Archive for the ‘Asian Cosmetic Surgery’ Category

Pretarsal show and Epicanthal fold are important terms when you do Asian Blepharoplasty

Tuesday, February 9th, 2010

I wanted to talk about the various terms that people are using when they consider Asian Blepharoplasty (Seattle’s Dr Young).  One is Pretarsal show. Essentially this is the height of skin that is exposed under the crease when the eye is opened.  See the picture below.  You measure or assess this when the patient’s eye is open and the height that is measured from the crease to the eyelid margin where the eyelash is located is the height of the pretarsal show when the eyes are open.  This is different from where the crease actually begins which could be, and usually is, much higher underneath the fold of skin that folds over where the crease begins.  When you determine where you put the crease, the amount of skin you take will affect the pretarsal show.  I usually use a metal pointer to stimulate where I will make the crease and have the patient open up there eyes.  At that point, I will ask the patient if the pretarsal show is high enough.  But I usually ask whether the “crease is high enough”. Usually the crease is set between 6 and 8 mm for a small fold.  If the pretarsal show is not high enough after placing the metal pointer at 8 mm I usually then think of taking more skin.  Then depending on how high the patient wants I usually estimate how much higher and then I multiply that by two which determines how much skin I take.

The other question I ask patients is whether they want they crease to end medially with an inside or outside fold. The picture below shows an inside fold.  An outside fold would be end closer to the nose and closer than the fold of skin where the epicanthal fold is located.  The epicanthal fold is just the extra skin that covers the fleshy part of the medial part of the eye (which is called the lacrimal lake).

To maintain you ethnicity, I usually like to make the pretarsal show no higher than 3mm and the medial part of the crease is usually an inside fold.

The epicanthal fold is another area that you can treat.  Through a different techinque you can make the epicanthal fold more open by transposing the tissue of the epicanthus more medially.  This can open up the eye and improve the results of an Asian Blepharoplasty.  I use Dr Park’s Z epicanthoplasty for most of my epicanthoplasty procedures. You can read my other blog on Dr Park’s Z epicanthoplasty that I like to do.  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

eye anatomy front view

Orbicularis to Levator Fixation can lead to longer lasting results and more definitive crease formation with Asian Double Eyelid Blepharoplasty.

Tuesday, February 9th, 2010

There are many options with Asian Double Eyelid Crease Formation (Dr Young Seattle) including whether to use incisions or not, how to fixate the crease, how high the incision should be, whether an inside the fold or outside the fold crease is desired, if an epicanthoplasty should be done.  This particular blog will focus on how we do the internal fixation.  Most surgeons, greater than 90%, use the external fixation sutures to make the crease.  Essentially what we do is first make the incision and then we have to make our way down to the orbital septum.  It is essential to be very careful in doing this because you don’t want to start too low and enter the orbital septum below where the orbital septum and levator come together.  If this is done you could injure the levator and cause ptosis which is when your eyelid is lower in relation to the iris and you essentially look like you aren’t opening your eyes as big as before.    After we reach the orbital septum we then enter into the “post” septal space and elevate the post septal fat and find the levator. Traditionally at this point  the skin is then tacked to the levator with sutures and this is what causes the crease to form.  These sutures are then taken out 7 days later.  Usually this is enough to cause enough scarring to last a long time.  Another way of doing this is to tack the orbicularis muscle as shown in the photo below to the levator with orbicularis-levator fixation sutures.  These are internal fixation sutures that stay in there permanently.  In addition to these sutures, I also do the external sutures for extra assurance that the fold will stay for a very long time if not indefinitely.  The internal sutures have the benefit of acting more like the natural action that the levator has on the skin that is in front of the tarsus.  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

Upper eyelid anatomy

For Asian Double Eyelid Blepharoplasty does the incision technique give long lasting results and for how long? How does the non incision technique compare?

Tuesday, February 9th, 2010

The incision technique while doing Asian Double Eyelid Blepharoplasty (Dr Young is in Bellevue Washington) gives a longer lasting and more reliable result than a non incision technique in most hands.  When done correctly the results should last 10-15 years or longer.  Essentially most results should be indefinite and be there permanently.  There are ways to make sure that the crease stays.  One method that I employ is the orbicularis-levator fixation technique which entails using internal sutures that attach the eye muscle that closes the eye (orbicularis) with the muscle and fascia of the muscle that opens up the eyes (levator).  These internal sutures are created with small nylon sutures that take a very long time to dissolve and sometimes never dissolve.  I also employ the more traditional skin to levator fixation sutures as well to ensure that the crease stays as long as possible.  Non incision techniques have a long history of having less than reliable fixation and also less definite crease formation.  The risks of incomplete creases, asymmetry, and loss of the fold are much higher with the non incision techniques. In my experience, it seems that most experienced surgeons lean toward doing more incision techniques after they have done non incision techniques for several years. The picture below explains some of what was mentioned above. 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

