symposium€¦ · korean college of cosmetic surgery (former) professor, catholic university...

KHOO TECK PUAT HOSPITAL13-14 MAR 20

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Organised byIn collaboration with

A Problem-based Approach

Oculo-Facial Reconstruction & Rejuvenation In Asians

Symposium:

Prof Choi Woong-ChulPast President,Korean College of Cosmetic Surgery(Former) Professor,Catholic UniversityManager,Choi Woong Chul Medical Centre

Featured Speakers

Welcome Address

IAdj A/Prof Yip Chee Chew

Dear Colleagues,

n light of the unique and complex Asian facial anatomy, a multi-disciplinary approach is sometimes required to optimize the results of oculo-facial reconstruction and rejuvenation procedures. It is therefore appropriate that we co-organize this symposium with our Facial Plastic and Plastic Surgery colleagues to offer a broad perspective and insight into the management of Oculo-Facial conditions.

The symposium is themed, “Oculo-Facial Reconstruction and Rejuvenation in Asians: A Problem-Based Approach”, to give our participants a realistic, clinically oriented and practical approach to manage common clinical cases as individual practitioners or as a team. To realize this theme, we are privileged to have invited a panel of distinguished and renowned experts from the various specialties. The scientific content has been selected to include an extensive range of clinically relevant topics often encountered in our daily practice. The symposium will give updates on the management of pathologies of the eyebrow, canthal angle, eyelid, nose, facial wrinkles and post-operative complications.We are fortunate to have invited Prof Fan Xianqun and Prof Li Dongmei from China, Prof Choi Woong-Chul from Korea, and A/Prof Yuen Kwok Lai Hunter from Hong Kong as our featured overseas speakers to share their extensive experience in the management of complex Oculo-Facial conditions. Being highly renowned in the Ophthalmic Plastic and Reconstructive Surgery fraternity, they have authored many peer review articles, book chapters and recognized with many awards and accolades.It is my hope that this meeting will foster fruitful interaction, close collaboration and lasting friendship amongst the three disciplines.May I welcome all of you to the 2015 Oculo-Facial Reconstruction and Rejuvenation in Asians Symposium!

Yours sincerely,

Adj A/Prof Yip Chee ChewMBBS(S’pore), MMed(Ophth)(S’pore), FRCS(Edin), FAMSChairperson, Organising Committee

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A/Prof Yuen Kwok Lai HunterClinical Associate Professor (Honorary), Chinese University of Hong Kong Consultant, Hong Kong Eye Hospital

Prof Li DongmeiChief,Division of Oculoplastic andReconstructive Surgery,Beijing TongRen Eye Centre

Prof Fan XianqunDean,Jiuyuan College of Clinical Medicine (Shanghai),Jiaotong UniversityDirector,Ophthalmology Department,Shanghai Ninth People’s Hospital

Local Speakers

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Dr Choo Chai TeckHead & Senior Consultant

Aesthetic ServiceSingapore National Eye Centre

Dr Dennis ChuaAssociate Consultant

Otorhinolaryngology DepartmentTan Tock Seng Hospital

Dr Heng Li WeiAssociate Consultant

Ophthalmology DepartmentTan Tock Seng Hospital

Dr Jo Anne HernandezConsultant & Assistant Chief

Orbit & Oculoplastics SectionCardinal Santos Medical Centre

Dr Samuel HoAssociate Consultant

Plastic, Reconstructive & Aesthetic SectionGeneral Surgery Department

Tan Tock Seng Hospital

Dr Lee Tee SinAssociate Consultant

Otolaryngology DepartmentChangi General Hospital

Dr Llewellyn LeeConsultant


Dr Ian LohConsultant

Otolaryngology DepartmentChangi General Hospital

Dr Audrey LooiHead & Senior Consultant

Oculoplastic ServiceSingapore National Eye Centre

Dr Eugenie PohConsultant


Adj A/Prof Seah Lay LengSenior ConsultantOculoplastic Service

Singapore National Eye Centre

Dr Tan Kar SuConsultant

Otorhinolaryngology DepartmentKhoo Teck Puat Hospital

Dr Valerie TayConsultant

Otorhinolaryngology DepartmentTan Tock Seng Hospital

Dr Livia TeoConsultant


Dr Marcus WongConsultant

Plastic, Reconstructive & Aesthetic SectionGeneral Surgery Department

Tan Tock Seng Hospital

Dr Morgan YangConsultant


Adj A/Prof Yip Chee ChewHead & Senior Consultant

Ophthalmology DepartmentKhoo Teck Puat Hospital

Prof Li Dongmei

Prof Li is Chief of the Division of Oculoplastic and Reconstructive Surgery in Beijing TongRen Eye Centre and Professor in the Department of Ophthalmology. She is the Vice-President of China Medical Association of Ophthalmology, Division of Oculoplastic Surgery and Orbital Disease of Academy of Ophthalmic Surgery. She is the past Vice-President of Asia-Pacific Society of Ophthalmic Plastic and Reconstructive Surgery.

Prof Fan Xianqun

Prof Fan is one of the “Distinguished Professor of Yangtze River Scholars” recognized by the Ministry of Education of the People’s Republic of China. He is the Dean of Jiuyuan College of Clinical Medicine of Shanghai, Jiaotong University; President, Ophthalmology Department, Shanghai Ninth People’s Hospital; President, Chinese Society of Ophthalmic Plastic and Orbital Disease; standing committee member, Chinese Ophthalmological Society and Past President, Asia-Pacific Society of Ophthalmic Plastic and Reconstructive Surgery. He is a recipient of the APAO Distinguished Service Award. As a principal investigator, he has obtained several national grants including key projects of international cooperation of the National Natural Science Foundation of China (NSFC). He has over 210 publications, 79 of which are SCI papers.

