CAUCASIAN UPPER EYELIDS BLEPHAROPLASTY

Caucasian Upper Eyelids

The aging Caucasian upper eyelid first presents as subtle loss of definition of the eyelid fold and ‘creepy’ skin above the eyes. This makes it a little more difficult to apply eye make-up evenly. With further aging, a look of heaviness and hooding develops, and eventually the upper eyelid fold becomes completely covered by the excess upper eyelid skin.

The INTERNAL FIXATION BLEPHAROPLASTY for the Caucasian eyes.

Conventional upper eyelid blepharoplasty relies on skin removal to achieve the desired effect. Because the technique relies on tightening the skin when skin is not naturally tight, it frequently results in unnatural appearance, visible scarring and in some cases, distortion or even inability to close the eyes completely. At best, this skin excision technique results in partial improvement which would only last for a several years and the procedure needs to be repeated.

The internal fixation technique in contrast operates internally, on the support layer of the upper eyelid, and not directly on the skin itself. This is the key to natural and lasting results. It restores the pleasing contour and curve above the eyes and remove the heaviness and drooping that occurs with age. The skin above the lash is also directly tightened, and the lashes which droops slightly with aging are naturally returned to their more youthful position. Essentially, the technique surgically recreates the internal eyelid structure found in people with beautiful eyes. Most importantly, because the internal fixation technique relies on contouring to achieve the desired result, skin excision is minimized giving a natural and lasting result with correct proportions between the lash , crease and skin below the brow.

Procedure

The procedure can be done under local anesthetic in the office. If other procedures are performed at the same time, the procedure can also be done under general anesthesia. Great care is taken throughout the surgery and in the aftercare to reduce post-operative bruising and swelling.

Facial Aesthetic Plastic Surgical Procedures

Male Upper Eyelids

MALE UPPER EYELID SURGERY

Male upper eyelid surgery is profoundly different from upper eyelid surgery in female patients. While the rationale for surgery, visual impression, and emotional and aesthetic goals that the procedure strives to achieve remains fundamentally the same as upper eyelid surgery in female patients (Please review the upper eyelid surgery section of our website as well), there are areas where the male upper eyelid surgery are profoundly different.

VISUAL IMPRESSION of AN ABSENT UPPER EYELID CREASE

An absent upper eyelid crease in the Male have the visual effect of making the person look reclusive, unfriendly and even distant. When the observer looks at the person, an absent upper eyelid crease have the effect of drawing the person’s attention to the upper eyelid, rather than the eyes itself. This is not ideal as we communicate and express our emotions via the intensity radiating from the eyes. In contrast, male patients with naturally occurring upper eyelid crease have the visual effect of making the person look more approachable, friendly and focuses the attention of the observer to the eyes rather that the upper eyelid. At a subconscious level, this allows for more effective communications.

Naturally occurring upper eyelid crease have the visual effect of making the person look more approachable, friendly and focuses the attention of the observer to the eyes rather that the upper eyelid.

AESTHETIC REQUIREMENTS of NATURAL MALE UPPER EYELID SURGERY

The male eyes need to look masculine. This is part of the alpha-male look that radiates intensity and masculinity. Accordingly, one need a profound appreciation of the male eyes when performing Aesthetic Upper eyelid blepharoplasty in male patients.

It is crucial that when performing the surgery, the surgeon is wary not to ‘feminize’ the male eyes. This would be to make the mistake of setting the upper eyelid crease at a level that is too high, removing too much upper eyelid skin, excision of excess upper eyelid skin and/or removal of too much fat from the upper eyelids.

 

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As can be appreciated by observing a male patient with naturally occurring upper eyelids (I have never had upper eyelid surgery done), in the ASIAN male, the crease is quite low and crisp and the upper eyelid is quite full (in contrast to the deep set Caucasian upper eyelids) (Figure 2).

