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[chuaoxford]

Unilateral ptosis (droopy eyelids), unless obvious, may not be easily detected. Although mild ptosis is usually of no funtional or cosmetic significance, its detection is important in patients who want to undergo upper blepharoplasty such as Asian blepharoplasty (double eyelid surgery) as the creation of a higher skin crease usually exaggerate the ptosis. One way of detecting unilateral subtle ptosis is to take a flash photo of the face with patient looking straight and look out for the following signs in the photo: a. The distance between the pupil reflex and the upper eyelid margin (this is decreased in the eye with ptosis); b. The difference in the show of the double eyelid (skin crease) if this is present. In ptosis the show of the double eyelid is increased and c. The height of the eyebrows. Patient with unilateral ptosis will normally raise the eyebrow unconsciously in an attempt to keep the eye open. These three patients who came for upper blepharoplasty had unilateral ptosis and exhibited all the three signs mentioned above. Top picture showed a right mild ptosis, middle picture left and bottom picture left mild ptosis. #ptosis #senileptosis #involutionalptosis #eyelidsurgery #droopyeyelids #blepharoplasty #malaysiaeye #malaysiaeyespecialist #malaysiaoculoplastic #oculoplastic #eyespecialist #kualalumpureye #optimax #penangoptimax #ttdioptimax #kuchingeyespecialist #kuchingoptimax #sibuisec #isecsibu #mirieye #miricolumbiaasia #isec #columbiaasia #chuachungnen #chuaeye #眼皮 #👀 #蔡钟能眼科医生 #马来西亚眼科医生

[chuaoxford]

Sometimes patient with Ptosis may not be aware of it until pointed out by the doctor. This patient came for eyebag consultation saying they made her look tired. However, she also had bilateral ptosis (being worse on the left as shown by higher left brow heigh) which added to her tired look and unless corrected simultaneously would not improve her overall appearance. She agreed to bilateral lower blepharoplasty (fat repositioning with orbicularis flap) combined with bilateral upper blepharoplasty and ptosis correction. #ptosis #contactlenssideeffect #droopyeyelid #posteriorapproachptosis #optimax #isec #columbiaasiahospital #malaysiaeyedoctor #chuachungnen #kuchingeyedoctor #sibueyedoctor #sibueyespecialist #mirieyedoctor #mirieye #蔡钟能眼科医生 #眼 #👀 #眼皮 #lowerblepharoplasty #eyebag

[chuaoxford]

[chuaoxford]

This 78-year-old woman had bilateral cataracts with best corrected vision of 6/36 in both eyes. I performed simultaneous bilateral phacoemulsification with monofocal implants. Postoperatively the vision improved to 6/7.5 unaided and she was able to read N5 with +2.50. However, she found reading difficult at times. Examination showed she had bilateral involutional ptosis (also known as senile ptosis in which the muscle that open the eye, levator aponeurosis, become dehisced due to old age, top picture). The droopy eyelids (ptosis) tend to be worse when the patient read or looking down. When 2.5% of phenylephrine was instilled into the eyes, her eyelids opened up and she found reading easier with the reading glasses (middle picture). As she was not concerned about the height of her skin creases (double eyelids) only the ptosis was corrected using the posterior approach method (bottom picture taken at one week post surgery).

[chuaoxford]

This 48-year-old woman complained of tired looking eyes, indistinct double eyelids and sunken upper eyelids (top picture). Six months earlier she consulted a “doctor” in a beauty saloon and had bilateral brow lifts. However, there were no improvements to her eyelid problems. Examination revealed all the changes that bothered could be attributed to ptosis. During the consultation, the patient also expressed her desire to have high skin crease (double eyelid). The ptosis correction (posterior approach) was combined with fat-sparing upper blepharoplasty in which excess skin was removed ( picture at the bottom taken at 10 days post surgery).

[chuaoxford]

The show of double eyelids (the amount of double eyelids visible when the patient look ahead) after ptosis correction is best illustrated in this patient. This patient had bilateral droopy eyelids and multiple skin creases (top picture). However, she attributed her sleepy appearance to indistjnct double eyelids. When the droopy eyelids was pointed out to her she agreed to have ptosis correction via posterior approach. The double eyelid heights were set at her original skin creases at about 7mm (middle photo, the blue dots indicate the height of the skin crease set). After the operations, she no longer appeared sleepy but was unhappy that her double eyelids were barely visible. The reason for this is because the patient had associated dermatochalasis (excess skin) which covered the skin creases (double eyelids). To make the double eyelids visible, the excess skin above the skin crease need to be excised for this patient.

