needed usually after one year.