Understanding the aesthetics of the Male ASIAN eyelids is crucial in the art of creating natural upper eyelid crease. With the appreciation, the surgeon do have the flexibility of designing specific upper eyelid crease that best fit the individual male patients based of the aesthetic balance of his face as well as specific requests and needs.

WHO WOULD BENEFIT from MALE UPPER EYELID SURGERY?

In general 2 groups of patients benefit from male upper eyelid surgery:

  1. Young patients with absent upper eyelid crease as in the patient in Figure. This would give the aesthetic benefit and change as we have discussed above.
  2. Older patients, where aging has caused significant hooding of the upper eyelids. Upper eyelid surgery can brighten up the eyes and make the person look more alert and friendly.

Please visit us for an in-depth discussion of your specific needs. As well please review the section the ASIAN Upper eyelid section of our of our website to understand more.

Aesthetic Plastic Surgical Procedure

Rhinoplasty

Rhinoplasty is a procedure that improves the aesthetics and balance of the nose. Today, rhinoplasty has evolved into a highly sophisticated and predictable procedure that addresses both the aesthetic and functional aspects of the nose.

What you’ll gain

  • enhanced facial symmetry and harmony
  • Improve self-confidence
  • Enhance breathing function
Procedure Overview

Rhinoplasty is a surgery that reshapes the nose to improve its aesthetic appearance and restore balance to the face. This surgical procedure can correct nose size, shape, width, and profile, and can also improve breathing function.

During the procedure, the surgeon will make incisions inside the nostrils or on the outside of the nose to access the bone and cartilage. Then, they will sculpt and reshape the bone and cartilage to achieve the desired result.

The procedure typically takes 1 to 3 hours and is performed under general anesthesia.

RELATED RESEARCH
Surgeon's scientific
articles

Staging of necrotizing fasciitis based on the evolving cutaneous features.

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Upper Eyelid Ptosis Correction with Levator Advancement Using the Levator Musculoaponeurotic Junction Formula in White Patients

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Newer Understanding of Specific Anatomic Targets in the Aging Face as Applied to Injectables: Aging Changes in the Craniofacial Skeleton and Facial Ligaments

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How is Rhinoplasty Performed?
Rhinoplasty is typically performed as an outpatient procedure under general anesthesia. The surgeon makes incisions within the nose or along its base to access the underlying bone and cartilage.
Recovery and
Aftercare

After the procedure, patients may experience some swelling, bruising, and discomfort around the nose and eyes, which can last for several days to a few weeks. Patients should avoid strenuous physical activities for at least 2 to 3 weeks after the procedure and should follow the surgeon’s post-operative instructions carefully to ensure proper healing.

It’s important to avoid any activities that could cause trauma to the nose during the healing process. Patients should also avoid blowing their nose for the first few days after the procedure to avoid disrupting the healing process. Most patients can return to work and normal activities within 1 to 2 weeks after the procedure.

Regular follow-up appointments with the surgeon will be necessary to monitor the healing process and ensure optimal results.

Non Surgical Minimally Invasive Procedure

Skin Care

At W clinic, we take pride in our range of skin pampering products that will cater to various skin care needs. W skin, our in-house medical-grade skin care range, is developed by our dermatologist, Dr Wang Yi Shi based on the philosophy: CORRECT, PROTECT and REVITALIZE. Whether you are troubled by acne, pigmentation, or sensitive skin; or wish for a smoother and more radiant complexion, our products are formulated to help alleviate these specific problems and achieve healthy, great-looking skin.

Cleansing product
Clarifying Wash

This gentle wash cleanses skin perfectly in the gentlest possible way without drying and irritating. It dissolves keratin, purifies and keeps skin free of dirt and grime. It also helps to balance the biological equilibrium of skin’s functions, thus helping skin defend itself against external aggressions such as pollution. Day after day, skin appears more youthful and the complexion becomes fairer and more radiant.