[chuaoxford]

Although patients with ptosis usually complain of droopy eyelids or tired looking eyes, some may present with multiple skin creases (double eyelids, red arrow) or sunken upper eyelid (sunken sulcus, blue arrow). It is important for doctors to detect Ptosis in such patients otherwise double eyelid surgery or filler injection may exacerbate the ptosis. This patient who was a contact lens wearer complained her natural double eyelids (skin creases) were faints and multiple (top picture). She asked for double eyelid surgery. However, examination showed she had bilateral ptosis and creation of double eyelids would only make the eyes more droopy and tired (middle photo). Posterior approach ptosis correction was done and the patient was happy that she looked more alert and the multiple skin creases and sunken sulcus were also corrected (bottom picture taken one week after ptosis correction).

[chuaoxford]

This patient complained that his right eye was droopy (ptosis). History revealed that he had allergic dermatitis and years of constant eye rubbing had resulted in dehiscence of the levator aponeurosis (the muscle that open the eye). Examination showed he had bilateral ptosis being more severe on the right. He agreed to bilateral ptosis correction to avoid postoperative asymmetry. The correction was done using the posterior approach (bottom picture taken at 5 days post surgery). Two additional changes are worth noting after ptosis correction: a. The eyebrow drops. This is because the eyebrow is often unconsciously raised in an attempt to open the ptotic eye. This excessive eyebrow raising may cause headache in some patients. b. The show of the skin crease (the amount of double eyelid that can be seen) is deceased. When the eye is droopy the show of the skin crease is increased. Once the eye is open this show is reduced. This fact is important to bear in mind when correcting ptosis in young females who often desire to have good show of skin crease for their make-ups. In such cases the ptosis needs to be combined with double eyelid surgery to raised the height of the skin crease.

[chuaoxford]

This patient also had contact lens induced left ptosis (droopy eyelid, top picture). Correction of the left ptosis resulted in droopy of the right ptosis which alarmed the patient (middle picture taken at one week after posterior approach ptosis correction). Two main factors may be responsible for this phenomenon: a. The patient had ptosis in both eyes with one eye being more severely affected. Therefore, successful correction of one eye will bring out the contralateral ptosis. b. The ptotic eye was overcorrected resulting in the opposite eye becoming droopy. However, most oculoplastic surgeons usually overcorrect droopy eyelid slightly so that any drop of the eyelid during recovery will be compensated. As this patient did not have right ptosis before the operation, the most likely cause for the imbalance is factor b and she was reassured. At 6 weeks follow-up the two eyes were nearly symmetrical (bottom picture).

[chuaoxford]

Contact lens wear (both hard and soft) is a known risk factor for Ptosis (droopy eyelid) in people under age of 35. The reasons may be : a. Stretching of the eyelid during contact lens insertion and removal and b. Low grade inflammation from contact lens may weaken the eyelid structure. This 35-year-old woman had been a contact lens wearer for over 20 years in the past 2 years she noticed the left eye had become progressively more droopy. Examination showed no neurological causes and a posterior approach ptosis correction restored the lid to the desirable level. #droopyeyes #droopyeyelid #ptosis #contactlens #blepharoplasty #optimax #isec #columbiaasiahospital #malaysiaeyedoctor #ophthalmology #oculoplastic #kuchingeye #sibueye #sibuisec #isecsibu #mirieye #penangoptimax #chuachungnen #eyelidexpert #蔡钟能眼科医生 #眼睛 #眼皮 #👀

[chuaoxford]

This young woman had double eyelid surgery performed in a beauty saloon by a visiting China “doctor” . Postoperatively she noted the right eye to be droopy in the medial two third of the upper lid. She returned to the “doctor” and was reassured that it will correct itself in a few months. But the droopiness persisted. When she returned to the beauty saloon, the owner of the centre told her the “doctor” would not return and asked her to see the new visiting “doctor”. The later told the patient that she was unable to correct the droopy eyelid and asked her to seek help in “proper” medical centre. On examination, she appeared to have damage to the medial 2/3 of her levator aponeurosis. Posterior conjunctivomullerextomy was performed with good outcome (bottom picture taken at one month postoperative). #asianblepharoplasty #doubleyelidsurgery #doubleeyelid #doubleeyelidsurgery #ptosis #beautysaloon #optimax #isec #columbiaasiahospital #kuching #sibu #miri #penang #kl #kualalumpur #eyelidsurgery #oculoplastic #chuachungnen #malaysiaeyespecialist #眼睛 #眼皮 #蔡钟能眼科医生

[chuaoxford]

This 54-year-old woman underwent lower blepharoplasty with fat repositioning two weeks ago. She presented with 2-day of chemosis (swelling of the eye white)and slight lower lid malposition (top picture). Chemosis is reported in 10% of lower blepharoplasty. Its cause is multifactorial and includes eyelid swelling, exposure and postoperative lymphatic malfunction. To quickly reduce the chemosis and lid malposition, multiple small punctures were made in the lower conjunctiva under topical anaesthesia (middle picture). The procedure was performed using an orange needle (25 gauge)and visualised with slit lamp. The chemosis and lid malposition were quickly alleviated (bottom picture).The patient was prescribed topical steroid to reduce recurrence.

