Eye surgery

Plastic Eye Surgery

The area around your eyes, perhaps more than any other part of your face, can make you look either rested or fatigued, content or angry, youthful, or prematurely aged. Cosmetic eye services can significantly improve the appearance of puffy or baggy eyelids, fine lines, and wrinkles. The results of these aesthetic procedures can last months or years, depending on the type of treatment.

Eyelid Surgery

Everyone is seeking the best shape of themselves. With the new standards of beauty, every part of the body can be adjusted and changed, especially the face.

You have probably heard many facial surgical terms lately. I mean you must have heard about nose jobs, facelifts, face liposuction, and eyelid surgeries.

Our video today is specifically about eyelid surgeries.

Eyelid surgery is one of the most common cosmetic surgeries, especially in South Korea.

South Korea is known to have the highest rate of surgeries per capita globally, and eyelid surgery is a very popular procedure there.

But why is eyelid surgery very popular in South Korea?

It is usually done for cosmetic reasons. For example, blepharoplasty is an effective way to improve sight in old people with sagging eyelids that get in the way of their vision.

Other procedures usually help people to achieve bigger and more lively looking eyes or even correct asymmetry to have better-looking eyes.

I just mentioned blepharoplasty. So, what is blepharoplasty?

It is a type of surgery that repairs droopy eyelids and removes excess skin, muscle, and fat.

As we age, our skin ages with us. It gradually loses its elasticity, and therefore the eyelids stretch and the muscles supporting them weaken.

In addition, excess fat, especially that fat that cushions the eyeball from the skull, may gather above and below your eyelids giving you saggy eyebrows, droopy upper lids and bags under your eyes. The thin membrane that holds that fat in place weakens as we age, and consequently, it lets that fat come forward into the eyelids like a hernia.

The lack of elasticity and the constant pull from gravity causes excess skin to collect on both the upper and lower eyelids.

Besides the old person appearance caused by these changes, if the eyelids are severely sagging, it will definitely affect your vision and field of vision, especially the upper and outer parts of your vision field.

Blepharoplasty can eliminate these vision problems and give you a younger look.

But have you heard about epicanthoplasty? It is also eyelid surgery. However, it is a different type of eyelid surgery.

So, what is epicanthoplasty? And how is it different from blepharoplasty?

Before we explain epicanthoplasty, you have to know about the Mongolian fold first.

The Mongolian fold is one of the most prominent features in Asian countries.

It is the skin of the upper eyelid that is covering the inner corner of the eye. It runs from the nose to the inner side of the eyebrow.

It sometimes looks like a web that covers the medial canthus of the eye.

People usually seek epicanthoplasty because these folds make the eyes look smaller laterally and more tired looking.

So, again, what is epicanthoplasty?

It is a type of eye surgery that aims to lengthen the inner part of the eyes so that they look wider and bigger. The procedure is also known medically as medial or lateral epicanthoplasty based on which fold is removed. It is sought by men and women who would like to have bigger, brighter eyes and a more alert look.

The procedure does not only give a bigger appearance, but it can also actually make the eyes physiologically bigger.

The procedure is often requested by people who have abnormally large epicanthal folds that impact the shape of their eyes.

You must have figured out the difference between epicanthoplasty and blepharoplasty by now. But as a quick recap, blepharoplasty is about removing excess skin and fat to have a younger look of the eyes, while epicanthoplasty is about removing the Mongolian fold to have a bigger more alert eye look.

So, who is a good candidate for each of the two surgeries?

For epicanthoplasty, it can be pursued by anyone who wishes to make their eyes wider as far as it is possible for them.

Although most of the people who seek epicanthoplasty are of Asian descent, it can be done to anyone who wants to improve their appearance with larger eyes.

So, epicanthoplasty can be done to people who wish to improve their overall look and:

They are in relatively good health.
Have eyes that are abnormally far from each other in terms of distance which leads to disproportionate appearance.
Have well-developed epicanthal folds.

As for blepharoplasty, people who are struggling with droopy or sagging eyelids that keep their eyes from opening completely or pull down their lower eyelids.