Featured Speakers’ Profile

Local Speakers’ Profile

Dr Choo is the Past President and Founding Member of APSOPRS. He is an Editorial Board Member, ORBIT Journal and an Invited Reviewer of OPRS Journal. He has received APAO Distinguished Service Award. Currently he is the Senior Consultant of Oculoplastic Surgery and Clinical Director of Aesthetic Service in Singapore National Eye Centre.

Dr Choo Chai Teck

A/Prof Yuen is a Consultant at the Hong Kong Eye Hospital and Head of the Oculoplastics and Orbital Service. He is a recipient of the Ten Outstanding Youth Persons Selections and Fourth Hong Kong Volunteer Awards in 2007 & 2011 respectively. He is also currently Vice-President of the Asia-Pacific Society of Ophthalmic Plastic and Reconstructive Surgery.

A/Prof Yuen Kwok Lai Hunter

Prof Choi is the Head Surgeon of MEPS (Myoung Eye Plastic Surgery); Clinical Attending Professor of the Catholic University; Vice-President of the Korean Ophthalmology Society (Moral and Law Committee); Academic Chairman of KAAS (Korea Academy of Aesthetic Surgery & Medicine); Director of Korean Ophthalmic Plastic Reconstructive Surgery; and Past President of KCCS (Korean College of Cosmetic Surgery).Prof Choi Woong-Chul

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Dr Chua did his medical undergraduate at the National University of Singapore and subsequently completed his otorhinolaryngology residency in Singapore. He was awarded the Health Manpower Development Plan to pursue a 1-year clinical fellowship in Facial Plastic & Reconstructive Surgery with Professor Stephen Park at University of Virginia where he operated with full privileges. He is currently working in the Department of Otorhinolaryngology, Head and Neck Surgery in Tan Tock Seng Hospital and is also the ENT Lead Tutor for Lee Kong Chian School of Medicine. Dr Dennis Chua

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Dr Jo Anne Hernandez

Dr Hernandez is a Consultant Oculoplastic Surgeon practicing in Manila, Philippines. She is a Diplomate of the Philippine Board of Ophthalmology and Fellow of the Philippine College of Surgeons. Currently, she is the assistant chief of the section of Orbit and Oculoplastics at Cardinal Santos Medical Center. She had her fellowship in Oculoplastics at the National Healthcare Group Eye Institute, rotating in Tan Tock Seng Hospital, Khoo Teck Puat Hospital and KK Women’s and Children’s Hospital. She graduated from De La Salle University with a Bachelor of Science degree in Biology and attained her medical degree at the University of Santo Tomas, Faculty of Medicine and Surgery. She had her postgraduate internship and residency training in ophthalmology at Cardinal Santos Medical Center.

Dr Ho is an Associate Consultant with the Plastic Reconstructive & Aesthetic Section of the Department of General Surgery, Tan Tock Seng Hospital. He underwent his HMDP Fellowship in Seoul, South Korea with Hanyang University Hospital. He was awarded the Gold Medal in his plastic surgery Exit Examination. He has published numerous articles in international journals, such as PRS and JPRAS, and has written a book chapter in Grabb’s encyclopedia of flaps.Dr Samuel Ho

Dr Lee Tee Sin

Dr Lee, upon completing his Otorhinolaryngology training was awarded the Health Manpower Development Plan to pursue a 1-year clinical fellowship in Facial Plastic and Reconstructive Surgery with the University of Toronto, Canada. This is a prestigious fellowship program endorsed by the Educational and Research Foundation for the American Academy of Facial Plastic and Reconstructive Surgery and is widely respected by the medical community. He also achieved the highest score in the 2014 IBCFPRS examination, administered in Washington, D.C. in cooperation with the ABFPRS and was honored with the Claus D. Walter Award for Academic Excellence. He is presently working in the Department of Otolaryngology – Head and Neck Surgery in Changi General Hospital.

Dr Heng Li Wei

Dr Heng is currently an Associate Consultant at the National Healthcare Group Eye Institute at Tan Tock Seng Hospital. She completed her medical school at National University of Singapore (NUS) in 2003, and was conferred the Masters degree in Medicine (Ophthalmology) in 2008. She attained Fellowship with the Royal College of Surgeons of Edinburgh (Ophthalmology) in 2012 and is also a Fellow with the Academy of Medicine Singapore. She was awarded the Health Manpower Development Programme (HMDP) scholarship in 2013 and subsequently underwent a 12-month clinical fellowship at McMaster University in Hamilton, Ontario, Canada. She completed her Fellowship in Ophthalmic Plastic and Reconstructive and Orbital Surgery under the mentorship of Clinical Assistant Professor Yasser Khan and Professor John Harvey. Her areas of ophthalmic practice include general ophthalmology, cataracts, with Oculoplastics as her sub-specialty.

