Before Minimally Invasive Blepharoplasty
Immediately after surgery
After more than a decade of dedicated research and technical improvement, we have developed what is now known as the “minimally invasive eyelid surgery”. This technique has been presented three times at the annual meeting of the Chinese Medical Association of Ophthalmology (the most important ophthalmology meeting in China). In addition, he has published two papers in the Journal of Plastic, Reconstructive & Aesthetic Surgery – Elsevier, a leading international journal of plastic surgery, and two papers in the Journal of the Chinese Medical Association (the highest level journal in China in this field). He has also published three papers in the form of a thesis in the Chinese Journal of Medical Aesthetics and Beauty (the highest level journal in this field in China).
However, the above speeches or papers are only an introduction to the results of this series of techniques, given that there are too many technical points about how to operate, which cannot be mastered by listening to reports or watching videos. Therefore, we can be sure that there are only a few doctors in the plastic surgery field who have mastered this technique and achieved the desired postoperative results. The credibility of the new online advertisements for “minimally invasive double eyelid surgery” is questionable.
The following is a brief diagram of the procedure and why it is “minimally invasive” and not “minimally invasive”.
Difficulty 1: Operating under blind vision is based on experience, but also on skill.
In Figure 1, the minimally invasive blepharoplasty design and the three small skin incisions are not difficult to accomplish, but it is very difficult to remove the prelid tissue within the dashed circle in a more thorough layered fashion without damaging the underlying levator aponeurosis. This is easy to do with the “full cut” method of eyelid surgery, but it is almost impossible to do without 10 years of minimally invasive surgery experience through small 3-point skin incisions. Thankfully, we “did it” with the aid of our self-developed “utility model patent” scissors.
Difficulty 2: How to suture
In the first 8 years, we often encountered the problem of exposed knots and inaccurate intraoperative fixation, and how to sew the stitches so that: 1) the stitches would not need to be removed after surgery; 2) the stitches would be fixed for a long time; 3) the knots would not be exposed after surgery; and 4) the knots would not be felt after surgery. We have now finally found the operation method that is close to perfect. This just-right suture looks simple but is extremely difficult to operate and is not something that can be imitated at will.
Difficulty 3: Eyelash position
Figure 3. A shows the pre-operative lash partition; B shows the pre-operative lash angle; C shows the post-operative lash angle.
We proposed the idea of minimally invasive eyelid surgery for upper eyelid ingrown eyelashes five years ago, and since then there have been a lot of “eyelash” eyelids on the Internet. However, the angle of the eyelashes does not change at will, and will continue to change afterwards, and both undercorrection and overcorrection can have negative effects. We have performed a large number of eyelid lash surgeries in the past and have a unique sense of direction for ophthalmologists in this area.
Difficulty #4: Are your eyelids done?
It is not difficult to have double eyelid surgery, but how to achieve a natural and realistic result after the swelling has completely subsided? In other words, to make people feel that you have grown a pair of beautiful double eyelids naturally. If you want to do this, it is much harder. The following are the most important aspects.
1. The scars are slight and almost invisible.
2. The skin under the eyelid line is light and tight.
3. Matching the size and shape of the eyelids to the face, occupation, and personality.
4. The eyes are closed and flattened.
5.Flattening of the lower vision.
It can be said that there are only a handful of patients who can meet the above requirements.
A.
B.
Figure 4 3 months after minimally invasive double eyelid surgery, A in the open eye position, B in the downward looking position, the scar is not easily detectable
The following is a brief introduction to eyelid surgery related knowledge.
I. Common upper eyelid forms
Generally speaking, there are five main types of double eyelids.
Type I: Open fan-shaped double eyelid
This is also one of the most classic double eyelids. It is characterized by a narrow inner and outer width, with the horizontal axis of the eye at a certain angle to the ground plane, and the corner of the eye slightly raised upwards, giving a feeling of radiance and a very divine look.
Type 2: Parallel double eyelids
Double eyelids are basically parallel to the upper eyelid margin. The eyelid line is designed so that the outer side of the eyelid does not exceed the outer corner of the eye. This is suitable for women with large eyes, high arches, eyebrows far from the eyes and thin upper eyelids. The above two types of double eyelids account for more than 80%.
The third type: double eyelids with wide inner and slightly narrow outer eyelids
It is suitable for women who do not have inner canthus, and the distance between the eyebrows and the eyes is relatively close to each other, which is more common in Western women.
