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Asian Double Eyelid Crease Formation / Blepharoplasty and Medial Epicanthoplasty Recovery Log

Wednesday, May 26th, 2010

I thought that this would be a nice way for people to see how they could potentially recover from Asian Blepharoplasty / Double Eyelid Crease Formation and Medial Epicanthoplasty Procedures (Philip Young MD is in Bellevue, Washington).  Below are some pictures after we completed these procedures for someone.  I will update these photos as more come in and time permitting. One thing you can see is the swelling and the bruising.  Some of the effects of the procedure on the eyelid will make the muscles that opens up the eyelid weaker from the manipulation.  This droopiness of the eyelid is called ptosis.  This is a very common occurance and will recover completely in days to weeks at most.  Sometimes this can last longer but is more rare. You can see that her ptosis is rapidly improving over just a couple of days. The incisions near her epicanthus or fold in the middle of the eye is from the procedure called the medial epicanthoplasty.  We explain these procedures in more detail in other blogets in the this main blog site.  We also have a video demonstrating these procedures for you to see.

Thanks for reading,

Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Day 1 Right After Surgery

Day 2

Day 3

Day 4

Day 5

Posted in Asian Cosmetic Surgery, Asian Double Eyelid Surgery / Asian Eyelid Surgery, Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags | Comments Off on Asian Double Eyelid Crease Formation / Blepharoplasty and Medial Epicanthoplasty Recovery Log

What is the Round Eye Deformity and how does a medial epicanthoplasty improve this situation when doing Asian Blepharoplasty?

Saturday, May 22nd, 2010

The round eye deformity is a consequence of making the double eyelid crease (Philip Young MD from Bellevue, Washington) too high for the particular persons eye shape.  What happens is that the eye appears to be much wider in the vertical dimension that appears Round and Odd without the horizontal natural appearing eye that most eyes should have.  Usually, most Asian eyelids should have at most 3mm of pretarsal show.  That is the amount of eyelid that is showing under the eyelid crease.  This area is usually smaller when the eye is open but larger when the eye is closed.  The most it should show when the eye is open is 3mm for an Asian Eyelid for an Asian eyelid to look the most aesthetically pleasing.   When the eyelid crease is higher than this, the result starts to put more tension toward the medial part of the eyelid.  There are solutions to this.  You can decrease the height of the eyelid crease so that it looks more natural. Or you can do another procedure, a medial epicanthoplasty which can open up the eyelid more in the horizontal dimension.  This helps release the tension that is placed in the epicanthal area.   My preference is to do Dr Park’s Z epicanthoplasty.  Previous epicanthoplasties were notorious for their propensity to create a lot of scarring.  The beauty of Dr. Park’s Z epicanthoplasty, is that it avoids the scarring and keeps the incisions within the double eyelid crease and the natural creases that would normally be created in the eyelid creases.  When you look at the picture below, the triangle ECA is removed.  The flap made from EAB is rotated into ECA.  This effectively helps reduce the prominence of the epicanthal fold and helps open up the eye in the horizontal dimension. We have a video demonstrating these procedures.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Asian Double Eyelid Surgery / Asian Eyelid Surgery, Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags | Comments Off on What is the Round Eye Deformity and how does a medial epicanthoplasty improve this situation when doing Asian Blepharoplasty?

Browlifting with Brow Bone Reduction, Hairline Lowering, and Removal of Frown Muscles can Markedly Improve Your Appearance

Thursday, May 20th, 2010

There are many reasons for browlifting (Dr Young specializes in Browlifts and Facial Plastic Surgery) and working with the upper third of the face.  One of the main reasons is to lift the brows when they are drooping.   In this case, raising the eyebrows can open up the eyelids and reduce the upper lid skin laxity.  This can be done through open approaches, through the eyelid and through minimally invasive means through small incisions behind the hairline.  What can also be done is removing the muscles between the eyes that causes the frowning.  This can reduce your needs for botox markedly to not having to need botox at all.  Some people also have significant brow prominence that can be reduced by burring the bone down.  this can be done through an eyelid incision or through an open approach which requires an incision from ear to ear.  Although the incision from ear to ear sounds daunting, the incision actually heals really well when you close it accurately. Also through an open approach you are more likely to get longer lasting results.   Reducing the brow bone can reduce the stern and masculine look that some women have.  Hairline lowering is something that can also be done for people with high hairlines. This is done through an incision right at the hairline.  This combination of procedures, browlift, brow bone reduction, hairline lowering, and brow bone muscle reduction is much more commonly done for certain patients that want to have more of a feminine appearance.  This typically is more common among my transgender patient.  Below is a picture of a just such a patient.  Although we have done this for many women.  Most of the women we have are more conservative in showing their pictures on our website.  Notice in the pictures that his brow bone is less prominent and his eyebrows are elevated to his desired height that we discussed prior to the procedure.  Other procedures that he has were a chin reduction, rhinoplasty, and permalip implants.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Before

AFTER

Before

After

Posted in Botox, Dysport, Botulinum, Browlift / Eyebrow Lift / Brow Lift, Transgender or Facial Feminization / MasculinizationSurgery, Wrinkle Treatment | Comments Off on Browlifting with Brow Bone Reduction, Hairline Lowering, and Removal of Frown Muscles can Markedly Improve Your Appearance

chin implants and the assesment of the vertical dimension and the possibility of a deficiency.