Dr Llewellyn Lee


Adj A/Prof Seah did her Oculoplastic Surgery Fellowship at Moorfields Eye Hospital, London and Orbital Surgery Fellowship at University of British Columbia, Canada. She is currently Senior Consultant, Singapore National Eye Centre; Adjunct Associate Professor, National University of Singapore, Yong Loo Lin School of Medicine; Adjunct Associate Professor, Singhealth Duke-NUS; Director, Undergraduate Education Program, Singhealth Acedemia and member of Orbital Society.Adj A/Prof Seah Lay Leng

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Dr Lee underwent a clinical fellowship in Seoul, South Korea, with his area of clinical interests in eyelid surgery and lid reconstructive surgery, as well as the management of a wide range of eyelid and orbital conditions. He is also Head of his department’s Training and Education Committee, and the inaugural Program Director for the National Health Group (NHG) Residency Program.

Dr Ian Loh

Dr Loh is a Consultant in the Department of Otolaryngology, Head and Neck Surgery of Changi general Hospital where he heads the Facial Plastic and Reconstructive Service.

Dr Audrey Looi

Dr Eugenie Poh

Dr Poh completed her Oculoplastics, Orbital and Adnexal Fellowship in Adelaide, South Australia. She is currently a Consultant with National Healthcare Group Eye Institute practicing at the Department of Ophthalmology in Tan Tock Seng Hospital. She has a special interest in eyelid reconstruction and lacrimal surgery.

Dr Tan Kar Su

Dr Tan exited as an ENT specialist and thereafter spent a year of Fellowship in the Gangnam district of Seoul, South Korea. Under the tutelage of Prof Jung Dong Hak and Prof Han Seong Yik, he spent most of his time performing Rhinoplasties and facial skeletal surgeries. Dr Tan is currently serving as a Consultant in the Facial Plastic Service of Khoo Teck Puat Hospital, ENT Department. His practice is centred around Facial Plastic work, in particular on his special interest - Rhinoplasty.

Dr Looi trained in Oculoplastics at the Singapore National Eye Centre from 2001 to 2002. She completed her fellowships in Oculoplastic, Orbital and Ocular Pathology at the University of British Columbia returning to Singapore in 2004 with a Best Fellow research prize. She is also a Visiting Consultant at the Kandang Kerbau Women’s and Children’s Hospital, Changi General Hospital and the National Neuroscience Institute. Dr Looi has published widely in oculoplastic journals and is a reviewer for Ophthalmology and Oculoplastic and Reconstructive Surgery journals. She serves the Royal College of Ophthalmology (Edinburgh) as an examiner and participates in Ophthalmology MMed examinations conducted at the National University of Singapore. She was also elected treasurer of the Asia-Pacific Society of Oculoplastic and Reconstructive Surgeons from 2006 -2010 and is currently Vice-President of the Society. She is a Board Director of iC2 PrepHouse, a charity set up in Singapore in 2011 to provide programmes that enable greater independence and continued education of children with low vision in mainstream schools.

Dr Valerie Tay

Dr Tay is a Consultant with the Department of Otolaryngology in Tan Tock Seng Hospital. She completed her fellowship in Facial Plastic Surgery in Navi Plastic Surgery Clinic, a high volume cosmetic surgery clinic in Seoul, South Korea. She was the course director for the TTSH Singapore Facial Plastic Surgery course in 2014.


Adj A/Prof Yip is Head of the the Ophthalmology and Visual Sciences Department at Khoo Teck Puat Hospital; Head of Oculoplastics Service at national Health Group Eye Institute; Vice President of the College of Ophthalmologists, Academy of Medicine Singapore; Past President of the Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery and Editor in the Oculoplastics Section of the Asia-Pacific Journal of Ophthalmology. Currently, he is an Adjunct Associate Professor at Yong Loo Lin School of Medicine, National University of Singapore. He was awarded the American Academy of Ophthalmology Achievement Award and the Eye and Visionary Award.

Adj A/Prof Yip Chee Chew

Dr Wong is Senior Consultant and Founding Head of the Plastic, Reconstructive, and Aesthetic Surgery Service in Tan Tock Seng Hospital. He is an Adjunct Assistant Professor at Nanyang Technological University; and a Senior Lecturer at Yong Loo Lin School of Medicine. He is also Chairman of Chapter of Plastic, Reconstructive and Aesthetic Surgery, College of Surgeons, Academy of Medicine; Council Member of College of Surgeons, Singapore; Member of Residency Advisory Committee, Plastic Surgery Residency Program, Singapore and International Member of American Society of Plastic Surgeons.Dr Marcus Wong

Dr Livia Teo

Dr Teo is a Consultant in the Oculoplastic & Aesthetic Eyeplastic sub-specialty division at Singapore National Eye Centre. A graduate of The National University of Singapore, she was on the Dean’s List in her final year where she was also awarded the 2nd Mekie Book Prize in Surgery, and the Dermatology Book Prize. She served as Chief Resident in 2009 and obtained her Fellowships from The Royal College of Surgeons (Edinburgh) and Academy of Medicine (Singapore) in 2012. In the latter, she excelled and won medals in the final Specialists’ examinations, viz. for Oculoplastic and Adnexal Disease, and Cornea and Refractive Surgery. She completed her training in Oculoplastics in Singapore in 2013 and she was awarded the Ministry of Health (MOH) HMDP postgraduate scholarship in 2014 to pursue further training overseas. She was a fellow at Severance Hospital, Yonsei University Healthcare System, Seoul, South Korea and Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, where she further subspecialized in pediatric and adult ptosis and related eyelid conditions, ophthalmic plastic and reconstructive surgery of the face and orbits, and lacrimal surgery.

