I Never Know You Can Get Cancer in Eyelids

Whenever I told somebody that I am an eye surgeon specializing in eyelid surgery, the reaction is invariably: "Oh, so you specialize in double eyelid surgery". I always try to correct them by saying: "Actually, I also manage other eyelid conditions such as eyelid cancer etc etc". The reaction is usually: "I never know you can get cancer in the eyelids".

Compared with the Europeans, eyelid tumour is not as common in Malaysia but in Kuching I come across three to four cases per month. Most of these cases usually present late with extensive tissue destruction (more on these cases in future blog). Below is an 80 year-old native woman who presented with a rapidly growing left upper eyelid tumour. There was destruction of the eyelashes and the appearance is strongly suggestive of sebaceous cell carcinoma. I performed excision of the lesion with clear margin followed by one-stage reconstructio using reversed McGregor's flap using the principle of Z-plasty.

A destructive lesiono f the upper eyelid occluding the vision.

Marking of the eyelid to determine the amount to be excised

and reconstruction after the excision.

After removal of the eyelid tumour with clear margin.

About half of the upper eyelid was removed.

A reversed McGregor's flap mobilizing the tissue from the

temporal side of the orbit was used to cover the defect.

Closure of the defect after mobilizing the tissue from the

temporal side of the orbit.

At the conclusion of the surgery, the eyelid will take about 3

to 4 weeks to return to its near normal shape and size.

Note the transposition of the tissue in the orbit as

evidenced by a changein the position of the Z. 

Extreme Makeover without the Pain aka Made in China

Recently I read that China has produced a bullet train that beat the speed of the Japanese counterpart. I am afraid the Chinese has also succeeded in extreme makeover without the pain. Here is a Chinese man who successfully disguised himself as a Caucasian man and got into Canada without being discovered by the custom. I suppose in trying to wow a woman, this Chinese guy would win miles ahead of the Japanese guy in my previous blog. It would be a thrill for a girl being flirted by an old Caucasian man who sounded Chinese and only to discover he is a brillant disguiser rather than a young Caucasian man who sounded Japanese and need to have another painful operation to reveal his true self ;)

Exreme Make-over: Westernization of Eyelids and Nose.

This young Japanese man in his attempt to look Caucasian underwent extreme facial makeover. He had double eyelid surgery with epicanthoplasty (in which a skin fold of the upper eyelid covering the inner corner of the eye is removed). In addition, he had a nose implant to make his nose taller and straighter and bone implant on his forehead to make his the eye sockets appear deeper. At first glance, he may appear like an unremarkable Caucasian, a closer shows the nose to be too rigid and unnatural.

Pre and post facial make-over.

It would be interesting to know how he gets on in Japanese society with his new look. Personally, I think the only benefit for him to acquire this look would be if he lived in Hawaii during the Pearl Harbour attack so that he would not be sent to the Concentration Camp by the US Government. And he would only succeed in his disguise if he also pretended to be dumb otherwise the moment he opens his mouth, his Japanese accent would betray him!

Why Do Double Eyelid Make the Eye Bigger? Part 3

In patients with asymmetrical double eyelids, there are several methods of restoring the symmetry by creating double eyelids in the smaller eyes. The methods can be divided into surgical method and non-surgical method. The surgical method involves either the incision or suture technique to produce a new double eyelid. The non-surgical method involves the use of either tape or glue.

Doubl eyelid surger was performed to both eyes to

restore the symmetry.

The right eye only had double eyelid surgery.

Post-operatively, the right upper eyelid has some swelling.

The right double eyelid was created using tape.

The right double eyelid was created using glue.

Why Do Double Eyelids Make the Eyes Bigger? Part 2

In the previous blog, I mentioned that patients who have asymmetry of eyelid skin creases (doube eyelids) always find the eyes without the double eyelids appear smaller than the ones with double eyelids. In eye with double eyelid, the double eyelid forms a barrier and holds back the upper eyelid skin so that it does not fall over the eyelid margin. In eye without double eyelid,  the upper eyelid skin droop over and occlude the upper eyelid margin. When viewed from the front, this skin hooding makes the eye appears smaller.

The right eye has no double eyelid so the skin falls over the

eyelid margin (blue arrows) making the eye appear smaller,

the left eye has a double eyelid which hold the skin away

(red arrows) from the eyelid margin.

The same principle applies to double eyelid surgery (Asian blepharoplasty). A successful double eyelid will create a skin crease that form a barrier so that the upper eyelid skin is held back from the lid margin. The picture below belongs to a patient whom I performed double eyelid surgery three months ago. The creation of the double eyelid (red arrows) make the eye appears bigger by holding back the skin from the eyelid margin (blue arrows).

The blue arrows indicate the position of he upper eyelid before

the double eyelid surgery. As the skin falls over the lid margin,

the eye appears small. Following creation of double eyellid,

the skin is held back by the skin crease (red arrows) so that

 the whole eye is now exposed making it appear bigger.

I shall mention in my next blog what I did to the 4 patients mentioned earlier to restore the eyelid symmetry.

Why Do Double Eyelids Make the Eyes Bigger? Part 1

One of the reasons where people desire double eyelids is to make theis eyes appear bigger. In my clinic, I often see young patients who complain that one eye is smaller than the other. In about 10% of these patients, the apparent difference in size is the result of unequal double eyelids rather than because the eyelid muscle is weak (ptosis). The smaller eye is always the one that does not have double eyelid or only weakly formed double eyelids.

Right eye appears smaller caused by absent double eyelid.

Right eye is smaller because the double eyelid is poorly formed.

Left eye is smaller because of absent double eyelid. 

This patient has had suture technique for double eyelid

elsewhere which left him with a small right double eyelid but

 the left double eyelid disappear 6 months after the procdure. 

The right eye is smaller because of absent double eyelid.

The left eye has a double eyelid which is partially covered by

the eyelid skin even than it makes the eye bigger than one

without double eyelid at all.



Sometimes You See Them Sometimes You Don't aka The Elusive Double Eyelids in East Asians

Double eyelids are seen in 50% of Chinese, however, not all of these double eyelids are stable. It is not uncommon to see patients in clinic who complain that their double eyelids sometimes disappear at the end of the day and reappear when they wake up or vice versa. The reason for these unstable double eyelids is the result of weak insertion of the levator muscle (the muscles that open the eyes) into the skin. This weak insertion is thought to be caused by the forward protrusion of the fat pad in Chinese which interferes with the muscle insertion.  In some patients, the double eyelids become more apparent with age as a result of fat shrinkage (fat atrophy) making the insertion more stable.

The pictures show a cute baby with single eyelid who occasionally develops double eyelids on waking up.

Normal eyelid appearance.

Double eyelids on waking up.