So, in conclusion, blepharoplasty is the best option for people who have:

Baggy or droopy upper eyelids.
Bags under their eyes.
Excess skin on their upper eyelid that interferes with their peripheral field of vision.
Excess skin on the lower eyelid.

Although it might seem simple, each procedure has its own risks. Anyone who considers one of these procedures should be aware of the risks and complications.

Common risks of eyelid surgeries in general include:

Infection.
Bleeding.
Anesthetic complications and adverse effects.
Difficulty closing the eye.
Scarring.
Injury to eye muscles.
The need for follow up surgery.
Skin discoloration.
Temporary blurring of vision.
Rarely losing sight.
Blood clots.

However, you should discuss these risks with your surgeon and decide if the surgery is the best option for you after thinking about the benefits and risks.

But all in all, if the surgery is performed by a licensed well-experienced surgeon, it will be a safe procedure with very high success and satisfaction rates.

One of the risks of eyelid surgeries we just mentioned is the need for follow-up surgery. So, what is this?

This is called revision eyelid surgery, have you ever heard that term?

When we say revision blepharoplasty or revision epicanthoplasty, we usually refer to a secondary procedure that is done to correct any problems that have arisen from the initial eyelid surgery or to improve the results of the initial surgeries.

When the patient is not happy with the results of the surgery due to disfigurement or a resulting defect that is distressing them, then, a revision procedure will be recommended.

Revision eyelid surgery is one of the most popular eyelid surgeries. When performed professionally and correctly, revision eyelid surgeries can dramatically refresh and rejuvenate one’s facial appearance.

Although it only focuses on a patient’s dissatisfaction, revision surgeries are more complex than the primary procedure and can be done in several ways. That’s why you need to look past the usual advertisements and base your surgeon selection on irrefutable qualifications.

Let’s take revision blepharoplasty as an example.

Why would a patient undergo a revision of blepharoplasty?

Because, as we mentioned earlier, people may be unhappy with the primary surgery results. Maybe it is due to noticeable scarring around the incision. Maybe the original surgery was an under corrected surgery. Or maybe the surgeon removed too much skin and fat.

Because blepharoplasty deals with a very delicate area in the face, many problems can arise. However, the complexity of the problems varies significantly from person to person.

But here are the most common causes of undergoing revision blepharoplasty:

Scarring. Normally, eyelid skin heals very well. But sometimes the scar can be too vigorous that it can lead to noticeable bumps around the eye. The patient may have not anticipated such a visible scar. It is usually dealt with effectively by a scar revision procedure.
Under corrected eye surgery. Imagine undergoing surgery and then the problem is not completely fixed. In blepharoplasty, under correction means not enough skin was removed and the muscles are not tightened enough. When this happens, the face appears older and heavier. The patient then feels that the surgery was pointless. In this case, revision surgery is highly recommended because the problem can affect the patient’s visual field.
Over removal of skin or fat. This can lead to severe problems for the patient, especially when the changes are on the lower eyelid which leads to retraction and wider exposure of the eye. Lower lid retraction complications are severe. They cause dryness and soreness of the eye as well as unsatisfactory aesthetic results for the patient. Another problem that can arise from too much skin and fat removal is poor positioning of the eyelids. An asymmetrical and unnatural appearance can result. In this case, revision blepharoplasty is done just to restore the previous symmetry and realign everything in its normal place. Retraction usually results from too much skin removal, but what happens if the surgeon removed too much fat? This can lead to a hollow sunken look under the eyes. But this can be simply fixed by injecting fillers or transferring fat to this area.

Complications are an inherent risk of any surgery. However, the better and more professional your surgeon is, the better the results are.

Acne Scars

What is the lowering the lower eyelid or dual epicanthoplasty procedure?

Lowering the lower eyelid (LLL) procedure, also, called lower eyelid shortening, is a surgical procedure to make a large eye opening vertically with a cosmetically desirable shape of the eyes.

Who are suitable for the lowering the lower eyelid procedure?

People seek large oval eyes with following features of the eye shape:

An up-slanting appearance of the eye opening, including

1. Positive canthal tilt < 2mm
2. A steep inclination of the lateral third of the lower lid margin

How is the lowering the lower eyelid surgery performed?