Cleansing product
Deep Cleansing Wash

This cleanser is the first step to healthy skin. It gently creates a clean and healthy environment free of surface impurities. Perfect for normal, oily and blemish-prone skin, the wash contains salicylic acid to unclog pores while organic Edelweiss extract botanicals condition, soothe and nourish the skin. It also helps to lighten the appearance of blemish-related pigmentation for a more even complexion.

Moisturizing product
Ultralight hydrator

Comfort irritated skin and perk up a fatigued-looking complexion with this light textured lotion which gently moisturizes as it reveals a brighter-looking skin tone. Featuring the skin-soothing complex – Allantoin, Butcher’s Broom, Centella Asiatica, Calendula and Horse Chestnut – it brings comfort to irritated skin and boosts the skin’s natural hydration levels over an extended period of time. Skin is refreshed, purified, quenched and soothed throughout the day.

Revitalizing and skin brightening serum
Skin illuminating serum

This high-performing brightening treatment targets dark spots, freckles, and dullness to restore your skin’s luminosity. It lightens your overall complexion and enhances clarity plus glow. The remarkable formula works within skin and the combination of potent actives including niacinamide and alpha-arbutin provides an all-rounded solution to pigmentation. Skin is fortified and protected to restore glow from a dull, tired complexion.

Revitalizing and skin brightening serum
Vitamin C and E serum

This exclusive, super silky and non-greasy serum is powered by pure, potent actives designed to regain skin’s lightness and youthfulness. It helps to guard your skin against premature aging, discoloration and the cumulative damage induced by damaging free radicals and environmental aggressors. It may also help to promote essential collagen synthesis, leaving skin dewy, firm and more radiant, with better tone and texture.

Sunscreen
SPF 30 Ultralight Daily UV Protector

This non-greasy, ultra-light emulsion is the answer to complete protection from the sun’s noxious UV rays and other environmental pollutants. The spectacular blend of ingredients ensures tanning is effectively avoided, while providing full-spectrum shielding. Strengthened with vitamins C and E, skin enjoys an unsurpassed level of moisture and nourishment that helps keep it healthy. Skin feels velvety, smooth and light throughout the day!

Sunscreen
SPF 50 BB cream

This multi-functional cream combines the perfect shade to illuminate dull skin and provide an even, natural-looking coverage, while providing protection from UV radiation. Infused with nutrient-rich Portulaca Oleracea Extract, the high content of Omega-3 fatty acids, vitamins and minerals will protect skin against the damaging effects of free radicals while providing hydration and soothing properties.

Others

Our clinic also carries the reknown PCA ( Physicians’ Care Alliance) skin care range from USA.

The Cutera CoolGlide Hair removal laser

Hair Removal

The Cutera CoolGlide is the best laser hair removal system on the market for all skin types and tones, from light to dark, including tanned patients. Its unique design, longer wavelength, and innovative cooling design, allow extremely effective, safe and permanent results.

What areas can be treated with the CoolGlide?

The CoolGlide can remove hair from all parts of the body including the face, legs, arms, underarms, and back. It can also treat sensitive areas like the chest, nipples, and bikini line.

What do CoolGlide treatments feel like?

As the name implies, the CoolGlide handpiece cools and soothes as it glides along your skin. When the pulse of light is delivered, some patients experience a mild pinching or stinging sensation. A topical anaesthetic cream can be applied prior to the treatment to reduce the discomfort.

How many treatments will I need?

Most areas require 5-8 treatments. However, the number of CoolGlide treatments required for optimal long-term benefits depends on multiple factors – hair thickness, the area treated and your hair’s growth cycle. Interestingly, not all hairs are actively growing at the same time and actually go through three distinct phases: growth, regression, and resting. CoolGlide treatments work by disabling the hair that is principally in the active growth phase at the time of treatment. Since other hairs will enter this active growth phase at different times, additional treatments may be necessary to disable all of the hair follicles in a given area.

What happens after the treatment?