Dr Yang qualified as an Ophthalmologist in 2010. He completed a local Oculoplastic Fellowship at the Singapore National Eye Centre in 2012 and went on to train in Amsterdam under the auspices of Professor Maarten Mourits and Dr Peerooz Saaed on the HMDP training award. Currently he is a Consultant working in the Oculoplastic Service at the Singapore National Eye Centre. His research interests include thyroid eye disease and tears cytokine analysis and he holds a concurrent appointment as an adjunct assistant Professor with Duke-NUS Medical School.Dr Morgan Yang

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Scientific Programme

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Day 1 13 March 2015 8.25am Welcome Address (Adj A/Prof Yip Chee Chew) Droopy Eyebrows 8.30am Endoscopic eyebrow surgery (Dr Choo Chai Teck) 8.45am Non-endoscopic eyebrow lift (Dr Morgan Yang) 9.00am Eyebrow repositioning in facial nerve palsy (Dr Jo Anne Hernandez)Eyelash Disorders 9.15am Upper eyelid epiblepharon repair (Adj A/Prof Seah Lay Leng) 9.30am Lower eyelid epiblepharon repair (Dr Eugenie Poh) 9.45am Upper eyelid trichiasis and cicatricial entropion correction (A/Prof Yuen Kwok Lai Hunter)10.00am Lower eyelid entropion management (Dr Llewellyn Lee) Morning Tea Break 10.15am - 10.45amReshaping the Canthal Angles 10.45am Lateral canthoplasty (Dr Llewellyn Lee)11.00am Traumatic canthal dystopia repair (Prof Li Dongmei)11.15am Epicanthoplasty (Prof Choi Woong-Chul) Double Eyelids11.30am Pre-operative planning for Asian upper blepharoplasty (Prof Choi Woong-Chul)11.45am Incisional upper blepharoplasty (Dr Livia Teo)12.00nn Suture blepharoplasty (Dr Samuel Ho)Lunch 12.15pm - 1.15pmDroopy Eyelids 1.15pm Mild upper lid ptosis correction (Dr Heng Li Wei) 1.30pm Severe adult ptosis correction (Prof Choi Woong-Chul) 1.45pm Congenital ptosis correction (Prof Fan Xianqun) 2.00pm Ptosis surgery complications and management (Prof Fan Xianqun)Eyelid Retraction 2.15pm Non-surgical treatment of eyelid retraction (Dr Jo Anne Hernandez) 2.30pm Correction for upper eyelid retraction (A/Prof Yuen Kwok Lai Hunter) 2.45pm Correction for lower eyelid retraction (Prof Li Dongmei)Afternoon Tea Break 3.00pm - 3.30pmThe Unhappy Post-operative Patient 3.30pm Asymmetric upper eyelid crease (A/Prof Yuen Kwok Lai Hunter) 3.45pm Post upper blepharoplasty complications (A/Prof Yuen Kwok Lai Hunter) 4.00pm Post lower blepharoplasty complications (Prof Li Dongmei)

Day 2 14 March 2015Eye Bags & Proptosis 8.00am Evolving concepts in lower blepharoplasty (Adj A/Prof Yip Chee Chew) 8.15am Lower blepharoplasty (Prof Choi Woong-Chul) 8.30am Surgical correction of tear trough deformity (A/Prof Yuen Kwok Lai Hunter) 8.45am Orbital and fat decompression for proptosis (Prof Fan Xianqun)Facial Wrinkles 9.00am Orbito-facial rejuvenation with Botulinum toxin (Dr Audrey Looi) 9.20am Orbito-facial rejuvenation with dermal filler (Dr Marcus Wong) 9.35am Managing dermal filler injection complications (Dr Samuel Ho)Morning Tea Break 9.50am - 10.20amThe Unsatisfactory Nose10.20am The nasal dorsum (Dr Valerie Tay) 10.35am Tip surgery (Dr Dennis Chua)10.50am Deviated nasal septum (Dr Lee Tee Sin)11.05am Osteotomies (Dr Lee Tee Sin)11.20am The internal and external nasal valve (Dr Dennis Chua)11.35am The crooked nose (Dr Tan Kar Su)11.50am Alar repositioning (Dr Ian Loh)12.05nn Nasal reconstruction (Dr Ian Loh)

Optional Session (2.00pm - 4.00pm)Suturing & Flap Workshop Surgical Wetlab, Basement 1 Tower B, Khoo Teck Puat Hospital (Dr Eugenie Poh, Dr Samuel Ho, Dr Jo Anne Hernandez, Dr Llewellyn Lee, Dr Heng Li Wei)

Day 1 13 March 2015Droopy Eyebrows

Endoscopic eyebrow surgeryDr Choo Chai TeckEyeball alone is expressionless, it is the periorbital tissues that emit & decode signals in visual communication as the periorbital muscles play a role in visual and facial expression. Principles of brow lift surgery are brow reposition and stabilization rather than elevation after tissue release of the conjoined tendon, arcus marginalis plus muscle modification and periorbital tissue redraping. The surgery was originally used for cosmetic purposes, it has been applied in ophthalmic patients for therapeutic indication in eyebrow ptosis with severe dermatochalasis due to forehead aging, blepharospasm, seventh nerve palsy. The techniques of the surgery and cases will be presented in the lecture.