The fourth category: double eyelids with the inner third to one-half not double, (i.e. hidden double type) this double eyelid looks very oriental female.
The fifth type: European eyelid is the so-called “European eye” eyelid that many girls blindly want to do, which basically only suits the skeletal structure of the European face, which is also determined by the physiological anatomy of their eyelid lids. Moreover, their eyebrow arches are particularly high and their eyebrows are close to their eyes, so their eyelids are often wide and exaggerated. However, this is not very suitable for Oriental girls.
Second, is eyelid surgery painful or not?
There are dozens of eyelid surgeries, including minimally invasive blepharoplasty, and the most common concern before surgery is whether or not it hurts during and after surgery. We have summarized our experience in this area over the past 20 years in the following 3 simple statements for your reference.
1. Pre-operative: These surgeries all use subcutaneous infiltration anesthesia of the eyelid, so there will be some pain when injecting the anesthetic, depending on the individual pain threshold. Most people will feel fine, with only a slight pinching sensation.
2. Intraoperative: Almost everyone will not feel any pain during the surgery after sufficient anesthesia.
3.Postoperative: Due to the damage caused by the surgery, most people will feel different degrees of “swelling” after the surgery, rather than pain. Individuals with pain can take a painkiller to get through it.
Minimally invasive blepharoplasty (three-point incision) Name, characteristics, differences from the buried eyelid procedure, and surgical considerations
Dr. Bi’s papers “Clinical efficacy of minimally invasive blepharoplasty in the treatment of upper eyelid impingement in adolescents” and “Clinical study of eyelid thickness asymmetry in the Chinese population” were recently published in the Chinese Journal of Medical Aesthetics and Beauty, respectively. In addition, two articles on blepharoplasty have been published in the SCI journal Journal of Plastic, Reconstructive & Aesthetic Surgery – Elsevier. Dr. Bi also gave presentations at the recent 16th National Eye Congress in Guangzhou, the 14th National Eye Congress in Chongqing, and the 15th National Eye Congress in Beijing in September 2011. The presentations were on the principles of minimally invasive blepharoplasty, complications, and other difficult issues. Some of the information is summarized below.
(i) Evolution of Dr. Bi’s minimally invasive eyelid surgery.
1998-2005: Simple bilateral symmetrical small incision blepharoplasty
2005-2006: Improved treatment of the orbicularis oculi muscle
2006-2007: Improved release site for orbital septum fat
2007-2008: Started research on asymmetric blepharoplasty for asymmetric eyelids
2008-2010: Discovered that the majority of young Chinese women have asymmetrical upper eyelids, and explored the rules of asymmetric surgery
2010-2011: Discovered a low-tension fixation method for the same eyelid height and different eyelid shapes, resulting in a more natural and realistic eyelid shape after surgery
2011-2012: Learned that there are many factors that influence true minimally invasive blepharoplasty, and that a thorough preoperative evaluation is an important part of achieving the desired postoperative result
2012-2014: Learned that minimally invasive blepharoplasty is not an incision of the inner corner of the eye, but an internal fixation of the inner corner of the eye.
2014-2015: Exploration and gradual maturation of the ROOF trimming method for those with swollen eyes, thus being another method to improve swollen eyes in addition to the release of fat in the orbital septum.
(II) On the naming of the procedure:
Recently, we found that many websites on the Internet quoted the original text of this section and renamed “minimally invasive double eyelid surgery” as “Korean double eyelid surgery”. In fact, the two surgical methods are similar, as I started my own “minimally invasive double eyelid surgery” in 2001, but it seems that there was no “Korean” at that time, and there were experts in China who performed this surgery earlier and named it “small incision blepharoplasty” or “tunnel incision blepharoplasty”. The name “Korean” is also used by experts in China who performed this surgery earlier. The name “Korean” seems to be a blind attempt to follow the trend and confuse the public. The author believes that the name “minimally invasive” or “small incision” is reasonable, based on the following considerations: “minimally invasive” is not “non-invasive,” i.e., there is an incision during surgery. “Minimally invasive” is not “non-invasive”, that is, there is an incision during surgery, and there is a trace of scarring in the skin after surgery for a certain period of time, which is visible only when the eyes are closed and dissipates with time. Beauty seekers need to note that any surgery has damage, only the size of the damage and post-operative healing makes a difference.
(iii) Seven advantages of minimally invasive (small incision) blepharoplasty.
