1 Ms. Jiang asked: I am 34 years old and recently a colleague went to a beauty hospital to have double eyelid surgery and the result seems to be quite good. I also have single eyelids, but I heard that there are two forms of double eyelid surgery: incision and stitching, which one is better? Is there any precautions to take before having double eyelid surgery? Hello Ms. Kang, double eyelid surgery is known as blepharoplasty in hospitals and is one of the most common cosmetic surgery procedures. As you said, there are three main types of eyelid surgery: compression, submerged, and incision, depending on the method of operation. Each method has its own strengths and weaknesses, and the application of the right one can lead to good results, so it is not advisable to simply compare surgical methods. Each type of surgery has its own indications, relatively speaking, it is more important to choose the surgery method that really suits you. The compression and buried wire methods are mainly suitable for young people with single eyelids who have little orbital fat and thin, tight skin on the upper lid, while the incision method is suitable for older people who have loose upper lid skin, a lot of fat in the orbital septum, require wider eyelids, and have recurrent buried wires. Surgery requires a diagnosis of no serious liver, kidney, heart or brain disease, and pregnant women and patients with serious blood disorders should also avoid surgical treatment; women need to avoid menstruation; and to suspend anticoagulant medications such as aspirin before surgery. In addition to these routine pre-operative precautions, it is more important to have a detailed communication with the doctor for pre-surgical design to determine the appropriate surgical approach. 2 Ms. Zhang consultation: I don’t know why, my eye bags have always been heavy, especially after reaching 30 years old, more obvious, in the newspaper once saw a called “scarless eye bag removal” can eliminate eye bags. I read in the newspaper that “scarless eye bag removal” can eliminate eye bags. Is there any danger in this surgery? Hello Ms. Zhang, eye bag surgery is one of the most routine surgeries in cosmetic surgery. Depending on the incision site, it can be divided into two categories: lower lid conjunctival incision and lower lid margin skin incision. The lower lid conjunctival incision is made on the inner conjunctiva of the lower lid, and the incision site is located within the eyelid, so the incision cannot be seen from the outside, which is also known as “scarless eye bag removal”. The incision is not really scarless, but should be invisible. It is a short procedure with no external incisions and has less impact on work and life. It also has obvious disadvantages, namely, there is still the problem of loosening of the existing skin and its underlying myofascial system after the surgery, and the skin loosening may be more serious for older patients subjected to this surgery. Therefore, this procedure is suitable for younger patients who have bulging orbital fat but do not have laxity of the lower eyelid skin. The main complications of this surgery are conjunctival edema, hematoma, postoperative bleeding, and most of all, failure to solve the lower eyelid skin laxity and failure to achieve the purpose of correcting under-eye bags. 3 Mr. Li consultation: my eyes are particularly small, outsiders generally difficult to see my eyes, please ask the doctor I am “small eyes”? Can I make my eyes bigger through plastic surgery? Hello, Mr. Lee, microphthalmia is a medical condition called microphthalmia syndrome, which is an autosomal dominant disorder of the periocular region. The main features include narrow lid fissures (reduced eyelid length and height), ptosis, widened internal capital spacing and inverted canthus, also known as the KOMOTO tetralogy of Fallot. For you, the diagnosis requires further physical and laboratory examination and measurement of specific data, as well as differentiation from ptosis. These disorders tend to be familial in presentation and can be treated surgically, especially if performed at a young age, to improve the patient’s development and achieve good results in adulthood. For adult patients, surgery can also be performed, starting with an inner canthopexy in the first stage and correcting ptosis in the second. In your case, a clear diagnosis is needed to determine the next step in the surgical protocol.