Saturday, May 15th, 2010

So a common question is would I benefit from a chin augmentation (Dr Philip Young Seattle/ Bellevue Wa)?  I addressed this question in a recent blog but I didn’t talk about the vertical component.  How much vertical augmentation do I need and do I even need to add anything to the vertical dimension of my chin? Firstly, it is good to have some anatomical terms to refer to. In the first picture, the Glabella, labelled “G” is the most projecting point on the lower parto f the forehead and is usually right between the eyebrows. The nasion, labeled “N”, is the most depressed point below G and is usually at the root of the nose.  The Subnasale, labeled “SN”, is the point of transition from the nose to the upper lip.  It is where the nose, columnella, intersects the upper lip.  The upper vermillion is the point of transition from the white part of the upper lip to the red portion of the lip (Called the Vermillion) and is labeled “VU”. The same point coinciding with the lower lip is labeled “VL”. The Pogonion, labeled “PG”, is the point of the chin that is the most projecting anteriorly.  The mentum, labeled “MN”, is the most inferior portion of the chin.  One thing to be careful of is when the patient has a double chin.  The mentum is the part of the chin that is associated with the chin and not the inferior part of the sagging that can occur under the chin and posterior to the chin. The first rule for vertical augmentation is based on three lines drawn through the glabella, subnasale, and mentum.  Each of these distances created by these lines should be equal.  If your chin is making the distance from the mentum to the subnasale shorter than the distance from the subnasale to the glabella, you could benefit from a vertical chin augmentation.  If it is longer than you could benefit from chin reduction. This is shown in the second picture.  Now, if you draw a line through the nasion instead of the glabella the distance from nasion to the subnasale should be 43% and the distance from the subnasale to the mentum should be 57% o the total distance from nasion to mentum.   If the your distance from subnasale to the mentum is less than 57% you could possibly use some vertical enhancement.  the In the third picture, three lines are drawn through the subnasale, stomiom (or the opening between the upper and lower lips), and the mentum. The ratio of the distance from subnasale to the stomiom to the distance from stomiom to the mentum should be 1:2.  If the distance from your stomiom to the mentum is less than this ratio, you could benefit from vertical enhancement or an increase of the vertical dimension of your chin.  Below are some results of chin augmentation for you to see how a chin implant could enhance your appearance.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Profile Landmarks

Facial Thirds

Mouth Ratios

Before Chin Augmentation

After Chin Augmentation

Before Chin Augmentation

After Chin Augmentation

Posted in Chin Surgery | Comments Off on chin implants and the assesment of the vertical dimension and the possibility of a deficiency.

Custom Chin Implants are a good option for chin augmentation and how much anterior projections should I have.

Saturday, May 15th, 2010

Chin implants (Dr Young specializes in plastic surgery in the Face and Neck in Bellevue Washington) come in many shapes and sizes.  Sometimes, even with the many variations there  might not be one that fits all of your needs.  This is when a custom implant may be the perfect choice for you.  One of the first questions you should ask is whether or not a chin implant would work for you.  There are multiple ways of assessing whether you could benefit from enhancing your chin.  The first thing to do is to understand the various landmarks. In the first picture, the Glabella, labelled “G” is the most projecting point on the lower parto f the forehead and is usually right between the eyebrows. The nasion, labeled “N”, is the most depressed point below G and is usually at the root of the nose.  The Subnasale, labeled “SN”, is the point of transition from the nose to the upper lip.  It is where the nose, columnella, intersects the upper lip.  The upper vermillion is the point of transition from the white part of the upper lip to the red portion of the lip (Called the Vermillion) and is labeled “VU”. The same point coinciding with the lower lip is labeled “VL”. The Pogonion, labeled “PG”, is the point of the chin that is the most projecting anteriorly.  The mentum, labeled “MN”, is the most inferior portion of the chin.  One thing to be careful of is when the patient has a double chin.  The mentum is the part of the chin that is associated with the chin and not the inferior part of the sagging that can occur under the chin and posterior to the chin. One rule was developed by Gonzalez-Ulloa shown in the second picture.  The horizontal line you see will be refered to a lot by surgeons. It is called the frankfort horizontal.  It travels from the top of the ear canal and through the top of the inferior orbital rim.  The vertical line you see is part of there interpretation of where the chin should be.  The vertical line should travel through the Nasion and the the Pogonion should approximate this line. Some feel that the augmentation based on this rule would lead to too much projection. A similar rule places the vertical line of the Gonzalez-Ulloa line more posteriorly at the subnasale, although sometimes it is very close as in this picture, called the Epker and Fish Rule.  Based on this rule, the vertical line should travel from the subnasale and through the upper vermillion “VU” and the lower vermillion should be 2mm behind, and the pogonion should be 4mm behind. The third really common rule is based on the Nasal Chin Lip Line.  It is based on the ideal nasal length measure from the root of the nose at the level between the upper eyelid crease and the upper eyelid margin to the nasal tip.  From the half point distance, a line is drawn through the upper lip vermillion.  From this point, the pogonion should be be 3mm behind this line.  The last two rules are my most preferred ways to assess how much chin augmentation to do.  In another blog, I will address the vertical dimensional analysis.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Profile Landmarks

