Q: I’m a 21 year-old female of Chinese descent. I want to narrow and sharp my nose tip and wings and make the nose bridge higher. In the upper eyelids, I want to take out the fat and make them more deep and wide. I also want to open my eyes in the inner canthal area. Lastly, I want to reduce cheek and jaw and augment the chin so that the face looks more narrow and longer. I know some of these are common to the Asian face. I have provided some pictures for you to do computer imaging. Thank you very much!
A: Thank you for sending your pictures. I will do some imaging on them but I am limited as to what I can show because the quality of the picture and the angles from which they are taken are inadequate. The most useful photos for compiuter imaging are front and side views taken on a clean background (solid color wall or door) that are non-smiling.
In reference to your specific procedure requests: I can make the following comments:
1) Your nose reshaping/rhinoplasty requests are fairly standard for your ethnicity. Changing the nose by narrowing the tip and flare of the nostrils and making the bridge higher is common for this type of Asian rhinoplasty.
2) From an upper eyelid standpoint, you are referring to a double eyelid procedure with defatting and creating more of a prominent upper eyelid crease…which will make your eyes more wide or open looking. From an inner eye/canthus standpoint, you can get rid of the skin overhang with an epicanthoplasty but the scar trade-off must be carefully considered.
3) For facial narrowing, cheek and jaw angle reduction can be done from inside of the mouth. Whether this is best done by burring or oteotomy/ostectomy reduction is an issue for discussion.
4) The chin can be augmented with a specific female-type chin implant that makes it longer and comes to more of a point.
Dr. Barry Eppley
Q: Dr. Eppley. Five years ago, I had surgery on the right upper eyelid to reduce the size of my eye opening. My right eye used to be larger than the left one. Some times for a few seconds my right eyelid seems relatively normal but as I blink, it seems like the skin detaches from the muscle and the eyelid goes back to a droopy appearance. Unfortunately, it seems like the scar didn’t heal well or the stitches weren’t placed correctly. If the inner crease or fold would stay inside it would have a normal look. I wouldn’t want my right eye to end up larger or deformed compared to the left side again.
A: In looking at your pictures, one can see that with the eye open there is a fold of skin that hangs down onto the lashes of the upper eyelid. However, when the upper eyelid closes completely that fold of skin disappears. That dynamic piece of information is critical in selecting the right blepharoplasty procedure.
Trying to correct this problem by only removing all the extra skin may cause exactly the problem you are trying to avoid. Rather, a very conservative amount of upper eyelid skin should be removed and the dermis then sutured down to the tarsus or levator muscle. This is very similar to the classic ‘double eyelid’ operation done in Asians where they lack an upper eyelid fold. Your problem is conceptually similar.
Because it is only one one eyelid, the procedure can comfortably done under local anesthesia. This would also be helpful in that you would be awake and the dynamic action of the eyelid can be observed as the blepharoplasty repair is being performed.
Dr. Barry Eppley