Non-endoscopic eyebrow liftDr Morgan YangThe ageing and descending eyebrow may be rejuvenated with endoscopic and non-endoscopic surgeries. While the former gives good functional and cosmetic results, it incurs significant learning curve with the need for more and expensive sophisticated instrumentation, longer surgical time and higher manpower demand. Non-endoscopic eyebrow surgery (internal browpexy) via an upper blepharoplasty incision may be another good alternative that gives moderate lifting of the eyebrow and retro-ocularis oculi fat with reasonable results and safety. The pearls and pitfalls of various eyebrow rejuvenation surgeries will be discussed.

Eyebrow repositioning in facial nerve palsyDr Jo Anne HernandezThe most common cause of weak facial muscles is facial nerve palsy, particularly Bell’s palsy. Brow ptosis is common in facial nerve palsy where the eyebrow droops over the superior orbital rim that results in obstruction of vision. The normal eyebrow typically rests at or slightly above the superior orbital rim. There are several types of browplasties: direct brow lift, transblepharoplasty, midforeheard, pretrichial, coronal, and endoscopic approaches. With many surgical options, there is no single perfect treatment. The most common management for brow ptosis caused by facial nerve palsy is the direct browplasty. It is a simple and straightforward operation involving the removal an ellipse of

skin and muscle directly above the eyebrow, raising the brow above the visual axis. Subcutaneous tissue may be attached to the underlying periosteum. Other ocular problems related to facial nerve palsy may be present with brow ptosis, namely: corneal exposure, lagophthalmos, lower eyelid ectropion. Surgical procedures to correct these are often performed concurrently with browplasty.

Day 1 13 March 2015Eyelash Disorders

Upper eyelid epiblepharon repairAdj A/Prof Seah Lay LengLashes on the upper lid margin are important features that enhance the beauty of the eyes. When the position and direction of these lashes are abnormal, they result in lash cornea touch and in severe cases, corneal damage and scarring develop. Upper lid epiblepharon is common among Oriental eyelids and is considered as a developmental anomaly that could persist till adulthood. Clinically this condition is characterized by a horizontal fold of redundant skin and orbicularis muscle that overlap the eyelid margin and displace the lashes against the globe. Some are associated with vertical lashes irrespective of redundant skin or epicanthic fold. Surgical correction involves excision of excess skin and buried sutures to evert the lashes with or without epicanthoplasty. Post operative results are often rewarding with good functional and aesthically pleasing outcome.

Lower eyelid epiblepharon repairDr Eugenie PohLower eyelid epiblepharon is more commonly seen in the East Asian population. Surgical management is usually required for those cases in which there is no spontaneous resolution by middle childhood and where there is significant lash-cornea touch. This lecture describes the techniques of lower eyelid epiblepharon repair.

Upper eyelid trichiasis and cicatricial entropion correctionA/Prof Yuen Kwok Lai HunterMisdirected lashes can cause corneal irritation, corneal abrasion or even infection. Eyelid trichiasis & cicatricial entropion are common causes of such misdirected lashes. The author will present the diagnosis and management of such conditions.

Synopsis

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Synopsis

Lower eyelid entropion managementDr Llewellyn LeeLower lid entropion is a common lid disorder, due to a variety of causes. Of these, involutional entropion is by far the most common cause. An approach to the management of such cases will be outlined, followed by a short video highlighting the pearls of performing surgery in involutional cases.

Day 1 13 March 2015Reshaping the Canthal Angles

Lateral canthoplastyDr Llewellyn LeeLateral canthoplasty is a very common procedure, done either in isolation or in combination with other procedures. Quite a number of different methods of performing lateral canthoplasty have been described. A few of the more commonly performed methods are reviewed, with the merits of each outlined.

Traumatic canthal dystopia repairProf Li DongmeiTraumatic canthal dystopia caused by trauma results in telecanthal deformities, medial canthus displacement, absent of naso-orbital valley, sharp-angled canthus turns to an obtuse angle, damage to the lacrimal drainage system. Multiple procedures have been suggested for the management of medial telecanthal deformity. Anchoring of medial canthal tendon by titanium microscrew. Orbital fracture with bony defect of anterior lacrimal crest, Medial canthal tendon fixation with titanium plate. Fascia lata as substitute for soft tissue sever loss and used to recurrent cases. As to chronic dacryocystitis, the DCR was always tried to perform before the screw fixing into the anterior lacrimal crest. Canthal tendon fixation with external DCR. Endoscopic CDCR with the management of telecanthal deformity.

EpicanthoplastyProf Choi Woong-ChulEpicanthal fold is a unique appearance in the eyelids of Asians. The presence of an epicanthal fold weakens the aesthetic results of double eyelid surgery. Various medial epicanthoplasty techniques have been introduced to achieve a better aesthetic result. However, the incision for epicanthoplasty should be as simple as possible and be confined to the eyelid area. Basic techniques of all medial epicanthoplaties are Y-V or Z plasty.

The advantage of Y-V plasty is good to hide scars because incision is along the ciliary margin. With Z-platy, we do not need skin excision and design is simple relatively. We pay attention to make free mobilization of the triangular flaps and do suture the interpositioned flaps without tension. These methods can be used for simple epicanthal folds except severe cases such as congenital anomalies.