Immediately following your CoolGlide treatment, the area may appear a bit red and swollen. Three to seven days after treatment you may experience what seems to be regrowth of hair. Actually, most of these hairs are being shed as a result of your treatment and are not regrowing. Between treatments you should not wax or pluck your hair, but it is permissible to shave.

Are there any restrictions on my activity after treatment?

Following the treatment, you can return to your normal activities right away, but some redness may occur. The use of sunscreen is recommended on any treated areas exposed to the sun.

What are the possible side effects?

Although patients experience few side effects, the most commonly noticed are slight reddening and local swelling of the skin. These effects typically last for several hours or less. In rare instances, blistering may occur. Consult with your medical professional for complete information on the benefits and risks of treatment.

Why choose CoolGlide over other laser hair removal systems?

Using the latest technology in laser hair removal, the CoolGlide can rapidly treat large areas without the limitations of older technologies. The CoolGlide longer wavelength allows it to be used safely and effectively on patients with light or dark skin as well as tanned skin. Unlike other systems, the CoolGlide can treat the fine hair on a woman’s upper lip just as easily and effectively as the coarse hair on a man’s back. The cooled handpiece increases patient comfort and minimizes the adverse skin reaction commonly seen with other lasers.

"Beauty is in fact bone deep"

Skeletal Augmentation

Patients with naturally retruded skeleton therefore will benefit profoundly from augmentation of the facial skeleton. The added projection from the skeletal augmentation adds to the 3 dimensionality of the facial features and add depth and character to the facial features.

We now know that the facial skeleton changes profoundly with aging. Certain areas of the facial skeleton are susceptible to resorption with age and the resultant loss of soft tissue support here contributes to the sagging that we see with aging. Accordingly, patients with facial aging would also benefit from skeletal augmentation for a more harmonious result with facial rejuvenation. Skeletal augmentation can be done alone or more commonly with the surgical rejuvenation (known as the ‘lift and fill’ approach).

Skeletal augmentation can be done with a variety of materials. It can be done with facial implants such as silicone, medpore or more recently hydroxyapatite granules. Hydroxyapatite granules in particular have been gaining popularity recently. It has the same chemical composition as bone and integrates completely with the facial skeleton. It is very safe when used in the face.

The use of fillers (Hyaluronic Acid fillers) are also very effective with minimal down time. A variety of fillers are currently available for different areas of the face and they vary in flow characteristics and permanence. Fillers last from 9 months to 2 years depending of the material used. Fat grafts may also be used. The benefit of the use of fat is that, once taken it is a permanent ‘filler’ material. Also, fat have the effect of rejuvenating the overlying skin when injected into the face. Fat may be harvested via the abdomen or the thighs via tiny incisions under local anesthetic with minimal discomfort. Mendelson and Wong APS (ppt).

For a detailed discussion of materials that best suit your needs, please visit us for a detailed consultation.

Non Surgical Minimally Invasive Procedure

Fillers

As we age, there is a significant loss of skeletal support and the volume of soft tissue. This is why we see the obvious deflation that comes with aging. Fillers are used to restore the soft tissue volume, effectively lifting the tissues and correcting the deflation.

This minimally invasive procedure usually takes about 30 minutes, and the patients can see immediate improvements. They can then return to work immediately following the procedure with make-up. Bruising and swelling are usually minimal.

While there are several filler materials available, we use only the safest and most established products in our clinic. We use products based on hyaluronic acid (HA), which is a chemical compound that is found in our body. It is safe and can be digested by the body over time. Depending on the location and technique of the injection, fillers can last anywhere from 9 months to 18 months. Different types of HA with differing viscosity and durability are available and is selected by the doctor based on the desired effect, location where correction is needed and individual requests. Besides regular fillers, more long lasting or permanent fillers are available and may be suitable for selected patients.

