Eyelid surgery by unlicensed practitioners: complications and management

by Prof Dr Chua Chung Nen

Case 1

A 25 year-old woman complained of bilateral low skin creases 12 months after Asian blepharoplasty (picture on the right). The surgery was performed in a hotel by an unlicensed doctor from oversea using the suture technique. She was unhappy with the appearance and returned to the doctor asking for the skin creases to be raised. However, she was informed that further surgery was not possible. Her ocular examination was normal and the skin creases measured 5 mm with some overhanging of skin over the creases. After discussing with the patient, a revisional double eyelid surgery was performed and the skin creases were raised to 7mm (picture on the left).

Case 2

A 50 year-old woman presented with bilateral ptosis and asymmetrical skin creases. She underwent Asian blepharoplasty in a hair salon two years ago. Suture technique was employed. She returned to the beautician for correction but was told that her eyes were normal. She required revisional surgery to lower the left skin crease and to lift the eyelid via levator resection.

Case 3

A 15 year-old girl presented with multiple swellings of both upper eyelids along the skin creases. She underwent four Asian blepharoplasties over the past 12 months. The procedures were performed by the same beautician in a hair salon over a two year period. However, the skin creases failed to form adequately and after the last surgery which was 9 months ago, she was left with unsightly lumps in her upper eyelids. The beautician was unable to offer any remedial treatment for the swellings. To resolve the problem, she underwent an incisional method of Asian blepharoplasty to remove the swellings and to create new skin creases. Intraoperatively, the lumpy lesions were found to be caused by prolene sutures. These sutures were excised and skin creases were created with a height of 7 mm. She made an uneventful recovery.

Case 4

A 35 year-old woman presented with a left congenital ptosis. The left eye had poor levator function measuring only 3 mm and the left upper skin crease was poorly formed. She consulted a beautician one year ago and was advised to have a left Asian blepharoplasty as the beautician assumed that the ptosis was caused by the absence of the left upper eyelid skin crease. Following a suture technique to create a left skin crease, the ptosis failed to improve and the left skin crease was poorly formed. She returned to the beautician but was informed that no further surgery was possible. We performed a left frontalis suspension procedure using the pentagon configuration with 2/0 prolene suture and the ptosis was satisfactorily corrected.