Day 1 13 March 2015Double Eyelids

Pre-operative planning for Asian upper blepharoplastyProf Choi Woong-ChulUpper blepharoplasty requires meticulous preparation, planning and technique. Lack of patient understanding of these procedures’ goal will lead to disappointment. Because symmetry is important, inaccurate markings when designing the upper eyelid crease or unequal removal of fat and orbicularis muscle will lead to revisions in the future. Lack of precise techniques may also lead to potential complications such as contour deformity, lash problems, asymmetry. Epicanthal fold should be considered before surgery. It exists in more than 50% of Asian people and appears as a skin web that stretches the upper pretarsal skin downward and makes the double eyelid surgery less useful. Especially, in Asian lid it is necessary to remove burden factors properly to improve functional problem and get a good cosmetic result.

Incisional upper blepharoplastyDr Livia TeoIn performing incisional upper lid blepharoplasty, there are many aspects of surgery to consider. These can be broadly classified into patient factors and surgical factors. Patient factors to consider prior to surgery include patient demographics e.g. age, gender, ethnicity; patient preferences and a patient’s overall appearance. Surgical factors to consider include the choice of type of incision, lid crease height and contour, fat removal and the addition of medial epicanthoplasty or ptosis correction to enhance the effects of the upper lid blepharoplasty. Case examples and and a discussion of potential complications will be used to illustrate how best to optimize surgical outcome and patient satisfaction.

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Synopsis

Suture blepharoplastyDr Samuel HoUpper blepharoplasty is a commonly sought cosmetic procedure, particularly in the young Asian population. There are many techniques to achieve an aesthetic double eyelid fold - incisional and non-incisional. The difference is in the amount of downtime and the ability to correct other concommitent abnormalities such as eyelid ptosis. Suture blepharoplasty is a non-incisional technique that creates a double eyelid fold with less downtime, and can be performed quickly in an outpatient setting.

Day 1 13 March 2015Droopy Eyelids

Mild upper lid ptosis correctionDr Heng Li WeiThe surgical correction of mild upper lid ptosis is often challenging, especially if it is an unilateral correction, and has both functional and cosmetic implications. The ptosis repair can be done either via an anterior approach or a posterior approach, both of which has its advantages and disadvantages. In determining the optimal surgical approach, one must consider the etiology of the ptosis, the severity of the ptosis, and the amount of levator function. The various surgical approaches and techniques will be discussed with special regards to the management of mild upper lid ptosis.

Severe adult ptosis correctionProf Choi Woong-ChulTo distinguish congenital ptosis from aponeurotic ptosis, caused by stretched or detached levator aponeurosis, you need to make the patient look up and down. If lid lag becomes bigger when looking down because of the levator muscle’s inherent inability to relax or if the eyeball hides behind the upper eyelid when looking up, you should consider congenital ptosis with poor levator function. In patients with asymmetric or unilateral ptosis, latent ptosis of the normal appearing eye should be identified by elevating, closing, or instilling phenylephrine to the ptotic eye. Despite a negative Hering’s test, there are patients who still develop a postoperative decrease in their MRD and resulting ptosis. The most common clinical ptosis is ptosis resulting from stretching and dehiscence of the levator aponeurosis.In general, levator function of aponeurotic ptosis is good. However

if the levator aponeurosis totally detaches from the tarsal plates, the levator function will be very poor. there are two types for surgery in severe ptosis correction: 1. Levator surgery: tucking, advancement, resection, 2. Frontalis sling. The difference of a levator resection from advancement is vertical incision of the medial and lateral horns to tighten the levator muscle more. Frontalis sling is a very effective surgery for revision cases after multiple levator surgeries or in cases showing poor levator function below 4mm.

Congenital ptosis correctionProf Fan XianqunUnder normal condition, when we look straight forward, the upper eyelid covers 1.5-2 mm of cornea without control of the frontal muscle. In patients who have ptosis, the upper eyelid covers more than 2 mm of cornea with congenital weakness or dysfunction of Levator Palpebrae or Müller’s muscle. The height and movement of the eyelid controlled by the levator palpebrae superioris, the Müller’s muscle and the frontal muscle. According to causes, Congenital ptosis can be classified into four types: Simple ptosis, external ophthalmoplegia associated ptosis, Blepharophimosis Syndorme and Marcus Gunn’s Jaw-winking Syndrome. The majority harms of congenital ptosis are the formation of deprivation amblyopia and the affection of the appearance. Correction by surgery is the effective way to prevent or solve these problems. When eyelid hiding the pupil over 20%, it is the indication for ptosis correction. In order to avoid the amblyopia, the right time of surgery for children with mild or moderate ptosis is three to five years old. At this time, the risk of operation failure and the danger of anesthesia is much lower than youngers. But if the ptosis is severe, surgery should be done as soon as possible, usually at one to two years old. Before surgery, we should evaluate degrees of ptosis, the strength of the levator palpebrae superioris and other preoperative neurologic and ophthalmologiec examination. We choice different ways of surgery mainly according to the levator function. For strength less than 4mm, we choice frontalis suspension in order to use the strength of frontalis. For strength more than 4mm, levator resection is enough. If the strength is good, more than 9mm, there can be more choices: levator resection, resection of tarsus-conjunctiva-müller muscle or levator aponeurosis plication. Frontalis suspension and shorten the levator palpebrae susperioris or Muller’s muscle are two main ways of surgery.

