Monday, June 25, 2012

Cautionary Tale: Correcting other Surgeons' Unsatisfacotry Results

The following news reminded me of a case in my clinic recently: a 26-year old patient who wanted to look like a Chinese film star underwent 4 eyelid operations by the same plastic surgeon: 2X double eyelid surgery, 1X epicanthoplasty and 1X brow lift. She showed me the picture of the film star and said she was unhappy because the surgeon did not achieve the results she wanted. She wanted me to widen her double eyelids further. While the surgery involved only removal of some loose skin I was reluctant to comply because of her demanding and pedantic behaviour. I was of the opinion that if the result were not 100% perfect, she would blame me for all the imperfections from the pervious operations. I politely asked her to see her plastic surgeon for correction. There is a saying in medical profession: "It takes 10 years to learn how to operate and another 10 years to learn when not to operate."
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Woman spends $16k on botched double eyelid surgery


SINGAPORE - A Singaporean permanent resident is demanding that her double eyelid surgeon refund her the $16,000 she spent on double eyelid surgery that she claims resulted in uneven eyelids.
According to Shin Min Daily, Miss Sun, 37, who is originally from China, said that because her natural eyelids are not beautiful, she went for four double eyelid surgeries from 1992 to 2010.
After having been operated on, she felt that there was an improvement, but still believed there were certain flaws that she was dissatisfied with. Hence, on April last year, she forked out $16,000 for a prominent plastic surgeon here to do her fifth surgery.
However, before the doctor removed the stitches, she discovered that the surgery appeared to have gone wrong. Her eyes looked uneven and the widths of the double eyelids were different.
The doctor then assured her that it takes time for the wound to recover, and told her to do physical therapy. In the end, the surgery still ended up a failure, she lamented.
Miss Sun is now demanding a full refund, but the doctor is only willing to return $6,400 to her.
"I am not satisfied. I had an appointment with the doctor to meet at 8am to discuss the situation. I arrived 10 minutes late, and the doctor's assistant said the doctor is at a surgery and has no time to see me. This is not sincerity," she told Wanbao.
Miss Sun said she then opted to wait at the clinic, but was driven away by security called in by the clinic.
After explaining to the security officers the reason why she was waiting at the clinic, she said they eventually allowed her to stay.
However, the clinic resorted to calling the police instead, she claimed.
The police have confirmed that they have received complaints regarding this dispute, and have explained to the relevant parties on what legal action is available to them.
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不满前4次手术 找狮城名医操刀 女郎割双眼皮变“大小眼”

2012-06-22 18:01
  • 孙小姐花约3万8000令吉动第五次割双眼皮手术,结果变成“大小眼”。
(新加坡22日讯)女郎4次割双眼皮不满意,花1万6000元(约3万8000令吉)找知名整形医生5度动刀,结果竟变大小眼,要求医生退手术费遭拒。女郎上诊所讨公道,诊所报警处理。
这起纠纷发生在昨天早上8时许,地点是在一家由本地知名整形医生开设的诊所内。
来自中国的孙小姐(37岁)说,由于眼睛不美,她从1992年到2010年,在中国动了4次割双眼皮手术。
动了手术后,她双眼虽然匀称,但仍有瑕疵让她不满意。
2009年成为新加坡永久居民的孙小姐说,她去年4月14日,花了1万6000元5度动手术,由一名新加坡著名整形医生操刀。
不过,在还没有拆线前,她就发现手术似乎不妥,双眼的宽窄变得不一。
医生称需时间康复
“医生当时说,需要时间让伤口慢慢康复,还叫我做物理治疗,但最后我觉得手术是失败的。
仅获部分退款 诊所竟先报警
孙小姐要求医生全数退款,但从去年谈到现在,医生只愿意退回6400元(约1万5360令吉)。
“我不满意,昨天约好医生早上8时见面谈,我迟到10分钟,助理就说医生去做手术了,没时间见我,很没诚意。”
孙小姐欲在诊所等待,岂料诊所却致电保安赶她走。
“我和保安解释后,获准留下,但诊所却竟然报警。”
狮城警方接获投报 
警方受询时证实接获这起纠纷的投诉,并已向双方解释各自能采取的法律行动。
被朋友笑“金鱼眼”
整容失败被朋友取笑“金鱼眼”,女郎出门需戴眼镜遮丑。
孙小姐表示,双眼整容失败后,眼眶大小不一,右眼明显比左眼小,她出门时都需要戴眼镜遮丑。
双眼不时突出
此外,她的双眼也出现“金鱼眼”现象,双眼会不自觉突出,样子有点吓人。
“我朋友看到就取笑我,说我眼珠突出,看起来很凶,这让我深受困扰。”
她透露,心理上大受打击,本来是要整容让自己变得更美,现在却变得更丑。







Sunday, June 10, 2012

Recovery Rate for Incision versus Suture Techniques

The two basic techniques for double eyelid surgery are suture technique and incision technique. The advantages of suture techniques over incision techniques are:
a. faster surgery
b. less swelling
c. shorter down time
Below are the pictures of patients who underwent suture technique versus incision technique.