Minimal discomfort will be felt during the procedure, and local anesthetic creams can be applied to numb the area before the procedure. Some of the more advanced filler are mixed with local anesthetic, making the injection quite painless. Should more pain relief be needed or in cases where more fillers are needed, nerve blocks, which are very targeted anesthetic to numb the entire face can be applied.

Soft tissue filling

  • Laugh lines (nasolabial folds)
  • Lip lines Marionette lines
  • Corners of the mouth
  • Lips
  • Tear trough
  • Cheek Augmentation
  • Chin Augmentation
  • Jawline
  • Correction of temple hollowing
Filler RHINOPLASTY

This procedure uses fillers to refine and improve the nose, where the bridge of the nose can be raised, the tip projected more and made sharper. The results are subtle and natural. Filler rhinoplasty is ideal for patients looking to refine the nose but may not be ready to undergo a surgical rhinoplasty

To further explore the use of fillers for your needs, please come in for a consultation as well as to review some photos for a better understanding of the expected outcome from these procedures.

SKELETAL AUGMENTATION

It’s been said that the foundation of our appearance is the facial skeleton. This is obvious in individuals blessed with prominent facial features such as a strong supraorbital ridge (the part of the bone under the brow), prominent cheeks and a strong jaw line. These are the individuals who look good and will eventually age well.

Patients with naturally retruded skeleton will naturally benefit profoundly from augmentation of the facial skeleton as the procedure adds depth, dimension and character to the facial features Today, we know that the facial skeleton changes profoundly with age. Certain areas of the facial skeleton are susceptible to resorption as we age and the resultant loss of soft tissue support in those areas contributes to sagging. As such, patients with facial aging would also benefit from skeletal augmentation for a more harmonious result with facial rejuvenation. Skeletal augmentation can be done alone or more commonly with the surgical rejuvenation (known as the ‘lift and fill’ approach).

Skeletal augmentation can be done with a variety of materials, such as facial implants like silicone, medpore or more recently hydroxyapatite granules. Hydroxyapatite granules have been gaining popularity as it contains the same chemical composition as our bones and integrates completely with the facial skeleton. This makes it very safe when used in the face.

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Types of fillers available

The use of fillers (Hyaluronic Acid fillers) are also very effective with minimal down time. A variety of fillers are currently available for different areas of the face and they vary in flow characteristics and permanence. Fillers last from 9 months to 2 years, depending of the materials used. Fat grafts may also be used, and the main benefit of this is that once taken, it becomes a permanent ‘filler’ material. Most importantly, fat can rejuvenate the overlying skin when injected into the face. Fat may be harvested via the abdomen or the thighs via tiny incisions under local anesthetic with minimal discomfort.

For a discussion of the procedure that best suit your needs, please visit us for a detailed consultation.

Non Surgical Minimally Invasive Procedure

Neurotoxin

Neurotoxin has many cosmetic uses and a very long safety record, with several millions treatment done worldwide. Experience has shown that it can be applied to different areas of the face safely, with profound effects. The key to safety and efficacy is knowledge of how the toxin works, precise placement and detailed understanding of the anatomy of the face.

Neurotoxin is used to target specific muscles, relaxing the muscle that is responsible for particular frown lines, for example the corrugators for the glabella frown line and masseter for the square jaw.

More advanced concepts of using Neurotoxin involves selectively targeting opposing muscle or muscle groups that animate the face. This is done by selectively leaving antagonistic muscles activated to cause the relative shifting of soft tissues, for procedures like a non-surgical brow lift. The toxins are injected at multiple different levels, from subdermal to subperiosteal as well the use of various dilutions of the toxin, in regular, meso and well as microdilution depending on the nature of organs targeted.

In our practice, we apply these advanced concepts for the routine delivery of superior results with safety and predictability.

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Non Surgical Minimally Invasive Procedure

Ultherapy

Ultherapy is one of the latest non-invasive treatments for lifting and toning skin on the face and neck without any downtime. Ultherapy is able to penetrate deeply and precisely into the foundational layers of facial tissue, bringing about tightening and lifting of the brows, jawline, jowls, facial skin and neck.