Very little surgical damage (because we avoid or reduce unnecessary operations)
Minimal eye scarring (six months after surgery, with your eyes closed, you may have little or no scarring)
Natural and permanent heavy eyelid crease (fake eyelids are better than no eyelids, real eyelids will make people who don’t know you think you haven’t had surgery)
No sutures required for heavy eyelid incisions and no stitches to be removed after surgery (makes it a lot easier for friends who come from far away)
Selective fat placement (minimizes swollen eyes)
Quick recovery after surgery (just for the incision method, many people can go back to work or go out shopping on the same day, but it’s best to take 2-3 days off)
Suitable for young, middle-aged women, before and after surgery changes
(iv) Main differences between minimally invasive (small incision) method blepharoplasty and the buried eyelid method.
Recently, many people and even professionals have questioned our “minimally invasive blepharoplasty”, thinking it is some kind of buried lid surgery, but there is a fundamental difference between the two.
In minimally invasive blepharoplasty, we remove the entire orbicularis muscle below the preset eyelid line with special scissors (Dr. Bi was awarded a national patent and the 2014 Shanghai Outstanding Invention Award) (note that the location and shape of this muscle, as well as its completeness and continuity, is an important part of the post-operative shape, which is the main difference between Dr. Bi and others). This is the main difference between Dr. Bi and others.) This makes the upper lid lighter and more natural, and the lid line more permanent, which is the main reason why the lid line is less likely to disappear after minimally invasive blepharoplasty.
In minimally invasive blepharoplasty, the fat in the orbital septum is released in a targeted manner, usually in different amounts for both eyes, so that the postoperative eyelid is less bloated and symmetrical. The amount of fat released does not need to be “more” but rather “more”, “more”, and “more”. This is one of the important differences between Dr. Bi and other surgeons.
(5) The difference between Dr. Bi’s minimally invasive (small incision) double eyelid surgery and other people’s minimally invasive double eyelid surgery: 1.
1. The concept and way of preoperative design are different.
2. The size of the skin incision is different.
3.The position of skin incision is not symmetrical for both eyes.
4.The disposition of the orbicularis oculi muscle is different.
5. The “point”, “degree” and “balance” of releasing fat in the orbital septum are different.
6.The way and position of fixation varies from person to person and does not require removal of stitches.
7.If joint eye surgery is performed, you can choose scarless eye angle shaping (slightly smaller) or scarred eye angle shaping.
(F) Minimally invasive (small incision) method double eyelid surgery preoperative, intraoperative and postoperative precautions.
Pre-operative precautions: contraindications to surgery include: ① menstrual period; ② facial nerve disorders and mental disorders; ③ eyes that are too prominent; ④ upper lids that are too sunken; ⑤ requirements that are not realistic or those who do not agree with themselves and their families; ⑥ serious organic diseases, blood system diseases or metabolic diseases in the whole body.
Intraoperative attention.
1. Intra-operative pain only occurs during anesthesia, similar to the pain of a normal intramuscular injection, one injection per eye, and no intolerable cases have been found at this time.
2, there will not be any pain sensation during the surgery, individual pain is mostly individual differences, generally about 0.1%.
3, the cooperation during the operation is extremely simple, only need to be able to open or close the eyes according to the doctor’s requirements.
Postoperative attention.
1. The wound should not be touched with water within 7 days after surgery, and the wound needs to be cleaned with alcohol cotton balls every morning and evening.
2. the second day after surgery is often more swollen than the first day.
3. The swelling will decrease in 5 to 7 days after surgery, and the swelling will be completely gone for about 1 to 3 months after surgery.
4. The recovery of swelling in the eyes is usually asymmetrical in the first month after surgery, and the subjective perception of so-called “large and small eyes” is often seen, but we need to emphasize that “this is an illusion”, although we always insist that 100% identical double eyelids cannot be made.
5.Post-operative medication is generally not needed, if special needs, respect the doctor’s orders.
6, no special attention to the post-operative diet, generally light is good.
7, one week after surgery, both eyes as much as possible to do open activities, generally the day after surgery can read books, watch TV or computer, not because of surgery and excessive sleep, the result is often slower to swelling.
8. Generally, you can go home alone after surgery, without the need for others to accompany you, and you do not need to follow up the day after surgery. Another special precautions or special circumstances, Dr. Bi will individually explain or deal with according to the actual situation.