Doc, Was it Because I Ate Strawberries While Pregnant?

This 6-month old baby girl was born with red birth marks above her right eyebrow and the mother became alarmed when a large red mass began to appear in the right eye which grew rapidly. She was told by her doctor this was a strawberry naevus and referred for urgent treatment. The mother thought it was caused by her eating strawberries duing pregnancy until we explained to her that this was a type of congenital eyelid anomalies caused by overgrowth of blood vessels (haemangioma) and not associated with any food intake at birth. Strawberry naevus is common in babies and most disappear spontaneously without leaving any serious problems. However, in some patients, the lesion can grow to a huge size and interfer with important structure such as the eye as in this patient. The right eye was completely covered by the red mass which grew from below the right upper eyelid. Because the eye was occluded there was a risk that the right eye may become lazy eye as it was not receiving proper visual stimulation during growth. Consequently, it was importat to treat the condition urgently (to be continued ............)

The right eye was competely covered by a red mass.

The mass arose from under the right uppe eyelid.

Cutis Laxa (elastolysis or dermatolysis) and the Curious Case of Benjamin Button

iIn the Curious Case of Benjamin Button, the main male character was born old and grew progressively younger. Unfortunately, some young people are affected by cutis lax(elastolysis or dermatolysis) which make them two or three times older than their actual age except that unlikes Jeremy Button they don't grow younger. Plastic surgery is the only way to restore some of their youthful appearance.

Cutis laxa is a rare disorder caused by defects or destruction of the collagen  in the skin. It may be hereditary or acquired.  Its typical dermatologic characteristics are loose skin with folds and premature aged appearance. In addition, some patients may also show premature ageing of their body organs like the hearts and lunds. Below are three sufferers from China. There are less than 10 cases in the whole of China.

This 21 year-old woman (left) appears as old as

her 70 year-old granny (right).

23 year-old man with the face of a 60 year-old. He underwent

a face lift to make him look younger but unfortunately

he is unable to regain the face of a 20ish.

A 29 year-with the face of a 70 year-old and after face lift.

Despite the extensive surgery, he still appears over 50.

Friday Presentation in UNIMAS

This Friday (14th Jan, 2011) is the turn of the Eye Department of UNIMAS to give a lecture to the faculty. After juggling with the topics (Double eyelid surgery, Eyelid Reconstruction, Sleepy Eyes, Recent Advances in Cataract Surgery etc), I decide to give a talk on eyebags and dark circles entitled: "All you need to know about eyebags and dark circles" in the Main Lecture Theatre, Ground Floor, UNIMAS Medical School. All are welcomed, the talk will review all the common procedures for eyebag surgery including transcutaneous, transconjunctival, fat repositioning, pinch blepharoplasty, fillers for tear trough and different treatment options for dark circles and how effective are there.  

This Friday talk.

Previous Talk.

Another Double Eyelid Disaster from Beauty Salon

Insanity has been defined as doing the same thing over and over again and expecting different results. In the following case, the insane one is the patient and the beautician the unscrupulous one.

This 15 year-old girl presented with multiple swellings of both upper eyelids along the skin creases. She underwent four double eyelid surgeries over the past 12 months. The procedures were performed by the same beautician in a bauty/hair salon over a two year period. However, each time the double eyelids failed to form and after the last surgery which was 9 months ago, she was left with unsightly lumps in her upper eyelids. The beautician was unable to offer any remedial treatment for the swellings and as expected told her that she got "special" eyelids which were not suitable for double eyelid surgery.

The arrows in the top picture show the lumpy lesions. The bottom

picture show the prolene sutures excise (arrows).

She became depressed and afraid to go out for fear people would see the lumps. To get rid of the lumps and at the same time create stable double eyelids, I perform the incision technique . The lumpy lesions were found to be caused by prolene sutures wich were placed repeatedly by the beautician in the hopeless attempt to create double eyelids. These sutures were excised and skin creases were created with a height of 7 mm. She made an uneventful recovery.

The eyelids before and after revision with the lumpy

lesions removed.

The Hollywood Double Eyelids (blepharoplasty)

In my previous blog, I discussed the type of double eyelids (high skin creases with hollow upper eyelids) that some young Hollywood actresses used to aspire to but is not longer in fashion. However, when the new generation of Hollywood celebrities grow old and develop excess upper eyelid skin (dermatochalasis), they invariably go to Hollywood cosmetic surgeons who all seem to be taught by the same teacher. They without fail create hollow upper eyelid with exceedingly high double eyelids and elevate eyebrows (through brow lifts). Consequently, these ageing celebrities seem to have come out from the same factory. Unfortunately, these make them appear old as the loss of fat in the orbit (as evidenced by hollow orbit) is one of the sign of ageing.

Some victims of Hollywood blepharoplasty.

Do Caucasians Need Double Eyelid Surgery?

Almost all Caucasians are born with double eyelids so one may assume that they don't need double eyelids to make their eyes bigger. However, you may be surprised that some Caucasians undergo eyelid surgery to make their double eyelids even higher as these are thought to make them more glamorous. These so-called "Hollywood blepharoplasty" used to be popular amongst leading Hollywood actresses in th 50s and 60s and the most famous of which is Marilyn Monroe. To achieve these Hollywood double eyelids, the surgeons would remove orbital fat to make the eye sunken and suture the skin creases excessively high so that the patient would have some degrees of droopy eyelids. That may be why Marilyn Monroe always has a sleepy look.

Nowaday these looks are thankfully out of fashion, all the Hollywood movies would be full of sleepy beauties. Nonetheless, the height of the skin creases used to confer audience and director impression of the actress and got them tyecasted. A high skin creases gives the impression of a larger eye opening and accentuates the expression of the upper lid and much favored by leading actresses playing seductress. A low skin crease, in contrast, gives the eye a narrow and rather expressionless look. However, this can give mystery and intrigue to some actresses making them prime choice for mystery movies.

Marlene Dietrich (right) with her high double eyelids always played

seductress whereas Laura Bacall with her low double eyelids always 

casted as the woman of mystery.



Botched Dobble Eyelid Surgery by Phony Surgeon and How to Check the Validity of Your Doctor

This unfortunate woman came to see me a few months ago after a botched double eyelid surgery performed by a "doctor". Examination showed that she had unequal double eyelid heights and the double eyelids were too deep with unsightly scars. In addition, she had sunken orbit as a result of too much orbital fat being removed. She returned to the doctor but was told he did what she wanted and he could not see any problems.

When I asked her about the doctor, she produced a name card which showed the doctor had an oversea qualification. I began to smell a rat when she told me that he performed the procedure in his wife's beauty salon. I searched for the doctor name in the Malaysian Medical Council Register and could not locate his name. It is bad enough for ignorant people to have double eyelid surgery performed in beauty salon without proper sterilization and worse still for some crooks pretending to be doctors and peform invasive procedures.

If you want to find out if your doctor is genuine, you may visit the Malaysian Medical Council and enter his/her name to verify his qualification.