Thank you for your question.
You've submitted photos showing your progress from having undergone non-incisional Asian
eyelid surgery with fat removal approximately 12 days prior.
And you state in your question that the left upper eyelid is considerably more swollen
and more tender and is having some difficulty with movement.
And your doctor stated that if your eye did not improve that the next day or day 13 would
be the time when you would want to lower a stitch.
And now you're questioning whether or not it is safe to do this procedure at a time
when things are swollen.
Well I can certainly give you some guidance in this question.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon, specialize in complex eyelid surgery for a variety of conditions.
And in addition, I have focused a lot on Asian Eyelid Surgery.
So I can give you some guidance as to what I believe your doctor may be thinking at this
time.
It seems like you've definitely chosen a very good doctor and you know – and you made
that decision and your doctor wanting to intervene at a relatively early stage.
It has to be for a reason.
So I’ll tell you what my thinking would be in this circumstance.
And although it’s been generally my policy not to operate on some tissue that’s swollen,
there are always going to be exceptions.
I mean, this is something that is very important to understand about the clinical medicine
and the practice of medicine.
The training gets you to a certain point.
That’s when you're younger and you get trained.
But then, your experience both good, bad, and everything in between is what defines
your style and your approach.
And majority of that is never – can never really be written and recorded in a way that
is meaningful in textbooks or videos.
It really takes firsthand experience.
It’s like the number of hours it takes to be a great pilot or a great musician.
So to understand what is being done with Asian Eyelid Surgery, regardless of non-incisional
or incisional, there is a part of this procedure which involves anchoring of the skin to a
structure called the levator muscle.
Now the levator muscle is what lifts the eyelid.
And usually that’s the point where the levator muscle is engaged; is at the ideal point where
the crease should connect.
Now that being said, when you do this procedure, there is also a structure called the septum
and the septum is a more stiff structure that connects the bone in the upper rim or the
eye socket to the muscle.
And in Asians, that connection tends to be a little bit low.
Now when you open the septum that’s where you get the fat and that’s how the fat is
removed whether it’s incisional or non-incisional.
Now I suspect your doctor may be concerned that some of that septum may have been engaged
when the suture was placed to create this crease.
And so it might be restricting your eye movement.
Now again, this is speaking without a physical examination and without looking at the different
levels of your eye movement.
It’s not unusual to sometimes gets enough swelling that the eye can look low as it does
on your – in your photo.
But if your doctor wants to move forward with doing something sooner rather than later,
they’re maybe concerned of either the septum or the engagement of the levator muscle in
a way that might be restricting the ability of the muscle to open the eye fully.
And in situations like that, there is a justification for earlier intervention.
You know, when we do surgery whether it’s for Asians or non-Asians, there’s kind of
a routine follow-up process and then the door is always open so that we can identify opportunities
should there be a need for intervention.
So we see people not only – well, in during surgery, we actually have patients open and
close their eyes and we’ll even sit them up and look at them to make that the crease
and everything looks good.
But after surgery, we’ll see them in a week and then at two to three weeks later and then
a month later.
But if someone has anything unusual, we see them more frequently.
So it seems like your doctor is really on top of this situation for you.
And I think that if you trusted the doctor to do the procedure based on your understanding
of the doctor’s experience and expertise, then I think you should most likely follow
your doctor’s guidance and maybe ask your doctor what your doctor is thinking so it’ll
help you understand the justification for the timing of intervention.
So I hope that was helpful.
I wish you the best of luck.
And thank you for your question.