The pictures were taken before and ten days after double eyelid surgery.
The patient who underwent incision technique still had some swelling
whereas the suture technique patient had little swelling.

Thursday, May 10, 2012

Small Incision for Droopy Eyelid and Double Eyelid

Like most surgeries in other parts of the body, the smaller the incision made to the eyelid the faster the recovery. Small incision is useful in selected patients who want to have double eyelid surgery or correction of droopy eyelids with reduced down time. This patient presented with a left droopy eyelid as a result of contact lens wear. During the consultation, she also desired double eyelids. Small incisions were made to the eyelids (about 1/3 to 1/2 the length of the eyelids) to form double eyelids in both eyes and also to reposition the left levator muscle (which is used to open the eyelid) to correct the droopy eyelid.

Very low double eyelids and left droopy eyelid.

Small incisions about 1/2 the length of the eyelids were created to form
double eyelids and to correct the left droopy eyelid. The left eye has
incomplete closure because the left levator muscle has been pulled
down to lift the lid. Closure usually returns to normal after about
two weeks.

Appearance of the eyes 3 hours after the surgery.

Appearance of the eyes at 6th operative day. Apart from
the bruisings, the eyelids have minimal swellings.

The incision sites occupy only 1/3 to 1/2 the length
of the eyelids.The lid closure of the left eye has
also improved.


Monday, April 9, 2012

Doc, My Child has this Swelling Since Birth !

In the previous blog, the patient presented with an inflammed orbital cyst in adulthood. However, most cases are brought to the attention of ophthalmologists because of parental concern.
Below was a typical case in a 3 year-old boy. The cyst presented as a slow-growing, painless, subcutaneous mass. Intense inflammation may occur if the cyst ruptures spontaneously or because of trauma. Excision resulted in complete resolution.

Swellling of the left upper eyelid below the eyebrow.
Feature typical of an orbital dermoid.

Marking was done below the eyebrow to hide
the scar.

Incision was made below the eyebrow.

The dermoid was exposed via blunt dissection.

The cyst was removed intact to avoid leaving behind
any remnants which may cause inflammation.

The cyst measured 1.5cm in diameter.

Cheesy content inside the cyst.

The wound was closed with 6/0 vicryl.

Appearance at 6 days post-operative, the scar will fade
with time and become inconspicuous as it is hidden
by the eyebrow.

Monday, April 2, 2012

Doc, I Got a Big Lump in My Upper Lid !

This young man who had had a small lump in the right upper eyelid since young. Recently, the lump suddenly ballooned with pain. The location of the lump was classical for dermoid cyst and the sudden increase in size meant the cyst has become inflammed possibly due to trauma or spontaneous ruptured of the cyst.

Dermoid cyst is a developmental abnormality in which a bit of skin has been pinched off from the surface and comes to lie in areas where they are not usually found. The most common site for dermoid cyst on the face is below the lateral side of the eyebrow. This cyst can continue to grow because of secretion from the component. It is advisable to remove the dermoid cyst when the patient is young to prevent its continous growth or inflammation as a result of trauma.
The cyst in this patient showed transillumination indicating the cyst is filled with fluid.

About 4 ml of yellowish-green fluid was aspirated from the cyst. The aspiration was done to reduce the pain from distension and also help with surgery so that the wound created does not have to be too big.

To make the scar less conspicuous, the incision was made below the eyebrow.


The whole lump was removed completely so that there is no remnant to cause future inflammation or reaccumulation of the fluid.


The flaccid cyst measured 1.5cm across.


The cyst has thickened wall and contained some cheesy materials secreted by the inner surface of the cyst.

The wound was closed with 6/0 nylon suture and he had no recurrence at 6 months follow-up.

Sunday, March 18, 2012

Allergy to Tapes for Double Eyelids

There are several non-surgical methods of creating double eyelids to make the eyes bigger. The most common ones are using glues and tapes. However, no everybody finds these methods satisfactory for several reasons: a. time consuming; b. failure to form double eyelids in those with excessive skin or puffy upper eyelids and c. contact dermatitis (skin allergy to the glues or tapes).

This young girl had been using tapes for years to create double eyelids. Recently, she started to develop itchy eyelids whenever she used tapes despite switching to different brands.

Sore and red skin from glue and tape application.

Examination shows inflammation and excoriations as a result of contact dermatitis.
Contact dermatitis made obvious after
removing eye make-up.

As the patient finds it difficult not to use eye make-up because of her profession as a beautician, double eyelids were created using the incision technique.

One-week post eyelid surgery.