LLL procedure is performed by either trans-conjunctiva static shortening of the lower eyelid retractors, or trans-conjunctiva approach + sub-ciliary skin excision.

In RCSS, Dr Xu performs the LLL procedure through a trans-conjunctival approach in most of cases. This approach makes no scars in the skin of the lower eyelids.

LLL procedure takes about 1-2 hours and can be done under local anesthetics or LA + sedation.

What is possible outcome?

Lowering the lower eyelid procedure was performed as an effective option for patients desiring large oval eyes as an independent or ancillary procedure. Combing LLL procedure with levator-aponeurotic surgery would be the best way to vertically enlarge the eye opening.

What are possible risks and complications?

Conjunctiva swelling and inflammation
Lower lid malposition
Temporary double vision
The eyelid turning inward toward the eye
Asymmetry
Under-correction or overcorrection

Epicanthoplasty

In the current era, you can change anything in your appearance, whether it is functional or aesthetic. For example, rhinoplasty, also known as nose job operations, have now become very popular and very easy. The patient can leave the hospital on the same day of the operation.

Likewise, you can apply this example to many changes we can make to improve the way we look.

Our video today is about a type of plastic surgery that has become very famous.

Although it might seem a very simple surgery, it can totally change the look of your eyes.

Epicanthoplasty surgery

So, for those who have never heard about it, what is epicanthoplasty?

Epicanthoplasty is an eye surgery that modifies the epicanthal folds or the Mongolian folds. It is medically known as medial or lateral epicanthoplasty and it aims to lengthen the inner part of the eye to make the eyes look bigger.

Epicanthal fold

A strong epicanthal fold (also known as the “Mongolian fold”) means that a web forms over your eye and covers your medial canthus. This fold can hide the attractiveness of your eyelids and make your eyes appear smaller and weary. This operation is typically performed on people of Asian heritage, although it is available to any man or woman who desires brighter, larger, and more alert eyes.

The surgery is also known as “Inner corner fold removal” or “Mongolian fold correction”. It is a cosmetic procedure mostly performed in Asian countries. The Mongolian fold is one of the most prominent features in Asian countries.

The skin protecting the inner corner of the eyes has certain drawbacks:

The space between the eyes looks to be large. It makes the eyes feel uncomfortable.
Eyes can appear smaller
The shape of the eyes looks undefined

Epicanthic fold European

A Mongolian fold, which covers the medial part of the eyes and makes them look smaller than the rest of the facial features, is present in about three out of every five Asians. In the event of a Mongolian fold, a candidate’s result may be less successful or less natural-looking if simply double eyelid surgery is performed without epicanthoplasty.

When combined with epicanthoplasty, eyelid surgery can result in a more equal length between the eyes as well as a more delicate and defined eye look. In the case of Asian patients, the surgeon must be cautious not to remove the complete epicanthal fold. The patient may lose their original Asian identity in such a case.

In Asians with a harsher look, much of the epicanthal fold may be eliminated, leaving only a little portion. This will result in a softer, more open appearance. Patients with existing round facial features, on the other hand, should have a little epicanthal fold following surgery to contrast sharper eyes with other softer aspects of the face.

Epicanthoplasty is a procedure that includes making extremely small incisions on the inner corners of the eyes to address the issues listed above. Bigger, cleaner eyes are the result. Epicanthoplasty is frequently combined with Double Eyelid Surgery to create significantly cleaner, more attractive, and natural-looking eyes.

The Mongolian fold is the skin of the upper eyelids which covers the inner corners of the eyes. People usually go for epicanthoplasty due to the downfalls of the skin covering the inner corners of the eyes, such as:

It causes an awkwardness to the eyes because it makes the distance between both eyes look too far.
Eyes appear smaller than they are.
The folds give the eyes an undefined look.

Simply put, this skinfold can impair the beauty of the eyelid and gives the eye a smaller lateral appearance and a more tired-looking appearance.

Although the epicanthic fold or Mongolian fold can be associated with less prominent upper eyelid creases, or what is called “Single eyelids”, they both are distinct. A person can have both an upper eyelid crease and an epicanthal fold, one of them only, or neither of them.