Nasal Chin Lip Plane / Line

Posted in Chin Surgery, Uncategorized | Comments Off on Custom Chin Implants are a good option for chin augmentation and how much anterior projections should I have.

Transgender Surgery Involves Multiple Steps

Friday, May 14th, 2010

There are multiple procedural steps for someone interested in Transgender Surgery (Dr Young specializes in Transgender Facial Surgery in Bellevue, Washington).  The order by which you undergo these procedures can be individulized based on the particular person’s needs and anatomy.  1. Rhinoplasty, 2. Lip Augmentation (including Lip Lifts, Lip Plumping, V-Y Advancements, Lip Implants / Surgisil), 3. Chin Reduction Procedure, 4. Browlift, Brow Bone Reduction, Hairline Lowering, 5. Cheek Implants, 6. Fat injections to soften the facial structures, 7. Tracheal Shave / Thyroid Cartilage Reduction, 8. Angle of the Mandible Reduction or Botox Mandible Reduction, 9. Other Adjunctive Procedures including Blepharoplasty, Hair Reduction, etc.  The patient below had a conservative rhinoplasty, Permalip Implants, Lip VY Advancements, Chin Reduction, Browlift with Brow Bone Reduction, Hairline Lowering procedures.  We are planning on Cheek implants to heighten the highlights of his cheeks, fat injections to soften all of his features, tracheal shave in the future.  Notice his higher eyebrows.  Now this can be interpreted as being high for some people tastes.  This was something that we had discussed with the patient and he likes the brows little more elevated.  The ideal should be that the distance from the bottom of the eyebrow to the eyelid margin should be about one to one and 1/2 iris widths.  Also notice the difference in his chin and the decreased prominence of his chin.   He also had permalip lip implants to enhance his lip’s size. The VY advancements in his lips has created more of an eversion to his lips so that it shows more red in his pout.  The other procedure that we did for this patient is that we also resected his brow muscles that are between his eyes.  These muscles pull the eyebrows closer together and give a person a stern, mean look.  These muscles also created the veritical and horizontal lines in between the eyes.  Resecting these muscles decreases a persons ability to do these maneuvers and decreases the wrinkles there.   Also it allows the brows to become higher naturally because the brow depressor muscles are weakened.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

BEFORE

AFTER

Posted in Transgender or Facial Feminization / MasculinizationSurgery | Comments Off on Transgender Surgery Involves Multiple Steps

Orbicularis fixation in combination with medial epicanthoplasty can have dramatic results on an Asian Eyelid

Thursday, May 13th, 2010

Orbicularis Levator Fixation (Dr Young specializes in plastic surgery of the face and neck and Asian Facial Plastic Surgery) is a technique that I blogged on before.  It entails attaching the levator (the eye muscle that opens the eye by lifting the eyelid up) aponeurosis to the orbicularis muscle, which is the muscle that surrounds the eye encircles it and is the primary muscle that helps close the eye and eyelid.  With a medial epicanthoplasty, another procedure that I blogged about, you can open up the eyes by increasing the eye’s aperture in the horizontal dimension.  The medial epicanthal area is an area that is prone to scar and doing procedures in this area requires a lot of planning and research.  In my opinion, the Park Z epicanthoplasty is the best procedure for this area.  I show some results of these two combined procedures in the pictures below. The results show that the procedure has incredibly opened up her eyes in a vertical and horizontal dimension.  The results have markedly improved her aesthetics. Here is video on Asian Blepharoplasty and Medial epicanthoplasty.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Before