Upper eyelid anatomy

Eyelid tape can work to a degree but it requires daily maintenance and the crease is always less distinct

Monday, February 8th, 2010

Eyelid tape can work to a degree but it requires daily maintenance and the crease is always less distinct.  My mother used to tape and it worked to some extent but her crease was never really distinct and her eyelid crease would have probably formed to that degree anyways.  Double eyelid surgery (Dr Young Seattle) is really the only way to make a distinct crease that will last for years and sometimes indefinitely.  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

Asian Hooded Eyelids, should I do a browlift / Asian double eyelid surgery / or fillers / injections?

Monday, February 8th, 2010

You may need a brow lift, volumizing or an Asian Double Eyelid Blepharoplasty (Dr Young, Bellevue Office). This would all depend on how you looked in person or in a photograph.   Your eyebrows should form an arch that is higher at the arch than either the lateral or medial end of the eyebrow.  Also the lateral eyebrow should be slightly higher than the medial eyebrow.  Also the distance from eyelashes to the bottom of your eyebrow should be one iris width until you reach the arch where the distance from the lashes to the eyebrow should be around 1 1/2 iris widths.  Also the highlight created by the arch should line up with the iris and nasal tip.  If your eyebrow is below this you could benefit from a brow lift or volumizing.  A browlift would be good if you never had this ideal before and you want to change your anatomy.  Volumizing would be good if you had this ideal before and want to restore it.  Volumizing is also good if you want to improve the loss of tissue around your eyes as well.  This loss of tissue often is the biggest culprit that causes aging around the eyes.  Volumizing can be done temporarily with fillers or more permanently with fat injections and the YoungVitalizer.  Asian double eyelid blepharoplasty is usefull if you would like to define the eyelid crease and to remove some extra skin.  One thing to realize is that removing extra skin can lead to thicker eyebrow skin being opposed to the thinner eyelid skin and this can look unnatural in the asian eyelid due to the thickenss of their skin.  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

What should I do with an extra fold over one of my eyes after Asian Double Eyelid Blepharoplasty that was done 2 1/2 weeks ago?

Monday, February 8th, 2010

2 1/2 weeks is a little early to judge the results after Asian Double Eyelid Blepharoplasty (Dr Philip Young, Bellevue Washington).  Swelling and inflammation could cause the extra fold that you are noticing by the new eyelid crease.  I would definitely advise you to wait.  You don’t want to do anything right now when there is swelling.  Because if you do something right now, when the swelling dissipates, your results will be different.  Also at this stage your eyes have different swelling and if you try to do something symmetrical right now it will be asymmetrical when the swelling goes down.  I would wait at least 3-6 months before contemplating a revision Asian Double Eyelid Crease Blepharoplasty (Double eyelid crease formation / Asian Eyelid Lift / Asian Eyelid Crease Formation).  Don’t worry things will look better for you over time.  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

Hooded eyelids could be improved by double eyelid surgery and / or browlift.

Tuesday, February 2nd, 2010

Hooded eyelids could be improved by double eyelid surgery (Bellevue, Washington) and / or browlift.  The big question is how old are you. If you are older the possibility that you have a droopy eyelid could be contributing to the hooded eyelid and a browlift could help.  Fat injections around your temple and forehead could elevate your eyebrow in a natural way. A double eyelid surgery could raise your eyelid crease and open your eyes a little bit.  Fat injections could rejuvenate your eyebrows and eye so that your eye is less hooded. A pictures of your condition could help.  Here is video on Asian Blepharoplasty and Medial epicanthoplasty.

Thanks for reading, Dr Young

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

Asian Double Eyelid Revision Surgery

Monday, January 18th, 2010

This topic is addressing perhaps the most difficult procedure to do. First of all, anything done around the eyes has the smallest margin of error. You can have a tiny variance of less than a millimeter and have it become very noticeable when anything is around the eyes.  That is why, procedures around the eyes have to be done with the utmost accuracy.

This is why Asian Eyelid surgery is so difficult. Some reasons for revision are ptosis.  This is a condition where the eyelid margin is lower than it previously was before.  When you do eyelid surgery for Asians and the goal is to recreate the eyelid crease, you have to work on the muscle that pulls up the eyelid.  It is essential to attach the skin edges, or elements of, to this muscle called the levator aponeurosis.  Sometimes work on this muscle can damage this muscle and lead to different affects on its function.  This can result in differences in movement and thus ultimately the height of the eyelid margin. Very small degrees of ptosis, or eyelid margin being lower than normal, can be noticeable to people  The way to treat ptosis is to expose the aponeurosis and shorten it through sutures.  This is done by grabbing the levator and attaching it to the tarsus which is the cartilage near the eyelid margin.