[chuaoxford]

This man had bilateral droopy eyelids (ptosis) as a result of constant eye running for itchy eyes. The ptosis is more obvious on the right than left (see a). After instilling a drop of mydfrin (2.5% phenylephrine) into the right right eye, the eyelid became more open within 5 minutes (see b). A posterior approach conjunctivomullerextomy was performed, picture c was taken at one hour postoperative. The right ptosis was corrected but there was a slight left ptosis which the patient was happy to leave. Picture d was taken at two weeks post surgery. #ptosis #droopyeyelid #malaysiaophthalmologist #sarawakeyedoctor #sarawakeyespecialist #isec #optimax #columbiahospital #sibu #kuching #miri #kualalumpureye #penangoptimax #chuachungnen #蔡钟能眼科医生 #眼睛👁️ #👀

[chuaoxford]

This teenage boy had a right convergent squint (esotropia) and asymmetry of the size of both eyelids since young. The vision was normal in both eyes. Squint correction and simultaneous double eyelid (Asian blepharoplasty) were done under general anaesthesia. The bottom picture was taken three weeks after operation. #squint #strabismus #esotropia #congenitalesotropia #blepharoplasty #doubleyelid #asianblepahroplasty #optimax #isec #columbiahospital #borneomedicalcentre #kuchingoptimax #kuchingborneomedicalcentre #sibuisec #isecsibu #miricolumbiahospital #columbiaasiahospital #penangoptimax #kloptimax #malaysiaeye #malaysiaeyedoctor #eyespecialist #ophthalmology #oculoplastic #chuachungnen #eyelidexpert #eyelidsurgery #sarawakeye #👀#眼皮 #斗鸡眼 #双眼皮#蔡钟能眼科医生 #眼科 #诗巫 #美里#古晋#槟城#吉隆坡

[chuaoxford]

This 18-year-old man wanted correction of his eyelid asymmetry. The right eye had always been smaller since young and he was diagnosed by a few eye surgeon as Ptosis. However, examination revealed this was caused by absent right skin crease (double eyelid) resulting in skin coming over the eyelid margin. Thus, giving an impression of a smaller right eye. I created a right skin crease with minimal fat excision to restore symmetry to both eyes. #asianblepharoplasty #doubleeyelid #asianeyelid #singleeyelid #isec #optimax #columbiaasiahospital #malaysia #malaysiaeye #sarawakeye #kuchingoptimax #kuchingeye #sibueye #mirieye #eyespecialistmalaysia #ophthalmology #ophthamologist #chuachungnen #双眼皮 #👀 #蔡钟能眼科医生

[chuaoxford]

This 64-year-old woman had bilateral tattooed eyeliners and lately found the eyelids to be swollen and the eyeliners covered by puffy eyelids. Her thyroid function tests were normal. Her beautician recommended Asian blepharoplasty (double eyelid surgery) to be done by a visiting doctor from China. However, she was unwilling to have drastic changes to her appearance and sought second opinion. To avoid high skin creases, the double eyelids were set at the upper margins of the eyeliners and excess fats were removed. Her nasal bridge was also raised with 0.5 ml of hyaluronic acid filler. #eyeliner #upperblepharoplasty #asianblepharoplasty #doubleeyelid #nasalbridgeaugmentation #filler #isec #optimax #kualalumpur #kualalumpureye #penangeye #columbiahospital #sibueye #chuachungnen #eyelidexpert #蔡钟能眼科医生 #眼睛 #👀 #眼皮

[chuaoxford]

This 60-year-old woman had a right mature cataract with light perception vision. The right eye was also noted to be turning out. The top picture was taken just before the operation and the bottom one 30 minutes after phacoemulsification and implant. The right eye was not longer deviated. #cataract #maturecataract #phacoemulsification #malaysiacataract #cataractsurgery #malaysiaeyedoctor #sarawakeyespecialist #sarawakeyespecialist #optimax #isec #isecsibu #sibuisec #mirieye #miricolumbiahospital #columbiaasiahospital #mirieye #sibueye #blond #blindness #ophthalmologist #ophthalmology #chuachungnen #蔡钟能眼科医生 #白內障 #眼睛 #👀#眼科医生