What are the different kinds of upper eyelid surgery?

Upper eyelid surgery is commonly done to create or enhance a crease (double eyelid). It is also performed to rejuvenate the aging upper eyelid. Upper eyelid surgery can also enhance the eye by increasing the opening of the eye in patients with a droopy upper eyelid (ptosis).

What are the different methods of creating a double eyelid?

• The suture (no incision or scarless) method)
This method is suitable for younger patients without minimal excess skin or fat. 2-4 sutures are placed in the upper eyelid to create a fold. This procedure generally has a shorter recovery time compared to conventional techniques – the crease will look natural within 1-2 weeks. However, there is a slightly higher chance of the crease fading, compared to the ‘cutting’ techniques. This procedure is usually done under local anesthesia (sometimes with light sedation) and takes 30-60 min.

• The conventional (incision or cutting) method
A cut is made along the upper eyelid to create a fold. In some cases skin and fat can be removed. Recovery time may be longer compared to the suture only method as swelling takes a longer time to resolve. However, there is a lower chance of the crease fading compared to suture only methods. The crease can be expected to last for many years, until the brows and upper eyelids start to droop. This procedure is usually done under local anesthesia (sometimes with light sedation) and takes 1-1.5 hours.

• The short or minimal incision method
The incision is shorter compared to conventional cutting method. In addition to a shorter scar, recovery time may be shorter compared to conventional techniques, with swelling subsiding faster. This method would be preferred if no excess skin needs to be removed. This procedure is usually done under local anesthesia (sometimes with light sedation) and takes 1-1.5 hours.

What about aging upper eyelids?

With aging upper eyelids, a there is usually some excess skin that needs to be removed. In many cases, there is droopiness or sagging of the eyebrows which is best corrected by a browlift procedure.

Can droopy eyelids be corrected?
A tired-looking appearance may be due to a drooping upper eyelid or upper eyelid ptosis. In true ptosis, the aperture of the eye (distance between upper and lower eyelids) is reduced. Possible causes include aging (resulting in stretching of the muscles that open the eye) and injury. In some cases ptosis is congenital (since birth). Surgery to correct ptosis usually involves repairing or tightening the muscles that open the upper eyelid. Creating or enhancing the eyelid crease is often done together as part of the same operation.

What are the different kinds of lower eyelid surgery?

Lower eyelid surgery, or lower blepharoplasty, improves the appearance of the lower eyelids, restoring a smooth contour, resulting in a rejuvenated appearance.

• The transconjuctival (no incision or scarless) method)
In younger patients without minimal skin wrinkles or laxity, excess fat can be removed through the inner surface of the lower eyelid. There is no external scar and recovery time (downtime away from work) is about 3-5 days. Transconjunctival lower blepharoplasty is usually done under local anesthesia with light sedation and takes about 1-1.5 hours.

• The conventional (incision or cutting) method
This method is suitable for older patients, with other signs of aging apart from excess fat, such as skin wrinkles and laxity, grooves below the eyebags and sagging of the eyelid and cheek. The skin incision is made just below the eyelashes. Excess fat is removed or re-distributed to smooth out deep grooves and improve lower eyelid contours. Excess skin is removed, and the lower eyelid is tightened to restore a youthful position. A lower blepharoplasty is usually done under local anesthesia with sedation, and takes from 2-3 hours. Downtime away from work is about 1 week.

This procedure can also be done together with a cheek-lift through the same incision, to rejuvenate a sagging, droopy mid-face.

This procedure removes a fold of skin at the inner corner of the eye, which makes the eyes look small and far apart. With newer techniques, this procedure can be done with minimal, hardly visible scarring. Medial epicanthoplasty is often done together with upper blepharoplasty to further enhance the result.

The effects of a medial epicanthoplasty would be removing the fold of skin (medial epicanthus), making the eyes appear closer together, making the inner half of the eye appear bigger, and enhancing the inner half of the double eyelid fold.

A brow lift or forehead lift is done to correct the sagging and drooping of the eyebrows and to smooth out forehead wrinkles that occur as part of the aging process. Unlike a conventional brow lift where a long incision is made in the hairline, an endoscopic brow lift requires several much smaller incisions made in the scalp. The forehead skin is elevated, repositioning the eyebrows to a higher, more youthful-looking position.

An endoscopic brow lift is usually performed under general anaesthesia and takes 1.5 to 2 hours. No hospital stay is required, and recovery takes from 2-3 weeks.

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What are the different kinds of rhinoplasty?

Nose surgery or rhinoplasty can change the shape of the nose in many different ways, improving appearance and enhancing facial proportions. Rhinoplasty is often done together with functional nose surgery, to relieve obstruction and improve breathing.

What are some of the commonly requested changes to the shape of the nose?

• A higher nose bridge
• A smaller or sharper tip
• More tip projection
• A longer or less upturned nose
• A narrower nose
• Smaller nostrils
• Flattening out of a hump on the bridge
• Correction of a crooked nose

What are some of the methods used to reshape the nose?

Rhinoplasty can be broadly classified by the surgical approach into either closed or open rhinoplasty. In closed rhinoplasty, all incisions are made within the nostrils, there are no visible external scars. In open rhinoplasty, the incisions within the nostrils are connected by an incision across the columella (the column between the nostrils). Although there is a small external scar, direct visualization and better access to the internal framework of the nose allows for more dramatic changes to be safely made.

The closed rhinoplasty approach is usually used for increasing the height of the bridge with an implant (usually silicone), or for smoothing out humps on the bridge of the nose.

The open rhinoplasty approach is used if significant changes need to be made to the tip of the nose. Cartilage grafts are often required for this, they are usually taken from the ear (through a small incision at the back of the ear), the septum (an internal sheet of cartilage within the nose) or one of the ribs (though a small incision in the chest).

How long does it take to recover from nose surgery?

The nose is usually protected with tapes and plastic splints for 5-7 days after surgery. External stitches (if any) are removed after 5-7 days. Bruising usually subsides after 1-2 weeks. Swelling gradually subsides over several months, however, it is usually sufficiently reduced to look natural within 2-4 weeks.

What is non-surgical rhinoplasty?

This refers to changing the shape of the nose with filler injections. This is usually limited to increasing bridge height, and only modest improvements can be achieved, compared to surgical augmentation. Little improvement can be expected from fillers injected into the tip of the nose. Only temporary (absorbable) fillers such as hyaluronic acid (HA) are used. Permanent fillers can result in complications and will make future surgery more difficult - they should never be used in the nose.

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