After

Before

After

Posted in Asian Cosmetic Surgery, Asian Double Eyelid Surgery / Asian Eyelid Surgery | Comments Off on Orbicularis fixation in combination with medial epicanthoplasty can have dramatic results on an Asian Eyelid

Scar revision basics

Saturday, May 8th, 2010

When I look at a scar I consider a number of things when I think about a possible scar revision (Dr Young has extensive experience in scar revision in Bellevue, WA) First thing to realize is that people tend to see and notice lines that are longer than 0.7cm.  Anything longer than that, a person is more easily able to identify the line.  So if a straight scar is longer than this it may be prudent to break it apart. This can be done with z plasty where the scar is broken up by a z pattern.  Or a geometric line closure, where the scar is broken up by a combination of squares, half circles, triangles etc.  That way, the scar is not noticed as much. If it is depressed, you should exise the depressed portion and close the new incision with it being elevated.  I have a number of techniques to do this.  The closure should be done in such a way that the incision is closed as the finest line possible.    After closure, I like to do resurfacing with either dermabrasion or co2 resurfacing or a combination 6-8 weeks later.  Ice pick scars can be elevated by excising around it and elevating the tissue and then with reclosure.  Box car scars that are a square or rectangular areas that are depressed can be elevated and then closed in the elevated state.  If the area is a large depressed area, sometimes rotating flaps into the area is the best and this depends on how it looks and how large and if there is tissue in the area.  Also the tissue in the area cannot be around a vital structure like the eyebrow, mouth or eye.  But even around these structures flaps can be developed and used for reconstruction purposes. Here is a video on Scar Revision.

scar treatment geometric line closure video

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Scar Removal / scar reduction / scar revision / scar treatment | Comments Off on Scar revision basics

Rhinoplasty of the tip can be done without the need for breaking the nose and more traumatic techniques

Saturday, May 8th, 2010

I saw a patient recently that went to another doctor who had suggested to add tissue to the top of the bridge of the nose and also the bottom to camouflage the mild elevation in the middle of the nose.  She really didn’t want to do that and was only interested in refining the nasal tip.  In my opinion, everything looked really good with her nose except a moderate amount of tip bulbousity.  On my exam, I noticed that her elevation was more inferiorly near the tip.  I attributed this elevation to extra large tip cartilages.  In my opinion she only needed to refine the tip by excising the top part of the tip cartilages through rhinoplasty or nose reshaping.  In the picture below, the lateral crus is where I identified where her tip cartilages were enlarged.  They were so enlarged that it increased the size of the bridge in this area.  By refining the lateral crus, it would decrease the bridge in this area and would effectively cause a little desirable break just above the nasal tip that is beautiful when it is achieved.  I thought that her nose would be significantly masculinized if she were to get her nasal bridge in between her eyes elevated and enhanced.  It would be a wrong choice for her by this other surgeon.   The other surgeon wanted to narrow her nose as well.  On my exam, her nasal bridge was about the width of her irises which to me was ideal.  This was consistent with her ideals as well and was also consistent with my theory on facial beauty. You can read my theory here (Dr Young received the Sir Harold Delf Gillies Award for this theory by the American Academy of Facial Plastics and Reconstructive Surgery). Going to someone who has a good sense of aesthetics is probably one of the most important things about a surgeon.  You can have the best techniques but if you don’t have  blueprint how are expected to achieve the result without knowing the ideal or what is the best end result. The best techniques can lead to a bad result even if everything was done right.  That is why aesthetics is so important!

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping | Comments Off on Rhinoplasty of the tip can be done without the need for breaking the nose and more traumatic techniques

Perinasal implants for sunken cheeks and nasolabial folds

Saturday, May 8th, 2010

One overlooked solution to sunken cheeks and nasolabial folds are perinasal implants (Dr Young specializes only in the face and neck and is located in Bellevue Washington) that you can insert next to the nose.  A lot of what creates nasolabial folds is the volume loss in the cheek next to the nose.  This can be a natural occurence for people or can result from aging.  A perinasal implant are most commonly silicone and medpor.  They can be inserted from the nose along the floor or within the mouth through really small incisions. The other to do this is through fat injections or the YoungVolumizer which I developed.  All options serve to plump up the perinasal area to decrease the nasolabial fold deep characteristic.  For the nasolabial folds you may also need some superficial volumization through fillers.  The perinasal implant can also volumize this area to give the medial cheek more prominence.  This tends to highlight the central face where you want the most attention.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Cheek Augmentation, Fat Transfer / Fat Injections, Midface Lift, YoungVolumizer | Comments Off on Perinasal implants for sunken cheeks and nasolabial folds

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