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Synopsis

Ptosis surgery complications and managementProf Fan XianqunPtosis is the droop of the upper eyelid in primary gaze either unilaterally or bilaterally. Patients often seek for medical treatment because of visual obstruction or cosmetic deformity caused by ptosis. A thorough review of the patients’ history and ophthalmic examination may help to identify the cause, classification and degree of ptosis, and also determine reasonable surgical procedure for patients. The potential complications of ptosis surgery include under or over correction, entropion or ectropion, exposure keratitis, lid lag, conjunctival prolapse, etc. The surgeons must be alert for these complications and their corresponding management, because the surgical effect of patients postoperatively are strongly affected and such severe complication as exposure keratitis would probably lead to serious result if treated improperly.

Day 1 13 March 2015Eyelid Retraction

Non-surgical treatment of eyelid retractionDr Jo Anne HernandezThe palpebral fissure is the opening between the upper and lower eyelid margins. The upper eyelid normally rests 1.5 mm below the limbus, whereas the lower eyelid rests 1.0 mm above the limbus. Eyelid retraction exists when these positions are altered, with the upper eyelid resting above the superior limbus and the lower eyelid below the inferior limbus, exposing the sclera. Thyroid eye disease remains the most common cause of eyelid retraction. Patients with eyelid retraction may develop dry eye and exposure keratopathy. Botulinum toxin and Hyaluronic acid gel injections are minimally invasive methods that improve eyelid position in cases of eyelid retraction. Botulinum toxin may be injected via the transconjunctival or transcutaneous route. Both products have expanded their use from aesthetic rejuvenation into functional purposes. The effects are reversible and repeatable, with doses that may be adjusted accordingly with relatively few complications.

Correction for upper eyelid retractionA/Prof Yuen Kwok Lai HunterUpper lid retraction is a common manifestation of thyroid eye disease. Other than disfigurement, upper lid retraction can cause variable degree of corneal exposure and discomfort. There are a number of surgical and nonsurgical methods to correct this.

The lecture aims to cover how to achieve optimal outcome in the management upper lid retraction with predictable and satisfactory eyelid contour and height.

Correction for lower eyelid retraction Prof Li DongmeiLower eyelid retraction can cause by trauma, facial paralysis, tumors and surgical procedures such as cosmetic blepharoplasty. Patient with this condition will relate to sclera show and lagophthalmos, dry eye syndrome. Lower lid retraction is not only functional, also cosmetical problem. Surgical management of lower lid retraction is directed by the etiologic factor or deficiency underlying the retraction. Anterior lamellar deficiency requires recruitment of vertical skin via a full thickness skin graft or flap graft. Middle lamellar deficiency (posttraumatic septal scarring) requires scar release. Posterior lamellar deficiency from conjunctival shortage may require a full thickness mucous membrane graft. Vertical laxtity of eyelid without anterior lamellar deficiency possible placement of a rigid spacer graft.

Day 1 13 March 2015The Unhappy Post-operative Patient

Asymmetric upper eyelid creaseA/Prof Yuen Kwok Lai HunterSuboptimal outcome after upper eyelid surgery is not uncommon and one of the main complains is asymmetrical upper eyelid crease. The speaker will share his personal experience in cases with asymmetrical upper eyelid crease after upper eyelid surgery. These include residual ptosis with skin crease problem, Low/ absent skin crease/ incomplete crease, high skin crease, multiple skin creases and other conditions.

Post upper blepharoplasty complicationsA/Prof Yuen Kwok Lai HunterBlepharoplasty is a widely practiced successful operation by various medical professions. Due to complex structure and function of the eyelids, a number of potential complications can occur. To minimize complications, the surgeon should have appropriate case selection, thorough discussion with surgical candidates, good understanding of the eyelid anatomy and optimal surgical skills and techniques. If complication does occur, effective treatment options are available and may improve the outcome. Complicated cases may require referral to those who are experienced in handling these cases.

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Synopsis

Post lower blepharoplasty complicationsProf Li DongmeiLower lid blepharoplasty is a surgery with rare complications , when they happened they may cause functional and cosmetic damage. Among possible complications, we stress lower eyelid malposition either lower lid retraction or frank ectropion, sunken lid,hematoma, chemosis, lagophthalmos. Ectropion and scleral show are the most common complications. Postoperative ectropion should initially be treated conservatively with massage. This may be effective up to 6 months postoperatively. If conservative measures fail, the etiology of the ectropion should be addressed. Laxity of the tarsus and canthal ligaments benefit from a horizontal lid-shortening procedure. Where there is vertical shortening from excessive skin resection or scarring of the orbital septum, there should be release and grafting of the deficiency. Chemosis is an infiltrative edema of the eye conjunctive .Steroid eye drops may be used in order to speed up the process. In cases of small hematomas, without visual or papillary changes, one must be very conservative, and strict follow up.

Day 2 14 March 2015Eye Bags & Proptosis

Evolving concepts in lower blepharoplasty Adj A/Prof Yip Chee ChewThere is a paradigm shift in the concept of doing lower blepharoplasty from a subtractive to an additive approach. The former incurs the risks of lower eyelid retraction, peri-orbital hollowing and skeletonisation and may be useful only in selected cases. An additive management approach that leverages on re-positioning and/or volumising orbital and facial fat compartments will be more preferred. It addresses the age related loss of fat volume to give a more natural and youthful aesthetic outcome.

Lower blepharoplastyProf Choi Woong-ChulAmong various lower bag surgeries, transconjunctival approach gained great popularity and acceptance, as it seems to be associated with less risk of postoperative lid malposition. However, disadvantage of the transconjunctival approach is lower lid wrinkles when it is not combined with other procedures such as laser resurfacing or chemical skin peeling. If there is redundant lower eyelid skin with periorbital rhytides, we can perform a skin pinch to the lower eyelid. The primary complications of the transcutaneous approach are lower lid retraction with scleral

show, lower lid ectropion, and round eye deformity. To create a youthful eyelid-cheek junction, fat reposition or septal reset techniques or orbicularis repositioning can be used.