Epicanthoplasty is not only an aesthetic surgery, it is sought by men and women who have abnormally large folds that impact not only the appearance but also t eye physiology, making them look bigger.

What Are The Benefits of Eye Enlargement Surgery?

So, what are the advantages of this procedure? Epicanthoplasty can be used to:

Reduce the space between your inner-canthal, which makes your eyes seem to be farther apart (an ideal distance between the inner-canthal is a 1:1 ratio)
Make your eyes look brighter and larger by exposing the medial part of your eyes.
Minimize the medial part of your eye folds to reduce wrinkles in your eyes and seem less fatigued.
Shift the medial canthus in a medial and upward manner to make your eyes look less slanted.
Epicanthoplasty can also assist to improve your face’s overall appearance by alleviating tiredness.

The question is, is anyone eligible for an epicanthoplasty? In other words, who should undergo epicanthoplasty?

Epicanthoplasty is originally a cosmetic procedure. However, it can be sought by anyone who wishes to have wider eyes than their physiology allows.

It is the ideal surgery for males or females patients who:

Have relatively good health.
Have eyes that are abnormally far from each other leading to disproportionate appearance.
Wish to improve their overall appearance, maintaining their ethnic features.
Have undergone or are going to undergo double eyelid surgery to further improve their look and have a much clearer and more beautiful look.
Have a very short horizontal length of the eyes.
Want a mild or soft shape of the eyes.
Want a larger appearance of the eyes.
Have undefined eyes which appear very close together due to Mongolian folds.

You will need to be in good general health to be a suitable candidate for epicanthoplasty. If you smoke, you must stop three weeks before and three weeks after surgery. This is because smoking might impair your body’s capacity to completely recover.

Epicanthoplasty is mostly sought by people who want to adopt a brighter, bigger, and more alert look of their eyes.

But, unless the epicanthal folds are cosmetically bothersome and abnormally large, it is not advised to undergo any surgical manipulation in this delicate area.

But as we know, every surgery has its complications and risks. So is the case with epicanthoplasty. Beauty is pain, isn’t it?

Medial Epicanthoplasty

The corner of the eye near the nose is the focus of this treatment. A Medial Epicanthoplasty shapes and contours the inner corner of the eyes, making them appear longer and more almond-shaped. It is frequently used in conjunction with Asian Blepharoplasty to give the eyes a rounder, clearer look.

Lateral Epicanthoplasty

Lateral Canthoplasty is a lower eyelid surgery that targets the outside corners of the eyes. This technique enlarges the outer corners of the eyes, making them appear larger and longer. When double eyelid surgery incisions are combined with a Canthoplasty, the combination improves the contour and angle of the eyes.

Lower blepharoplasty

As we age, the tissues that tend to hold the fat of the eye socket in place weaken, thus allowing for the prolapse of fat into the lower eyelids. The surrounding skin also becomes “crepey” and lax in many cases, and tendons in the outer corner of the eyelid may fall. All of these changes can collectively create the appearance of puffy lower eyelids, potentially with dark circles manifesting around the eye socket. Furthermore, some individuals will lose facial volume underneath the dark circles, accentuating the appearance of fatigue.

When these aesthetic concerns—and any others pertaining to the lower eyelid region—manifest for both women and men, lower blepharoplasty can often be an excellent treatment option.

What Is Lower Blepharoplasty?

In many instances, lower eyelid surgery is combined with treatments such as upper blepharoplasty, midface lift, and/or laser skin resurfacing to achieve a more comprehensive improvement of the eye region.

How Is the Lower Blepharoplasty Procedure Performed?

In a traditional lower blepharoplasty procedure, the fat of the lower eyelid is sculpted away to achieve a more rested appearance. When the aesthetic issue is more related to facial atrophy and hollowing, however, Dr. Cytryn will gear the correction towards moving the fat around into areas of the midface that lack volume—which is a technique called fat transposition. In younger patients, the fat can be removed from the inside of the eyelid, while in older patients the fat is generally removed with an incision made just under the eyelashes so that surrounding skin can be sculpted and the underlying muscles and tendons tightened. When extra skin and wrinkles are present, Dr. Cytryn meticulously removes a small amount of skin while ensuring not to over-excise lower eyelid tissue, which could lead to unsatisfactory aesthetic and functional results.

