Blethoplasty Question, my Surgeon Here in Indonesia Says He Only Does from the Outside As Less Chance of Infection? (photo)

the sugeon i have found here in Bali, indonesia. (german trained), only does external incisions for lower blethoplasty as he feels less chance of infection in our humid polluted environment. does this make sense? as i know similar environment thialand it appears now mostly transconjuctional. also he suggests doing upper and lower separately for better healing. make sense? i live here, so easier not to travel.

Doctor Answers 6

It may be common to have upper and lower blepharoplasty during the same operation.

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It is not possible to give you precise surgical advice without meeting you. For example, some patients have ocular problems, or other diseases that would preclude blepharoplasty.

Based on your photos, you may wish to consider a standard upper blepharoplasty with skin, muscle and fat removal. You may also consider a lower eyelid trans-conjunctival blepharoplasty for fat removal, and a possible lower eyelid skin-pinch. I am not aware of an increased risk of infection following transconjunctival blepharoplasty.

Hope this helps you.

Dr. Joseph

West Orange Facial Plastic Surgeon
4.9 out of 5 stars 429 reviews

Don't have surgery with this person.

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That is an absolutely ridiculous assertion.  What he is most likely telling you is that he does not know how to perform this procedure.  I recommend that you consider seeing Alice Goh, M.D. who is an ophthalmologist who trained for a year with Yoon Duck Kim, M.D. in Soul Korea, and just completed an second year of oculoplastic surgery training at UCLA.  She is returning to Malaysia to establish a private practice there.  She is stellar.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Blepharoplasty approaches

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First of all, I do not see any advantage to performing upper and lower blepharoplasty at separate times.  The advantage of performing them together is that the cost is usually less and you only have to deal with one recovery period.  In regards to incisions for lower blepharoplasty, I do not believe a transconjunctival approach has a higher incidence of infection than an external approach.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Trans-conjunctival blepharoplasty.

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 Upper  and a lower blepharoplasty do not need to be done separately, but should be done together under one anesthetic with one  postoperative recovery. The puffiness on the lower lids is best treated with a transconjunctival blepharoplasty whereby the fat removal is performed the inside of the eyelid. Removing fat from an external approach will involve cutting through the muscle which will weaken it  and can create a very unnatural appearance of  lower lids. The  only incision  made on the outside  of the lower lids in our practice is for  a pinch of skin only when there is excess.

It doesn't seem correct

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I agree with Dr. Steinsapir. I have worked with plastic surgeons in Southeast Asia, and upper and lower eyelids are often done together, and transconjunctival blepharoplasty is also common. In the region I can recommend Dr. Woffles Wu in Singapore and in Bangkok Dr. Charan Mahathumarat. Good luck.

Blepharoplasty Question, my Surgeon Here in Indonesia Says He Only Does from the Outside As Less Chance of Infection?

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Speaking in general terms, the approach to the lower eyelid depends upon surgeon preference and what needs to be removed (fat only vs. fat and skin). I am not aware of any other Facial Plastic Surgeons or Oculoplastic Surgeons that would consider transconjunctival approach to raise the risk of infection. In fact, neither approach has a high risk of infection. With regard to performing upper and lower blepharoplasty together, that is typically the recommendation for patients that are upper and lower blepharoplasty candidates. I hope this information is helpful.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.