Thursday, August 24, 2017

Doc, Can You Show Me Pictures of How You Do Incisional Double Eyelid Surgery?

In my experience, most patients who wanted Asian blepharoplasty (double eyelid surgery) were happy with diagrams detailing the procedure. However, a small group were curious and wanted to see the graphic details. 

This patient had narrow palpebral apertures (width of the eyes) caused by puffy eyelids from fat and absent skin crease (double eyelids).

The desired height of the skin crease was discussed prior to the operation. 
Indentation was made with a paper clip to give an impression how the eyes 
would look postoperatively.

A side view of the right eye with and without indentation shows that the eye 
the skin away from the edge of the eyelid.

The desired height was marked. In this patient the height was 8mm.
Steps of incision procedure: A. The desired skin crease was marked; B An incision was made along the marked line; C. The fat was removed to reduce the puffiness and allowed better formation of the skin creases, to get to the fat (F) two overlying layers had to be removed first: OO = orbicularis oculis the muscle around the eye and OS= the orbital septum. D. The fat was teased out to expose the underlying levator aponeurosis (LP the muscle that open the eye) ; E. The fat was clamped and removed; F. The levator aponeurosis that appeared as white was now fully exposed; G. The levator aponeurosis (LP) was sutured to the remaining orbicularis oculi (OO) anteriorly; H. The skin was closed with 6/0 nylon.

Immediately after the surgery. The asymmetry was caused by swelling 
and reaction to the anaesthesia.

The appearance of the eye 24 hours later.

Two weeks after the surgery.

Three weeks after the surgery. Most swellings have subsided.

Before and after pictures for comparison.

The following are some other patients who had had incision Asian blepharoplasty. 

Before and one month after operation.

Before and two months after operation.

Before and two months after operation.

Friday, August 11, 2017

A hyperthyorid patient with eye protrusion and severe dry eyes.

Hyperthyroidism is associated with ocular changes which can cause eye protrusion and severe dry eyes. This patient developed hyperthyroidism three years ago. Despite medical control of the condition, she noticed her eyes were becoming more protruded with eyelid retraction and frequent tearing that cause blurring of vision.  The tearing was a reflex response to dryness as a result of ocular exposure. In order to reduce the exposure, the lateral aspects of the eyelids were closed surgically (lateral tarsorrhaphy). The operation was performed as followed:

Hyperthyroid patient with ocular exposure due to eye protrusion 
and lid retraction.

Before surgery, the amount of lid closure was determined by closing 
the upper and lower lid laterally.

Before surgery, the amount of lid closure was determined by closing 
the upper and lower lid laterally.

The amount of tissue needed to be removed was marked.

The amount of marked tissue was incised.

The anterior lamella of the eyelid was split to take out the anterior lamella.

The picture showed the tissue removed with the lateral anterior lamella.

The angle of the eyelid was formed with 6/0 vicryl.

The posterior lamella was closed with 6/0 vicryl.

The orbicularis muscle was closed with 6/0 vicryl before the skin 
also with 6/0 vicryl.

Immediately after the procedure.

At two weeks postoperative. The exposure was reduced.