What does collagen do?

Collagen is a natural protein that gives skin its youthfulness by keeping it firmed and toned. As we age, collagen loses its strength and its ability to stand up to the effects of gravity that pull the skin downward. Ultherapy jumpstarts a repair process that strengthens your existing collagen and produces fresh, new collagen.

How is Ultherapy different from other cosmetic procedures?

Ultherapy is the only nonsurgical cosmetic procedure that uses ultrasound to specifically target the foundational layer of facial tissue that doctors address in surgery. The use of ultrasound also enables us to actually see the layers of skin we are treating, allowing the energy to be delivered precisely to where it will be most productive.

Is it safe?

Ultrasound energy has a proven track record, with use in medical imaging for over 50 years. In addition, the procedure has been cleared by the FDA after demonstrating safety in clinical studies, and tens of thousands of treatments have been performed worldwide without any significant adverse events.

Who is a good candidate for Ultherapy?

There is a broad range of people who can benefit from Ultherapy, but typically those in their thirties and older are candidates. While this is not a replacement for surgery, Ultherapy is ideal for people who desire some lifting, in order to look more refreshed and toned but are not ready for surgery.

How many treatments does it take?

Majority of people need only one treatment, while those with a fair amount of laxity may require more than one treatment. Annual touch-up treatments can help slow down the rate of skin ageing.

How long does the treatment take?

One full face and neck treatment usually takes about 60 minutes.

Does it hurt?

Comfort thresholds vary from patient to patient, but there can be some discomfort while the energy is being delivered, which is temporary and a signal that the collagen-building process has been initiated. We will take measures to make the experience as pleasant as possible, and this may involve the use of numbing creams and painkillers.

How long do the effects last?

Patients treated with Ultherapy still have fresh young collagen after a year’s time following the procedure, but skin continues to age. Yearly touch-up treatments can help keep pace with the ageing process.

Are there any side effects?

There may be slight redness for a few hours following the treatment, and it’s not uncommon to have slight swelling, tingling or tenderness to touch for a few weeks, but these are typically mild and they are temporary in nature. There can be other post-procedural effects such as bruising and small areas of numbness but these are less common and, again, temporary.

Facial Aesthetic Plastic Surgical Procedures

Midcheek Lift

The midcheek is a very important aesthetic reference point of the face. A full rounded midcheek located high on the cheekbone conveys a powerful impression of vigor and youth. Conversely, a droopy or descended midcheek that hangs off the cheekbone is immediately associated with aging.

Addressing the midcheek is therefore an important aspect of the overall strategy to rejuvenate the face.

Article
Midcheek lift

In this paper, Dr Wong and Dr Mendelson described the Tear Trough-Orbicularis Retaining Ligament Complex, the key structure that hold the soft tissues of the midcheek.Recent advance in the understanding of the midcheek anatomy, in particular the description of the tear trough-orbicularis retaining ligament complex by Drs Wong and Mendelson have allowed for the development of safer and more effective procedures designed to lift the midcheek.

Midcheek lift can be performed via from 3 approaches:

  1. Midcheek Lift with lower Eyelid Blepharoplasty
  2. Midcheek lift with Composite Facelift (High SMAS Facelift)
  3. Midcheek lift with the DEEP TEMPORAL LIFT

The choice of the approach depends on the patients’ specific needs, requests and concomitant procedures that are to be performed. For example, in patients presenting with eyebags who also has midcheek descent, a lower eyelid surgery with midcheek lift offers the ideal solution to address all aspects of mischeek aging without the need for additional incisions.

Depending on what approach is selected, the procedure, incisions, recovery and potential complications differs. These will be discussed in detailed during the detailed preoperative consultation. Please visit us for an in-depth discussion on your specific needs.

Dr Wong has published his Mid Cheek Lift technique in the journal Plastic and Reconstructive Surgery. You may review the technique here.