One patient's decision to go under the knife.

14 12 16 casestudy 0

Name: Undisclosed

Procedure: Asian blepharoplasty

Performed by: Dr. James Oestreicher

14 12 16 casestudy

Elevate: When did you first decide to get blepharoplasty surgery?

Patient: Actually, I first considered it almost three years ago. I made an appointment to see Dr. Oestreicher and he did the initial assessment. He told me that I was a good candidate for the operation. We even set a surgery date. Before the actual date came, however, I got cold feet and decided not to go ahead with it, so I cancelled.

Elevate: Was there a pivotal moment that solidified your decision?

Patient: Last summer, I saw before-and-after pictures on the internet of Julie Chen, the American TV personality. I liked what she had accomplished with her operation, so I decided to go ahead with my own. I visited Dr. Oestreicher a second time, he did a few more tests, and we set a date in February for the operation. This time I didn’t change my mind.

Elevate: Did you have any reservations about the surgery before visiting the doctor’s office?

Patient: Certainly. Having surgery on your face is not an easy decision. However, I had a lot of confidence in Dr. Oestreicher.

Elevate: Why did you decide on Dr. Oestreicher?

Patient: My husband first saw Dr. Oestreicher about 10 years ago for another procedure. We were both very impressed with his skills, dedication and professional manner.

Elevate: How do you feel about your results?

Patient: I’m thrilled! The results were excellent.

Elevate: How did you feel about your new look after the surgery?

Patient: I couldn’t be happier. The look Dr. Oestreicher achieved was exactly what I was hoping to accomplish.

Elevate: What advice do you have for people thinking of getting blepharoplasty surgery?

Patient: Think it over carefully. Find an experienced surgeon that you have total confidence in, and if everything feels right, go ahead and do it!


Dr. James Oestreicher, MD, FRCSC Toronto Eyelid Surgery

Elevate: What specific type of surgery did you perform on the patient?

Dr. Oestreicher: This patient had an oriental blepharoplasty, which is a “double eyelid surgery.” This involves making an incision at the desired height of the eyelid crease and creating internal attachments that create a strong reproducible crease. This opens up the appearance of the eyes but does not actually elevate the height of the upper eyelids.

Elevate: Why was this patient a good candidate for this surgery?

Dr. Oestreicher: She is a healthy woman with no significant dry eye or eyelid pathology. She is intelligent, motivated and realistic in her expectations. She has a good idea preoperatively what outcome she would like. She has not had a lot of other unsuccessful eyelid surgery, which I often see in my practice referred from elsewhere in Canada or overseas. She wanted a result that is still ethnically consistent, meaning she is not trying to change herself into something unusual or unnatural.

Elevate: What does the procedure consist of?

Dr. Oestreicher: I first discuss where the crease should be with the patient. Often bringing in photos from movies or magazines helps since most Asian starlets have had the surgery done often surprisingly asymmetrically. The surgery itself is done in our private surgi-centre with intravenous sedation. The eyes are covered with laser shields so the patient is protected and doesn’t have to watch the surgery. A lid crease incision is made and, depending on the situation, a small amount of skin may or may not be removed. The incision is deepened down to the anterior surface of the tarsal plate (the fibrous “backbone” of the eyelid). CO2 laser is used to make the internal surface “stickier” after the pretarsal tissue is partly removed. This is an advanced technique that many surgeons do not have the equipment to do. Any minor bleeding is cauterized. The closure with sutures creates adhesions between the skin and the tarsal plate, not to the levator, as in Caucasian surgery.

Elevate: What were the patient’s biggest concerns about the procedure?

Dr. Oestreicher: As with all patients, this patient wished for symmetry, a natural appearance and a result that would last her whole life. Patients worry about pain but can be reassured that this is not a problem. Almost everyone says it was much easier than they anticipated.

Elevate: Was the patient happy with her results?

Dr. Oestreicher: She was extremely pleased with the quality and natural results she achieved, with very little downtime. Although photos were taken at three months, she states that her eyes continued to improve beyond that in subtle ways.

Elevate: What are the common misconceptions you hear about ethnic surgical procedures?

Dr. Oestreicher: Some patients think they should go to Korea or Japan to have this done. Although this is possible, I have repaired many complications from overseas surgeries since it is difficult to have a follow-up across the Pacific Ocean. Other techniques, such as dimpling sutures, are an imperfect method compared to a true incisional blepharoplasty. It is also possible to require touch-up surgery in the first year.

Elevate: What advice would you want to give those debating whether or not to get an ethnic procedure done?

Dr. Oestreicher: Be confident in your self-image and imagine what your eyes might look like with a fold. Play with a Q-tip or eyelid tape to see the effect. Find a qualified, experienced surgeon. Look for a website with many pre- and post-op photos, and find one with an entire “oriental blepharoplasty” section. Your surgeon should be an eyelid specialist, not someone who would rather be doing rhinoplasty or breast implant surgery!