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The Asian eye is typically one that is mono-lidded, slit-like, narrow and at times droopy, a far cry from a beautiful flower that most associate the eyes with.
As such, many Asians are turning to the knife to give their tiny beady eyes a huge makeover, making Upper Blepharoplasty (Double eyelid surgery), the most popular plastic surgery amongst Asian countries.
But like any surgeries, it is essential for us to learn of the Dos and Don’ts before we nosedive into the double eyelid surgery procedure. And what better way to clear our doubts with the expert opinion of Singapore’s very own plastic surgeon, Dr Colin Tham.
1) What is the difference between the suture vs partial incisional vs incisional method? And who is suitable for which procedure?
Suture methods have tiny incisions and hence less scarring. Patients with less fatty eyelids and who want lower folds are more suitable.
Incisional methods are typically more definitive. Through the longer incision, fat can be removed, muscles can be tightened to enlarge the eye aperture and anchorage of the double eyelid is more secure throughout the length. Although the scar is longer, if performed well it heals to look like a natural double eyelid skin crease.
Partial incisional methods shorten the incision and hence the scar. As the access is shorter, control and anchorage of the double eyelid crease at the inner and outer aspects is compromised. This may result in shallow folds at the inner and outer aspects. As my incisional scars heal well, there is little reason for me to perform this technique.
2) What are the pros and cons for incisional and non-incisional?
Non-incisional: Less downtime primarily due to not removing the fat (Fat removal is the main cause of swelling). Potentially less durable especially if performed in patients who have heavier or fatter eyelids and there is less initial scarring.
Incisional: It is more reliable and durable. Skin and Fat removal or sculpting possible for this incisional method. There will be more swelling due to fat removal and visible scar in the initial recovery stages. However, scarring is not an issue if surgery is performed well as it looks like a natural double eyelid crease.
3) What is done for each type of method?
Non-incisional: Desired height is marked. Usually performed under local anaesthesia and light sedation. I perform the Double Strand Twisting (DST) method. 3 small puncture sites in the upper eyelid through which a fine stitch is passed to anchor the skin to the underlying cartilage.
Incisional: Desired height and skin removal marked. Usually performed under local anaesthesia and light sedation. Excess fat which prevents anchoring of the double eyelid is then removed. Muscle tightening performed if necessary. Skin anchored to underlying muscle and cartilage.
4) What determines a good upper blepharoplasty?
Symmetrical results with non-visible scars, even with eyes closed. Height should be harmonious with the patient’s face, gender and race characteristics. Shape should be aesthetically pleasing with a mild lateral (outer) flare. Tapered or parallel according to patient’s desires.
5)What can upper blepharoplasty do for the eyes?
An upper blepharoplasty can make the eyes look bigger and brighter. Ptosis correction can be performed concurrently. Excess skin causing hooding can be removed. Uneven or asymmetric eyelids can be made more symmetric. Partners bring their boyfriends / husbands because they complain that their single eyelids make them look too fierce.
6) Scarring for both procedures? Are there any ways to remove the scars?
The scars of my upper eyelid patients have all healed quite well, there has been no request to improve the scarring. For some patients operated elsewhere, I have performed lasers to improve the scars.
7) Lifestyle changes before surgery?
Smoking cessation only, it slows down healing.
8) Foods to avoid or things to do before surgery?
No foods to avoid. Stop smoking 2 weeks before. There is a list of medications and supplements to avoid from 1-2 weeks before surgery. As we usually sedate our patients, we ask them to fast 6 hours beforehand.