Surgical correction of tear trough deformityA/Prof Yuen Kwok Lai HunterThe eyelid fat pads are actually the anterior extension of orbital fat. Such fat pads often need to be addressed in aesthetic oculoplastic surgeries. The author will present his surgical technique in correcting eyebag with tear trough deformity.

Orbital and fat decompression for proptosisProf Fan XianqunThyroid related orbitopathy is one of the most important extra thyroidal features of thyroid disease, which decrease the quality of life significantly. Orbital and fat decompression is a cornerstone in the treatment of TRO with severe exophthalmos in stable phase. However, techniques are at times limited by insufficient proptosis reduction and surgically induced diplopia or strabismus. The selection of optimal techniques that predictably and efficiently result in exophthalmos reduction is important for a successful operation. After analyzing hundreds of operations in our department, we have got the following advancements: 1.The advocated sequence for decompression is orbital fat, lateral bone, medial wall and finally orbital floor. Considering the difference of Hetel readings, combination techniques are also applied.2. Area for decompression is extended to deep lateral wall.3. Strabismus occur which is relevant to decompression methods. 4. New approaches can be more efficient and aesthetic.5. Navigation and endoscopy system was designed to facilitate safe and precise removal of orbital wall and fat.

Day 2 14 March 2015Facial Wrinkles

Orbito-facial rejuvenation with Botulinum toxinDr Audrey LooiBotulinum toxin began its journey as therapy for patients with strabismus. The use of botulinum toxin has since expanded to include aesthetic indications such as facial rhytides and undesirable soft tissue bulk in the facial region. This talk will provide essential information required for safe injecting as well as additional pearls that allow for excellent outcomes.

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Synopsis

Orbito-facial rejuvenation with dermal fillerDr Marcus WongAsia has witnessed tremendous growth in the demand for injectable and non-surgical procedures for aesthetic facial treatments. Among these include injectable treatments with fillers and botox. Technological advances and improved results and awareness have increased the popularity of filler treatments. In this talk, the speaker deals with the basic and advanced principles and techniques of filler injections for the Asian face.

Managing dermal filler injection complicationsDr Samuel HoFillers, be it permanent or absorbable, are increasingly being used in a variety of non-invasive cosmetic procedures, such as nasal, chin or malar augmentation, eradication of prominent facial creases or wrinkles, and the general re-voluminization of the face. One of the most popular alloplastic fillers is the Hyaluronic Acid (HA) filler in its various guises; whereas fat remains a popular autologous option. While these fillers allow for easy, clinic-based minimally-invasive procedures with relatively little downtime, they do come with a set of potential complications, ranging from comparatively minor complications such as bruising and irregularity, to potentially devastating ones such as blindness and skin necrosis. This talk serves to run through the gamut of complications and present a variety of measures to prevent as well as treat these complications should they occur.

Day 2 14 March 2015The Unsatisfactory Nose

The nasal dorsumDr Valerie TayThe L-shaped silicone for rhinoplasty is outdated and fraught with complications. This talk covers autologous and alloplastic materials used for dorsal augmentation in Asian rhinoplasty. The speaker will also show clinical examples, with tips and pearls to achieve a successful result.

Tip surgeryDr Dennis ChuaThe nasal tip is possibly one of the most challenging aspect in rhinoplasty. To ensure a good outcome, it is important to ensure an accurate nasal tip analysis and respect tip support mechanisms. Some of the common nasal tip surgical techniques will be highlighted in this lecture.

Deviated nasal septumDr Lee Tee SinThe nasal septum plays a vital role in the form and function of the nose. In this presentation, a variety of techniques to correct the nasal septum will be discussed.

OsteotomiesDr Lee Tee SinOsteotomy forms an important step in rhinoplasty in that it is the most invasive and unpredictable. It is necessary to straighten a crooked nose, narrow a broad nasal dorsum, and to close an open roof deformity. The principles, surgical techniques, and complications of osteotomy will be discussed in this short presentation.

The internal and external nasal valveDr Dennis ChuaThe nasal valve is the most important functional area in the nasal cavity. It must be addressed adequately during rhinoplasty and there are several surgical techniques available. This lecture aims to cover the surgical “workhorses” for nasal valve surgery and how to ensure a good functional outcome in patients undergoing rhinoplasties.

The crooked noseDr Tan Kar SuThe crooked nose is a commonly observed pathology. Its correction requires a careful analysis of the “crookedness” inside and out. We shall discuss how techniques of septoplasty, osteotomy and cartilage repositioning are appropriately utilized to get things to fall in line.

Alar repositioningDr Ian LohThe Asian alar base is typically flared and broad and alar base surgery is an often a required procedure in Asian Rhinoplasty patients. A variety of different indications, techniques and complications will be discussed in this short presentation.

Nasal reconstructionDr Ian LohThe nose occupies an important central location in the face and is a complex 3 dimensional structure. Various reconstructive techniques will be discussed ranging from simple small cutaneous defects to large full thickness defects.

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Notes

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Map to Khoo Teck Puat Hospital

Educational Grant Supported by

symposium€¦ · korean college of cosmetic surgery (former) professor, catholic university...

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