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   OZ (2015-12-07 14:02:26, Hit : 1992, Vote : 76)
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   4 way openings and calibration of eye opening in eye surgery
Have you heard about '4 way openings' 'calibration of eye opening' in Korean eye surgery ?
It became a trend in Korea nowadays, especially among teenagers.

4 way openings in eye surgery is a concept that the size of eye can be maximized by expanding their eyes in 4 ways.
Calibration of eye opening is a concept that eyes can look bigger when they are forced to open more.


In internet, many teenagers advice each other to undergo '4 way opening' and 'calibration of eye opening' with double fold surgery, even though they don't understand each procedure clearly.
As internet is overflowing with plastic surgery advertisement, provocative and incendiary remarks seem to gain more power than truth.
People have a tendency to believe what they want to believe.
They seem to be fantasized by misbelief that their eyes can become bigger and bigger with more aggressive and more extreme procedures.

History always repeats itself and truth will out.
You don't have to follow a trend in plastic surgery.
There are too many procedures were disappeared because they were proven ineffective, even though they had become a trend with the aid of advertisement and misbelief.

Too much is worse than too little in plastic surgery.
Too excessive and aggressive correction always make unnatural results and elevate the risk of complications.

Let's find out what is '4 way opening' and 'calibration of eye opening'.

1. Calibration of eye opening (ptosis correction)
Blepharoptosis, also referred to as ptosis, is defined as an abnormal low-lying upper eyelid margin with the eye in primary gaze.
(The normal adult upper lid lies 1.5 mm below the superior corneal limbus and about 80% of pupil is exposed.)
So, they look sleepy and the eyes are called 'lazy eye'.
By shortening of eye elevating muscle, ptosis can be corrected and their eyes become brighter and bigger.
This old technique can be applied to normal people and is called 'calibration of eye opening'.
This can make startled appearance and inability to close their eyes fully frequently when this is recommended to normal people.


Her eyes looked sleepy in primary gaze and she has ptosis definitely.
Ptosis correction exposed more pupils and her eyes look brighter after surgery.


For clearer understanding, I'll show you unilateral ptosis who underwent surgery 3 days ago.

Pseudoptosis(fake ptosis) is different from ptosis and refers to the situation when excess skin and monolids may encroach on the eyelid.
But these patients can look brighter with simple double fold surgery or blepharoplasty because their eye elevating muscle is normal.
They don't need ptosis correction or calibration of eye opening.



Monolids and excessive skin made her eyes look sleepy.
But it was corrected with simple double fold surgery with medial epicanthoplasty.

There are some problems in calibration of eye opening.
1. This is overly recommended to normal patients who don't need calibration of eye opening.
I guess this is also caused by too much popularization of medical consultants who have little knowlege and ethics about plastic surgery.
They have a tendency to recommend more expensive and more complex procedures just because of their higher incentives.
Most of pseudoptosis patients in my consultation room were recommended ptosis surgery from other clinics.

2. Too much popularization and too much fantasizing of calibration of eye opening can make unnecessary complications like startled apperance too often.
In addition, it can make the revision eye surgery more complicated and difficult.
Among my patients who undergo revision eye surgery, about half underwent unnecessary calibration of eye opening with double fold surgery nowadays.
They not only spent unnecessary cost and time to previous calibration of eye opening but also made their revision more difficult.

3. Some unethical clinics charge extra for calibration of eye opening without actual ptosis surgery.
Sometimes, I couldn't find any evidence of calibration of eye opening in revision surgery.

4. Some patients misunderstand conscentious or conservative doctors who don't recommend unnecessary calibration of eye opening as unskillful or outdated surgeons.
They are urging doctors to charge more to them for ineffective procedures.




2. Medial opening (Medial epicanthoplasty)
Many East Asians have Mongolian fold in the medial corner of their eyes, which makes their eyes look shorter and makes their eyes look apart.
Medial epicanthoplasty can make their eyes longer and bigger and closer (more balanced in Asians).
Releasing of downward tension of Mongolian fold also can make their double fold crease exposed more.
Even thouth the most common complaints in the past was noticeable scar, recent techniques leaves inconspicuous and minimal scar.
More than 70 % of patients who undergo double fold surgery also undergo medial epicanthoplasty together nowadays.

