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Eyelid plastic surgery is the most popular of all facial cosmetic surgery procedures performed on patients of Asian descent in the Orient and the West. More accurately considered a grouping of related operations rather than just a single procedure, the most well-known is double eyelid surgery, an operation designed to create or enhance the upper eyelid crease. However, all of the procedures described in this Section are tied together by their common primary intent, which is to make the Asian eye appear bigger and the eyelids look more opened. While the specific anatomic layers of the Asian eyelid are identical to those found in the Occidental or European lid, their different structural alignment and relative lengths and thickness are sufficient to account for the highly characteristic appearance of the typical East and Southeast Asian upper eyelid, epicanthal fold (epicanthic fold n. A fold of skin of the upper eyelid that partially covers the inner corner of the eye.), and crease (or lack thereof). Eyelids quite similar in physical appearance can be found in other distant groups of people, such as the indigenous Indian populations of North and South America, the result of nomadic migrations many centuries ago across the Bering Strait separating what is now Russia and Alaska. Confusingly, most of the people of northern, southern, and western Asia share few of what are considered "characteristic Asian traits," especially around the eyes. While the term "Oriental" might thus seem a more descriptive and localized designation for traits and operations designed for people of the eastern and southeastern sections of this large continent, its use is currently considered politically-incorrect. Many Asian eye surgeons consider eyelid surgery to be the most demanding and least forgiving of all cosmetic plastic surgery procedures. Results can vary tremendously with the training, skill, and experience of the doctor, and problems such as noticeable asymmetry, excessive scarring, misdirected eyelashes, unwanted accessory skin folds, hollowness, overdone or unnatural results, and a gradual loss of the crease are by no means rare. In more opinionated quarters, Asian cosmetic eye plastic surgery is seen as controversial or much worse because of its ability when overdone to mute or erase normal ethnic facial features, a process known as "Westernization." Although the number of operations performed continues to escalate, there is some early suggestion of an emerging "backlash" against anatomic modification within even moderate groups as Asia continues its rise in political and economic global importance. Asian blepharoplasty, also known as "double eyelid surgery," or colloquially "the surgery" is a type of cosmetic surgery where the skin around the eye is reshaped (blepharoplasty). The purpose of the procedure is to create an upper eyelid with a crease (i.e. "double eyelid") from an eyelid without a crease (i.e. "single eyelid") Anatomically, there are a number of differences in the upper eyelids of East Asians compared with the differences in the eyelids of other races. While there are some Asians with a double eyelid and some without, there is also a large variation in the crease position (double eyelid size) of the East Asian upper eyelid. The upper lid fold can range from 1 mm above the eyelash line to about 10 mm. Several methods can be used to create the double eyelid—including the full-incisional, partial incision and no incision methods (e.g. the DST method). Each has its advantages depending on the patient's anatomy and desires. Asian blepharoplasties have been reported to be the most common aesthetic procedure in Taiwan and other parts of East Asia.The procedure has been reported to have some risk of complications, but is generally quite safe if done by an expert plastic surgeon. Practitioners of Asian double eyelid surgery include plastic surgeons, otolaryngologists (facial plastic and reconstructive surgeons), and oral and maxillofacial surgeon (facial cosmetic surgeons), and ophthalmologists (oculoplastic surgeons). A procedure to remove the epicanthal fold (i.e. an epicanthoplasty) is often performed in conjunction with an Asian blepharoplasty. http://en.wikipedia.org/wiki/Asian_blepharoplasty Rhinoplasty is one of most frequently performed Asian cosmetic surgeries. Although the general concepts of Asian rhinoplasty are similar to those in the non-Asian, technical execution is different. The large majority of Asians seek nasal augmentation (augmentation rhinoplasty), in contrast to Europeans who generally request reduction (reduction rhinoplasty). On average, the Asian nose appears more triangular than in the Occidental when viewed from the front. The nasal bridge is typically flatter, the spine shorter and less defined, and the tip of the nose wider and less angular. The nostril opening may appear relatively larger and be more widely flared. For the Asian rhinoplasty surgeon, the operation can be more challenging because Asian cartilage is more fragile and the overlying skin is thicker. Many Asians patients request an increase in tip projection to lengthen the nose slightly and lower its typical upward angle. Southeast Asians typically benefit the most from augmentation of the bridge and length, while northeast Asians often request less or none at all. The desire for nostril reduction is also more frequent in southeast Asians than in those from the northeast. The more inclusive term ethnic rhinoplasty is sometimes used by rhinoplasty surgeons to indicate nose reshaping on non-European patients, particularly East Asian and African-Americans but also Middle Eastern and Hispanic. This designation is of minimal value as the needs in each group are complex and different. Rhinoplasty (Greek: Rhinos, "Nose" + Plassein, "to shape") is a surgical procedure which is usually performed by either an otolaryngologist (head and neck surgeon), maxillofacial surgeon, or plastic surgeon in order to improve the function (reconstructive surgery) or the appearance (cosmetic surgery) of a human nose. Rhinoplasty is also commonly called "nose reshaping" or "nose job". Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes to correct trauma, birth defects or breathing problems. Rhinoplasty can be combined with other surgical procedures such as chin augmentation to enhance the aesthetic results. Although techniques and methods employed during rhinoplasty surgeries are the same regardless of ethnicity, there are some trends that apply to patients of certain ethnic backgrounds, due to their similar anatomic features. East Asian patients often want their noses to appear narrower and their bridges higher. If very little elevation of the bridge is desired, the nasal bones can be cut and moved towards the midline. This technique will narrow the bridge and also cause a slight elevation in the dorsum. East Asian patients who seek greater augmentation of the bridge of their nose require implants. A variety of alloplastic implants including Gore-Tex, Med-Por, or silicone can be used. Tissues from the patient's own body (autologous) can be used for augmentation, in order to reduce the risk of complications such as infection or extrusion. Septum cartilage, rib cartilage (costal cartilage), ear cartilage (auricular cartilage), and fascia are being often used. In non surgical rhinoplasty, filler materials such as hyaluronic acid or calcium based microspheres can be injected under the skin, in the bridge of the nose. These injections however, are non permanent lasting between six months to a year. Patients of African descent commonly seek narrowing of wide nostrils in a procedure known as alar base reduction. This procedure may include removing sections of the base of the nostrils or sections of the nose where it meets the face. Risk of keloid scar formation is very low, if the patient has not had keloids in the past. The tip of the nose can be restructured by removing tiny sections of cartilage to give the nose more definition, or adding cartilage grafts to provide additional structure to the nasal tip. Non-surgical Non-surgical rhinoplasty refers to reshaping the nose with injectable substances rather than surgical means of altering the shape and structure of the nose. It is also called a "non-surgical nose job", and can be performed in the outpatient setting without anesthesia. Another non-surgical option used by some people are flexible "nose inserts" that are placed in the nostril area between the nose tip and back of the nose. The nose inserts reshape one's nose only while worn. http://en.wikipedia.org/wiki/Rhinoplasty Facelift, anatomical factors that distinguish the Asian face from the European face include thicker skin, more fat accumulation in the lower face and neck with aging, a prominent upper cheek, and flatter and wider facial skeleton that renders the heavier tissues of the lower face more susceptible to the downward pull of gravity. While these anatomic variations are certainly more typical of the Asian face, they are, of course, not exclusive to it. Thus, Asian facelift is similar to that in the non-Asian, and most good facial plastic surgeons know how to modify the procedure based on the underlying anatomy and pattern of aging in each individual patient. A facelift, technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful appearance. It usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. Facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep. The most common complication can be bleeding which usually requires a return to the operating room. Less common, but potentially serious, complications may include damage to the facial nerves and necrosis of the skin flaps, or infection. Contraindications to facelift surgery include severe concomitant medical problems. While not absolute contraindications, the risk of postoperative complications is increased in cigarette smokers and patients with hypertension and diabetes. Patients are typically asked to abstain from taking aspirin or other blood thinners for at least one week prior to surgery. New surgical options are always being developed. One such option is the use of Barbed suture, a type of knotless surgical suture that has barbs on its surface. While suturing tissue, these barbs penetrate inside the tissue and lock them in place, eliminating the need for knots to tie the suture. Although effective at wound closure, one of the greatest limitations of using sutures is the reliance on the surgeon’s ability to tie secure knots. If this is done improperly, it could lead to knot breakage, slippage and potentially re-opening of the wound or dehiscence. Furthermore, the use of knots can impede wound healing, restrict blood flow, increase scar formation, and distort tissue. Barbed sutures have bi-directional barbs introduced in an absorbable monofilament suture using micro machining techniques, which eliminate the use of knots. These sutures have gained slow but sure acceptance in the world of cutaneous surgery, primarily in cosmetic work. These sutures have shown many benefits, but like other sutures, are also not without complications. Blinded studies by Rashid Rashid and Murad Alam were some of the first unbiased studies to show the relative properties of these sutures in dermatologic uses. http://en.wikipedia.org/wiki/Rhytidectomy Liposuction, also known as lipoplasty ("fat modeling"), liposculpture suction lipectomy or simply lipo ("suction-assisted fat removal") is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs and buttocks, to the neck, backs of the arms and elsewhere. Several factors limit the amount of fat that can be safely removed in one session. Ultimately, the operating physician and the patient make the decision. There are negative aspects to removing too much fat. Unusual "lumpiness" and/or "dents" in the skin can be seen in those patients "over-suctioned". The more fat removed, the higher the surgical risk. |
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