Other reasons for revisions include asymmetrical eyelid creases / folds, too much fat taken out of the eyelids, discontinuous creases, multiple folds, round eye deformity, etc.

For asymmetrical creases, if it is a lower eyelid crease that is desired, one needs to find what the height is desired and then the new crease is incised and the old crease needs to be released.  To prevent adhesion, you can place a fascia graft (tissue from muscle covering), or fat graft from another source into the area that is released and also to prevent readhesion.  Another way of doing that, is to lower the fat inside the eyelid over the area of adhesion.  But in the case that the eyelid fat is lacking, you need to use fascia grafts or fat from another source as noted above.  The best option is to use the free fat grafts.  Of all of the tissues that helps to prevent adhesion, fat is the best tissue to use.

For multiple creases, this situation is essentially like a crease that you want to remove.  This requires elevation of the crease and prevention of readhesion with the techniques that were just mentioned with tissue grafts as above.

For discontinuous creases, you have to recreate the crease which may entail a new incision and redoing the crease forming sutures that were done before.  Some variations of this can be done to cause longer lasting fixation. Some recreation of the creases can be done with longer lasting sutures that are placed below the skin level and allowed to absorb on their own.  Other techniques can be done to improve the fixation.

Taking too much fat entails adding fat grafts.  This can be done with free fat grafts through an incision technique or through harvesting with a cannula.  Here is video on Asian Blepharoplasty and Medial epicanthoplasty.

Thanks for reading, Dr Young

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

Asymmetric Eyes after Asian Eye Lift / Blepharoplasty

Wednesday, September 9th, 2009

This is a question that I answered for a person with asymmetric eyes after Asian Plastic Surgery(Asian / Ethnic eye lift / belpharoplasty, Asian eyelid surgery, Asian Cosmetic Eye Surgery. She had multiple folds on the left side and the fold was shorter on the left as compared to the right.

I see that your left eye has multiple creases. I think what is going on is that the crease is not properly fixed on that side and needs to match the right side.  Sometimes these surgeries are difficult because you are so close to the eye when you approach the muscle that elevates the eyelid.  There is around 1-2mm of tissue thickness from the surface of that muscle and the eyeball.  That is not much room for any deviations.  Understanding the anatomy is vital in terms of identifying that muscle and fixing it to the skin edges to create the fold.  I think your situation can be corrected in a relatively uncomplicated manner.  I wouldn’t remove any skin in your situation and you might need to add skin and some fatty tissue to match the other side but I would start with correcting the crease.

Thanks for reading, Dr Young!

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

Asian Double Eyelid Surgery

Tuesday, August 4th, 2009

lowerlid-profile-preop

I have a lot of patients that come in to have “double eyelids”.  Many patients ask me what the difference is between a regular eyelift and an null that entails creating the double eyelid.  There are significant differences and going to someone that specializes in these type of procedures can mean the world of difference.  Creating the double eyelid requires a more thorough knowledge of the eyelid anatomy.  You have to understand all of the layers of the eyelid in order to find the muscle that elevates the eyelid called the levator aponeurosis (colored purple) in the picture.  This is the muscle that helps pull up the eyelid margin and create a tight layer of skin that folds under the more superior areas of skin.  The superior areas of the skin then hang over to be the crease part of the eyelid.  Prior to doing the procedure, it is important to relay to your doctor some of the important things you would like accomlished during the procedure.  Questions regarding whether you would like an inside or outside fold, how high you would like the crease, whether you would like the crease to follow the eyelid margin or flare upward as the crease approaches outside the eye or that lateral parts of the eyelid near the lateral part of your eyebrow, etc.  When people come in for an Asian Eye lid fold procedure, I sit down with them and recreate the crease while the patient looks in the mirror to determine exactly what they want.  This is a really important part of the consultation.  Going to a facial plastic surgeon that understands the Asian patient and how Asian eyelid surgery works for this particular patient is important as well.  Many surgeons attempt to make Asian patients look more caucasian and this can be a mistake. In fact, when an Asian Plastic Surgery requests this change I really talk to them about this and what this westernization type of eye lift / blepharoplasty can do to change their appearance.  I often get many Asian patients asking me to change their westernized eyelid back so they look more Asian.  Many times these patients had their surgery done in Asia, which is puzzling to me.

Dr Young is located in Bellevue near Seattle, Washington