But too much medial opening can make their eyes look awkward and artificial.
Nowadays, there are many patients who want to restore too much opened medial epicanthoplasty.
Too much is worse than too little, especially in plastic surgery..


Too sharp and fierce impression was softened with double fold surgery and medial epicanthoplasty.
Her eyes were elongated and became closer and look more balanced.




Medial epicanthoplasty alone made her eyes bigger and longer.
The medial portion of her double fold crease was exposed more (upward opening effect).
By elevating medial canthus, her lateral canthus looks lower and her eyes look less slanted, which made her impression much softer.


3. Upward opening
In fact, there is no upward opening surgery.
Medial epicanthoplasty can make the medial portion of double fold crease exposed more and this is called upward opening effect.
When vector of medial epicanthoplasty is toward upward more(instead of horizontal), it is sometimes called upward opening.



Slight elevation of medial canthus made upward opening effect with less slanted eyes which causes softer impression.

4. Lateral opening (Lateral canthoplasty)
Too high, too short, and too blunt lateral canthus can be made lower, longer, and sharper by lateral canthoplasty.
Even though there is little difference in front view, their eyes can look bigger and deeper in oblique and side view.
This lateral canthoplasty can be helpful in some patients(less than 10 % of patients), but is not helpful if their eyes are deep or lateral orbital rim is too close to their eyes.
Even though frequent relapse was the most common cause of revision, recent techniques has low relapse rate.
Too much exposure of conjunctiva and resultant red eye phenomenon and rectangular lateral canthus are the most common cause of revision nowadays.

The problem in lateral opening is most people can't benefit from this even though they took the risk and paid the time and money.
Like calibration of eye opening, too popularization, too much recommendation, too much fantasizing of patients are problems.


Lateral canthoplasty makes little difference in frontal view.


In oblique and side view, you can see the lateral canthus was elongated and white sclear was exposed more.
So, the eyes can look deeper and bigger.



High lateral canthus can be lowered to make softer impression.

5. Downward opening (Eversion and shortening of lower eyelid)
If lateral margin of lower eyelids is too high, eye can look smaller.
So, lowering of lateral 1/3 of lower eyelid can make their eyes bigger.
This is the same as eversion of lower eyelid which can be occured as a complication of lower blepharoplasty.
Detaching of globe and lower eyelid can make them tear continuously and make lower eyelid too red and tired.
Correction of this kind of complication is very hard.
As people get old, they loose tension in lower eyelid naturally and can have lower eyelid eversion naturally.
This shortening of lower eyelid elevates the risk of lower eyelid eversion in old age very high.


She is showing too much lower eyelid eversion after shortening of lower eyelid and lateral canthoplasty in another clinic.
Her lower eyelid was detached from her globe and looks red and tired always.
Her eyelash is pulled inferiorly too much and she complains frequent pain in her eyes.


New techniques are develping in plastic surgery continuously and there has been huge development in Korean plastic surgery within 10 years.
But new technique doesn't mean better techniques.
New naming doesn't mean more sophisticated techniques.
Patients should be extremely careful when they choose rather new techniques or newly named techniques.
They should acquire accurate facts about each procedure (possible complications and effectiveness),
should have a ability to choose right information among overflowing information, and
should meet a right surgeon.

Please remember more procedures or more expensive procedures don't guarantee better results.
The principle in successful plastic surgery is to minimize the risk by choosing effective procedures only and not to undergo ineffective procedures.
You should not be fooled by new naming and inflammatory advertisement of lousy doctors.
Don't trust doctors who overemphasize the bright side only.

In conclusion, double fold surgery and medial epicanthoplasty is the only way to be beneficial in most of cases.
Ask the effectiveness of calibration of eye opening, lateral canthoplasty, and lower eyelid shortening to your eyes to a good doctor.



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