Lower eyelid surgery is typically performed under light intravenous sedation. When conducted alone, the procedure usually takes an average of about 30–50 minutes to complete. That said, many patients also elect to have their upper eyelids and cheeks/midface addressed at the same time as lower blepharoplasty, which can extend the total treatment time.

Is Lower Blepharoplasty Painful?

Due to Dr. Cytryn’s meticulous surgical technique, the vast majority of lower eyelid surgery patients report experiencing minimal to no discomfort following treatment. During the procedure, Dr. Cytryn takes great care to limit trauma to tissues of the eyelids and surrounding areas, as well as to prevent bleeding before it ever starts—both of which help to significantly diminish the potential for postoperative pain. Furthermore, he provides customized instructions on how to facilitate healing during the recovery process in order to help limit the duration of any possible irritation and/or soreness.

Of course, pain tolerance is unique to every individual, so there may be instances in which analgesic medication is necessary to reduce any discomfort that might occur. That said, Dr. Cytryn’s patients rarely describe any considerable degree of pain after lower blepharoplasty—and most do not even bother with taking medicine.

What Can I Expect During Lower Blepharoplasty Recovery?

Following lower eyelid surgery, you can typically expect some swelling and/or bruising in the treatment area, but these side effects are temporary and should diminish with time. As previously mentioned, any discomfort experienced can usually be controlled with medication if necessary, though a notable degree of pain is uncommon. You will most likely look and feel well enough to return to normal, non-strenuous daily routines within five to ten days; however, Dr. Cytryn generally advises that all intense exercise, physical sports, and other vigorous activities be avoided for several weeks to help ensure proper healing.

Will I Have Visible Scars After Lower Blepharoplasty?

Scarring from lower eyelid surgery will depend on the specific maneuvers performed during the procedure, as well as factors such as genetics, sun exposure, and adherence to postoperative directions. When fat is being removed and/or repositioned for younger patients, Dr. Cytryn is often able to do so from the inside of the eyelids, therefore creating no external scarring. For older individuals—or in the event excess skin and/or wrinkles are present, regardless of age—a small incision placed just below the eyelash is typically required so that skin can be excised and muscles and tendons can be tightened in addition to fat removal and/or repositioning.

Fortunately, even when an external incision is necessary for lower blepharoplasty, it is usually made in a natural crease of the eyelid, and the scar tends to heal extremely well. Once scarring has faded to its final appearance, it is usually virtually indistinguishable from the surrounding skin—particularly when properly cared for during healing and maturation.

Recovery eyelid surgery

What is revision blepharoplasty?

Revision blepharoplasty, also known as eyelid revision surgery, is a secondary surgical procedure which is performed to correct any complications that have arisen or to improve the results of a previous eyelid surgery. When a patient finds that they are not happy with the outcome of a past blepharoplasty procedure, perhaps due to a resulting defect or disfiguration which causes them distress, then a revision procedure may be recommended.

Revision blepharoplasty is more complex than the first procedure and can be carried out in several ways, depending on the complexity of the problem. Revision blepharoplasty covers a range of problems, the most common of which are: Lower lid retraction, scarring, rounding of the corners of the eye, hollowing of the upper of lower eyelids or residual bags and bulges.

The images opposite demonstrate very typical complications from blepharoplasty with sagging of the eyelid laterally, and in more severe cases, loss of intercanthal tilt and ectropion. These changes can be aesthetically devastating and cause significant eye pain, discomfort, and vision loss.

Why undergo blepharoplasty revision?

There are many reasons why a patient may need to undergo blepharoplasty revision surgery, but, in most cases, patients are unhappy with the results of a previous eyelid surgery. As blepharoplasty deals with a very delicate area of the face, if the procedure is not carried out by a high-skilled oculoplastic surgeon, complications can occur.

The complexity of the problem can vary significantly from person to person, including minor degrees of scarring to severe eyelid malposition, which affects the integrity of the eye and its ability to function correctly.